Children with severe malnutrition i.e. signs of visible wasting, bilateral oedema or severely impaired growth. Children may, or may not be, on ART.

These children need 50 to 100% extra energy each day (based on actual weight rather than expected weight for age) for a limited period until weight is recovered. These children should be treated with therapeutic feeding which should continue until nutritional recovery is achieved (average ∼6-10 weeks). They should also be referred to an ART treatment site for assessment and exclusion of TB.

Severely malnourished infants with no medical complications can often be managed at home if they still have a good appetite. Children with a poor appetite, implying complications, should be referred for inpatient care. The nutritional management of HIV-infected severely malnourished children is largely the same as for children without HIV infection except that they should also be assessed for ART. Other opportunistic infections such as thrush, TB or cryptosporidiosis should also be excluded and treated (see page 11-12).

The presence or absence of appetite i.e. no medical complications determines if the child can be managed at home or needs admission to hospital

From: Step 3, Decide a Nutrition Care Plan

Cover of Guidelines for an Integrated Approach to the Nutritional Care of HIV-Infected Children (6 Months-14 Years)
Guidelines for an Integrated Approach to the Nutritional Care of HIV-Infected Children (6 Months-14 Years).
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