The World Health Organization (WHO) has developed guidelines for management of pediatric patients with severe malnutrition. One issue is whether the patient can be managed at home or being admitted to the hospital.
Patient selection: infant less than 6 months old with severe acute malnutrition
Criteria for inpatient therapy of malnutrition - one or more of the following:
(1) any pitting edema
(2) ineffective feeding (based on direct observation for 15-20 minutes)
(3) recent weight loss or failure to gain weight
(4) adverse social or medical circumstance affecting a caregiver
(5) one or more of the Integrated Management of Childhood Illness (IMCI) danger signs
IMCI danger signs - Indications for bringing a sick child back immediately for an assessment:
(1) the child is unable to drink or breastfeed
(2) the child the child has diarrhea and is drinking poorly
(3) the child has become sicker
(4) the child has developed a new onset of fever
(5) the child has bloody diarrhea
(6) the child is breathing rapidly
(7) the child is having difficulty breathing
Although not specifically stated, an infant who is not alert or responsive should probably be admitted.
