How to feed a severely malnourished person safely

October 18, 2025 •

4 min read

Worldwide, severe acute malnutrition affects millions and can be fatal if not managed correctly. Learning how to feed a severely malnourished person is a delicate medical process that must be overseen by healthcare professionals to prevent dangerous complications like refeeding syndrome.

Quick Summary

Re-nourishing a severely malnourished person must be medically supervised due to the high risk of refeeding syndrome. The process involves a slow, phased approach, starting with therapeutic foods to stabilize the patient's metabolism and electrolytes before gradually increasing calories for catch-up growth.

Key Points

Medical Supervision is Essential: Attempting to feed a severely malnourished person without professional medical guidance can cause fatal complications like refeeding syndrome.
Start Slow and Steady: Refeeding must be gradual, beginning with low-energy formulas to allow the body to readjust its metabolism safely.
Prioritize Electrolyte Correction: The initial focus is stabilizing dangerous electrolyte imbalances (hypophosphatemia, hypokalemia, hypomagnesemia) and not promoting rapid weight gain.
Use Therapeutic Formulas: Specialized formulas like F-75 and F-100 are used in the stabilization and rehabilitation phases, respectively, to deliver controlled nutrition.
Monitor for Refeeding Syndrome: Watch for signs like fatigue, weakness, confusion, fluid retention, and irregular heartbeat, especially during the first few days of feeding.
Transition Gradually to Solid Food: A normal diet is introduced only after the patient is stable and gaining weight, and involves nutrient-dense, fortified foods.

Why professional medical supervision is mandatory

Feeding a severely malnourished person is not a task for an untrained individual. The body of a starved person undergoes significant metabolic changes to survive, and reintroducing nutrients too quickly or incorrectly can trigger refeeding syndrome, a potentially fatal complication. This condition involves severe electrolyte and fluid shifts that can lead to heart failure, respiratory failure, and other organ dysfunction.

The dangers of refeeding syndrome

Electrolyte Imbalances: As the body switches from using fat and protein for energy back to carbohydrates, the resulting insulin surge drives essential minerals like phosphate, potassium, and magnesium into the cells. This causes dangerously low levels in the bloodstream (hypophosphatemia, hypokalemia, hypomagnesemia), which can lead to cardiac arrest and muscle paralysis.
Fluid Overload: The metabolic changes caused by refeeding can also lead to sodium and water retention. A weakened heart, common in severe malnutrition, may not be able to cope with this increased fluid volume, leading to heart failure and pulmonary edema.
Vitamin Deficiencies: Thiamine (vitamin B1) is a crucial cofactor in carbohydrate metabolism. Rapid refeeding depletes already low thiamine stores, which can precipitate Wernicke's encephalopathy, causing neurological damage.

The phased approach to nutritional rehabilitation

Medical professionals follow a structured, phased refeeding protocol, often based on guidelines from organizations like the World Health Organization (WHO). This cautious process ensures the patient's body can safely handle the reintroduction of nutrients.

Phase 1: Stabilization (Initial Treatment)

The first phase focuses on addressing immediate life-threatening issues, not on rapid weight gain.

Key actions during stabilization:

Address Hypoglycemia and Hypothermia: Immediate steps are taken to correct low blood sugar and low body temperature, both common in severely malnourished individuals.
Treat Dehydration: Oral rehydration with a special, low-sodium solution (like ReSoMal) is used, as standard oral rehydration solution is unsuitable and can cause fluid overload. Intravenous rehydration is typically avoided except in cases of shock.
Correct Electrolyte Imbalances: Mineral deficiencies, particularly potassium and magnesium, are corrected by adding supplements to feeds. Iron supplements are typically withheld during this phase as they can exacerbate infection.
Initiate Therapeutic Feeding: Small, frequent feeds of low-protein, low-sodium, and high-carbohydrate formula, such as F-75 therapeutic milk, are administered every two hours. This is designed to restore metabolic function safely, not to promote rapid weight gain.
Manage Infections: All severely malnourished patients receive broad-spectrum antibiotics, as infections are common but often hidden.

Phase 2: Rehabilitation (Catch-up Growth)

Once the patient is stabilized, alert, and has regained their appetite, the focus shifts to more intensive feeding.

Transition to Higher-Energy Formula: F-75 is gradually replaced with a higher-energy, higher-protein formula, such as F-100 therapeutic milk or ready-to-use therapeutic food (RUTF), like Plumpy'Nut.
Increase Feed Volume and Frequency: Calories are increased to promote rapid catch-up growth. RUTF is a particularly effective option for outpatient management because it is ready-to-use and requires no mixing.
Monitor Progress: The patient's weight gain is carefully tracked. Emotional and physical stimulation are also incorporated to aid recovery.
Introduce Iron: Iron supplements are added to the regimen only after the patient is gaining weight and has a good appetite, typically after two days on F-100.

Table: Stabilization vs. Rehabilitation Phases


Feature	Phase 1: Stabilization	Phase 2: Rehabilitation
Primary Goal	Restore metabolic function; treat immediate complications.	Promote rapid catch-up weight gain and growth.
Therapeutic Food	F-75 therapeutic milk (low-energy, low-protein).	F-100 therapeutic milk or RUTF (high-energy, high-protein).
Feeding Frequency	Small, frequent feeds (e.g., every 2 hours).	Less frequent feeds, often based on appetite.
Key Focus	Correcting electrolyte and fluid imbalances.	Intensive calorie and nutrient provision.
Iron Supplementation	Withheld to avoid exacerbating infection.	Introduced once appetite and weight gain are steady.
Patient Condition	Medically unstable, poor appetite.	Stable, alert, with returning appetite.

Moving towards recovery and normal diet

As the patient's condition improves and they approach their target weight, they can begin to transition to a normal diet. Parents or caregivers receive training on proper feeding practices to prevent relapse, and regular follow-up checks are crucial.

Encourage frequent, nutrient-dense meals and snacks.
Introduce fortified foods to increase energy and nutrient intake. Examples include adding milk powder to porridge or cheese to meals.
Prioritize a balanced diet with a variety of proteins, carbohydrates, and healthy fats.
Ensure proper food hygiene to prevent infections, as the immune system is still recovering.

Conclusion: The critical role of medical expertise

Feeding a severely malnourished person is a complex medical procedure, not a simple dietary change. The process requires a gradual, multi-stage approach, starting with stabilizing life-threatening metabolic imbalances and carefully managing electrolyte levels to prevent refeeding syndrome. The use of specific therapeutic foods, like F-75 and F-100, is essential in a controlled medical setting. Ultimately, a successful recovery depends on initial medical supervision and a structured plan for gradual nutritional rehabilitation, transitioning from specialized formulas to a normal, nutrient-dense diet under professional guidance. For more detailed information on refeeding syndrome and its management, consult authoritative medical resources such as the Cleveland Clinic. It is vital to seek medical help immediately for anyone suspected of severe malnutrition to ensure their safety and best chance of recovery.

Refeeding Syndrome: Symptoms, Treatment & Risk Factors

Frequently Asked Questions

Refeeding syndrome is a potentially fatal metabolic complication caused by a rapid reintroduction of food after a period of severe starvation. The sudden shift in metabolism can lead to severe electrolyte imbalances, fluid retention, and other complications affecting the heart, lungs, and brain.

No, it is extremely dangerous to feed a severely malnourished person at home without medical supervision. They are at high risk for refeeding syndrome, and their feeding needs must be carefully managed in a controlled medical environment.

F-75 is a specialized therapeutic milk formulated for the initial stabilization phase of treating severe malnutrition. It is low in protein and sodium but rich in carbohydrates to help the body's metabolism recover safely without overwhelming the system.

RUTF, or Ready-to-Use Therapeutic Food, is a high-energy, nutrient-dense paste or biscuit used in the rehabilitation phase to promote rapid weight gain. It is particularly useful for outpatient care due to its convenience and long shelf life.

Upon admission, doctors will immediately address life-threatening conditions like low blood sugar and hypothermia. They will also begin correcting fluid and electrolyte imbalances and administering broad-spectrum antibiotics to combat potential infections.

The most significant electrolyte imbalances are hypophosphatemia (low phosphate), hypokalemia (low potassium), and hypomagnesemia (low magnesium). These minerals are rapidly taken up by cells during the anabolic process, causing their levels in the blood to drop dangerously.

For severely malnourished patients, oral rehydration is preferred using a low-sodium solution like ReSoMal. It is administered slowly and monitored closely to avoid fluid overload, which can be particularly dangerous for their weakened heart.