Severe Acute Malnutrition (SAM) is a life-threatening condition requiring specialized care, particularly in children. The World Health Organization (WHO) has established a two-phase protocol for inpatient management using therapeutic milks known as F75 and F100. This guide delves into the calculation, preparation, and application of these critical nutritional formulas.
Understanding the Two Phases of Therapeutic Feeding
Successful treatment of SAM follows a structured two-phase approach to prevent complications and promote recovery. Each phase utilizes a specific formula tailored to the child's metabolic needs.
- Stabilization Phase (Phase 1): This initial phase focuses on restoring metabolic functions, correcting electrolyte imbalances, and managing complications like hypothermia or dehydration. The F75 formula is used because it is lower in protein and fat but rich in carbohydrates, which is better tolerated by a child in a fragile metabolic state. The primary goal is not weight gain but stabilization.
- Rehabilitation Phase (Phase 2): Once a child is stabilized and has regained their appetite, the goal shifts to rapid weight gain. The F100 formula, with its higher energy and protein density, is introduced to rebuild wasted tissues and support catch-up growth. This phase typically begins when a child shows consistent weight gain and reduced edema.
How to approach F75 formula calculation
Calculating the appropriate volume of F75 involves determining the total daily amount based on the child's weight and then dividing this into frequent feeds to avoid overwhelming their fragile system. This must be done under medical supervision.
Approaching daily F75 volume calculation
Guidelines for the stabilization phase often involve providing a specific volume of F75 per kilogram of body weight per day. In some cases, particularly with severe edema, this amount may be adjusted. The total daily volume is then divided into a number of feeds per day, often administered at regular intervals.
Preparing F75 formula
Whether using commercially available powder or locally sourced ingredients, precise measurement is non-negotiable.
Recipe for F75 (per 1000 ml) using dried skimmed milk:
- Dried skimmed milk powder: 25 g
- Sugar: 100 g (or 70 g with cereal flour)
- Vegetable oil: 30 g
- Mineral-Vitamin Mix (CMV): 20 ml
- Water: Make up to 1000 ml total volume.
How to approach F100 formula calculation
Once a child has moved from the stabilization to the rehabilitation phase, F100 is introduced to achieve rapid weight gain. This requires a higher daily caloric intake.
Approaching daily F100 volume calculation
During the rehabilitation phase, the energy intake is significantly increased. The required volume is determined by monitoring the child's intake and adjusting feed amounts incrementally.
- Step 1: Transition from F75 to F100 over a period, offering the same volume per feed initially and monitoring tolerance.
- Step 2: Increase the feed volume at successive feeds until the child begins to leave some uneaten. This indicates they have reached their ad libitum intake.
Preparing F100 formula
F100 preparation also demands strict adherence to recipes to ensure the correct nutritional profile for catch-up growth.
Recipe for F100 (per 1000 ml) using dried skimmed milk:
- Dried skimmed milk powder: 80 g
- Sugar: 50 g
- Vegetable oil: 60 g
- Mineral-Vitamin Mix (CMV): 20 ml
- Water: Make up to 1000 ml total volume.
F75 vs. F100: A Comparison
The following table highlights the key differences between the F75 and F100 therapeutic milk formulas.
| Feature | F75 Therapeutic Milk | F100 Therapeutic Milk |
|---|---|---|
| Energy Density | 75 kcal per 100 ml | 100 kcal per 100 ml |
| Protein Content | Low (approx. 0.9 g per 100 ml) | Higher (approx. 2.9 g per 100 ml) |
| Treatment Phase | Stabilization (Phase 1) | Rehabilitation (Phase 2) |
| Primary Goal | Correct metabolism and treat complications | Promote rapid weight gain and catch-up growth |
| Carbohydrate Content | High | Moderate |
| Fat Content | Low | High |
Important preparation and administration guidelines
To ensure efficacy and safety, the following guidelines are crucial for preparing and administering F75 and F100:
- Hygiene: Always wash hands thoroughly and use clean, sterilized equipment to prepare the feed. Contamination risk is high.
- Water Temperature: Use water that has been boiled and cooled to no less than 70°C, which helps dissolve the powder and reduce bacterial risk.
- Final Volume: Add water to the other ingredients to reach the final 1000 ml volume, rather than adding 1000 ml of water directly, which would dilute the mixture.
- Mixing: Whisk the ingredients vigorously to ensure the oil is fully integrated and does not separate.
- Storage: Reconstituted milk should be used within a limited time if stored at room temperature or refrigerated. Any remaining milk should be discarded.
- Medical Supervision: The use of F75 and F100 should be strictly managed by skilled health personnel in a hospital or therapeutic feeding center. It should not be distributed for at-home use.
Special considerations
- Infants Under 6 Months: A modified, diluted F100 formula may be used for infants under 6 months, as specified in WHO guidelines.
- Severe Edema: For children with severe edema, the initial daily fluid intake is often restricted to prevent overhydration.
- Transition Monitoring: The transition from F75 to F100 is based on careful clinical monitoring, including consistent weight gain and returned appetite.
Conclusion
Approaching the calculation and preparation of F75 and F100 accurately are fundamental steps in treating severe acute malnutrition. F75 is vital for stabilizing a child's delicate metabolic state in the initial phase, while F100 is essential for promoting rapid recovery and weight gain in the rehabilitation phase. Adhering to strict WHO protocols for ingredient measurement, hygiene, and administration ensures these therapeutic milks are used effectively and safely to save lives and promote healthy development. For detailed procedural information, healthcare workers should consult authoritative resources, such as UNICEF's technical guidance.
Disclaimer: This information is for general knowledge and should not be taken as medical advice. Consult with a healthcare professional before making any decisions related to health or treatment.
