Understanding the Stabilization Phase in Malnutrition: A Critical First Step to Recovery

October 26, 2025 •

4 min read

According to the World Health Organization, severe acute malnutrition affects millions of children globally, with the initial stabilization phase being the most critical period to prevent death. This phase focuses on addressing immediate life-threatening complications before attempting nutritional catch-up growth.

Quick Summary

The stabilization phase is the initial, inpatient stage of severe malnutrition treatment focused on resolving life-threatening complications. Medical teams address issues like hypoglycemia, dehydration, and infection while providing cautious, low-nutrient feeding. This prepares the patient for the subsequent nutritional rehabilitation phase.

Key Points

Initial Priority: The stabilization phase focuses on treating life-threatening medical issues, not promoting rapid weight gain.
Cautious Feeding: Feeding starts with a low-energy, low-protein formula (F-75) to prevent refeeding syndrome, a dangerous electrolyte and fluid imbalance.
Medical Management: This phase includes treating hypoglycemia, hypothermia, dehydration, and infections, as well as correcting mineral deficiencies.
High-Risk Period: The highest mortality rates for severely malnourished patients often occur during this initial week of treatment.
Gradual Transition: The phase concludes with a gradual transition to higher-energy feeding (F-100 or RUTF) once medical complications are controlled and appetite returns.
Inpatient Care: Due to the high risk and complex needs, the stabilization phase requires close medical supervision in an inpatient setting.

The Critical First Week: What is the stabilization phase in malnutrition?

For individuals, especially children, suffering from severe acute malnutrition (SAM), immediate and intensive medical care is paramount to survival. This care is structured into distinct phases, beginning with the stabilization phase. This is the crucial first step, typically lasting about a week, where the focus is not on weight gain but on correcting metabolic imbalances and treating life-threatening medical complications. During this time, the body's major organs—including the heart, kidneys, and liver—are severely compromised, requiring a cautious and carefully monitored approach to prevent further harm. Mortality rates are often highest during this initial period, making a standardized, protocol-driven approach essential for improving patient outcomes.

The 'Ten Steps' of Inpatient Care

The management of severe malnutrition during the stabilization phase often follows a protocol based on the World Health Organization's (WHO) 'Ten Steps' to recovery, ensuring all critical issues are addressed systematically.

Treat/Prevent Hypoglycemia: Low blood sugar is common and dangerous. Treatment involves administering glucose, followed by feeding every few hours, day and night.
Treat/Prevent Hypothermia: Malnourished individuals often struggle to regulate body temperature. Keeping them warm and re-warming them if necessary is critical.
Treat/Prevent Dehydration: Dehydration is tricky to assess in severe malnutrition. Cautious rehydration with a specialized solution like ReSoMal, which is low in sodium, is used, with IV fluids reserved only for cases of shock.
Correct Electrolyte Imbalance: Malnutrition depletes essential minerals. Extra potassium and magnesium are given daily, while sodium is restricted to avoid stress on the heart and kidneys.
Treat Infections: Infection is a common complication, and the usual signs like fever are often absent. Broad-spectrum antibiotics are administered routinely.
Correct Micronutrient Deficiencies: Supplementation of essential vitamins and minerals like zinc, copper, and folic acid is vital. However, iron is withheld initially as it can exacerbate infections.
Start Cautious Feeding: Feeding begins as soon as possible, but in small, frequent amounts. This prevents the life-threatening complications of refeeding syndrome.
Achieve Catch-Up Growth (Rehabilitation): This step follows stabilization, focusing on high-energy, high-protein foods like F-100 or RUTF to promote rapid weight gain.
Provide Sensory Stimulation and Emotional Support: Tender, loving care, play, and a stimulating environment are crucial for a child's mental and physical recovery.
Prepare for Follow-Up: Educating caregivers and planning for follow-up care are essential to prevent relapse.

Cautious Feeding and the Risk of Refeeding Syndrome

During the stabilization phase, the primary therapeutic food is a low-protein, low-energy formula called F-75. The use of F-75 is a cornerstone of cautious feeding. In a severely malnourished state, the body undergoes metabolic changes to conserve energy, and its functional capacity is significantly reduced. Suddenly reintroducing high levels of nutrients can cause a dangerous and potentially fatal fluid and electrolyte shift, known as refeeding syndrome. F-75 is specifically designed to meet the body's reduced metabolic needs without overwhelming its systems, providing modest energy and low levels of protein, lactose, and sodium. This allows the body to gradually recover its metabolic functions before being pushed toward growth.

A Comparison of the Malnutrition Treatment Phases


Feature	Stabilization Phase	Rehabilitation Phase
Goal	Address life-threatening medical issues; stabilize metabolism.	Promote rapid weight gain and catch-up growth.
Duration	Approximately 1-7 days (can vary).	Several weeks, both inpatient and outpatient.
Therapeutic Food	F-75 therapeutic milk or equivalent.	F-100 therapeutic milk or ready-to-use therapeutic food (RUTF).
Energy/Protein Content	Low-energy, low-protein (e.g., 75 kcal/100 mL).	High-energy, high-protein (e.g., 100 kcal/100 mL).
Key Action	Cautious, frequent feeding and medical treatment.	Encouraging generous food intake; providing sensory stimulation.
Monitoring	Frequent checks for hypoglycemia, hypothermia, electrolytes, and feeding tolerance.	Daily weighing to monitor catch-up growth rate.

Transitioning to Rehabilitation

The successful completion of the stabilization phase is marked by several key indicators: the resolution of acute medical complications, a significant reduction in edema (if present), and a return of the patient's appetite. Once these conditions are met, the patient can be transitioned to the rehabilitation phase. This transition is gradual and typically occurs over a couple of days. The F-75 formula is slowly replaced with a higher-energy, higher-protein formula like F-100, or with a ready-to-use therapeutic food (RUTF). The amount of food is progressively increased until the patient's intake is high enough to support rapid catch-up growth, which is the primary objective of the rehabilitation phase. During this time, the medical focus shifts to ensuring the patient is consuming adequate nutrition and gaining weight, while still providing a stimulating and supportive environment to aid their overall development.

Conclusion

In summary, understanding what is the stabilization phase in malnutrition is vital for effective treatment. It is a highly specialized and critical period that prioritizes medical stability over immediate weight gain. By addressing life-threatening complications and re-introducing nutrition cautiously, the stabilization phase lays the essential groundwork for successful nutritional rehabilitation and long-term recovery. This structured, phased approach, following internationally recognized protocols, dramatically improves the survival rates and long-term outcomes for individuals suffering from severe acute malnutrition. The care received during this critical week sets the trajectory for the patient's entire recovery journey.

UNICEF: Community Management of Acute Malnutrition (Example Outbound Link)

Frequently Asked Questions

Starting rapid feeding immediately can cause refeeding syndrome, a potentially fatal condition caused by dangerous fluid and electrolyte shifts in the body. The stabilization phase requires a slow, cautious approach to prevent this.

The primary goal is to address immediate, life-threatening medical complications like infection, dehydration, and metabolic imbalances. Rapid weight gain is the focus of the subsequent rehabilitation phase.

F-75 is a specialized therapeutic milk with a low energy and protein content. It's used in the stabilization phase to provide cautious nourishment without overwhelming the severely compromised body.

Common complications include hypoglycemia (low blood sugar), hypothermia (low body temperature), severe dehydration, infection, and electrolyte imbalances.

A patient is ready to transition to the rehabilitation phase when medical complications are controlled, edema is reduced, and their appetite has returned.

Iron is withheld during stabilization because it can exacerbate infections, which are a major risk factor during this critical period. It is introduced later during the rehabilitation phase.

The transition is gradual. The lower-energy F-75 is progressively replaced with a higher-energy, higher-protein therapeutic food, like F-100 or RUTF, over a few days to ensure tolerance.