What is Therapeutic Milk?
Therapeutic milk is a highly specialized, milk-based diet formulated for the treatment of severe acute malnutrition (SAM), a condition characterized by dangerously low weight-for-height and severe wasting. The World Health Organization (WHO) and other humanitarian organizations, like UNICEF, utilize these formulas to manage SAM in hospitalized patients, particularly children. The two most common types are F-75 and F-100, which are designed for different stages of the recovery process. These formulas are distinct from standard infant formulas and are strictly for use under medical supervision within a clinical setting.
Unlike standard food, therapeutic milk contains a specific balance of macronutrients and is heavily fortified with crucial vitamins and minerals, helping to restore a child's metabolic function without overwhelming their compromised system. The ingredients typically include milk powder, refined vegetable oil, carbohydrates such as sugar and maltodextrin, and a specialized vitamin and mineral premix.
The Two-Phase Treatment Protocol
According to the WHO protocol for managing severe acute malnutrition, treatment is divided into distinct phases, each requiring a different type of therapeutic milk to address the patient's changing needs.
F-75: The Stabilization Formula
F-75 is the "starter" formula used during the initial stabilization phase (Phase 1) of SAM treatment. This phase focuses on correcting life-threatening issues, such as electrolyte imbalances, hypoglycemia, and dehydration, rather than on promoting rapid weight gain.
- Low-Protein, Low-Lactose: F-75 has a lower protein content and is designed to be easily digestible for a child whose system is severely compromised.
- Balanced Electrolytes: It is formulated with a precise electrolyte balance to help restore metabolic function and prevent further complications.
- Energy Density: Providing approximately 75 kcal per 100 ml, its energy density is moderate, ensuring the child is not overwhelmed by an aggressive refeeding strategy.
- Duration: This phase typically lasts for 3 to 7 days, depending on the child's response to treatment.
F-100: The Rehabilitation Formula
Once a child is metabolically stable and has regained their appetite, they transition to the rehabilitation phase (Phase 2) using F-100. The goal of this phase is to achieve rapid catch-up growth and weight gain.
- High-Energy Density: F-100 delivers a higher energy density, providing approximately 100 kcal per 100 ml, to fuel the child's recovery.
- Increased Protein: The protein content is higher than in F-75, supporting tissue repair and muscle development.
- Nutrient-Dense: It is packed with the necessary micronutrients to address deficiencies and support overall recovery.
- Duration: This phase continues until the child has reached a healthy weight and can transition back to a normal diet.
Therapeutic Milk vs. Ready-to-Use Therapeutic Food (RUTF)
While therapeutic milk is for inpatient care, Ready-to-Use Therapeutic Food (RUTF) is a more recent innovation used for outpatient treatment of uncomplicated SAM. The key differences are highlighted in the table below:
| Feature | Therapeutic Milk (F-75/F-100) | Ready-to-Use Therapeutic Food (RUTF) |
|---|---|---|
| Use Case | Inpatient care for severe, complicated malnutrition. | Outpatient care for uncomplicated malnutrition. |
| Form | Powder mixed with water to create a liquid diet. | Energy-dense paste, often peanut-based, eaten directly from the packet. |
| Contamination Risk | Higher risk of contamination due to the need for mixing with water, requiring hygienic preparation. | Lower risk of contamination as it requires no preparation or water. |
| Nutritional Profile | Specifically formulated for metabolic stabilization (F-75) and rapid catch-up growth (F-100). | High energy, protein, and micronutrient profile designed for home-based recovery. |
| Administration | Administered under strict medical supervision in hospitals or feeding centers. | Given by caregivers at home, with regular monitoring by community health workers. |
| Primary Goal | Stabilize the patient, correct metabolic disturbances, and manage complications. | Promote rapid weight gain and recovery in a community setting. |
The Nutritional Science Behind Therapeutic Milk
Therapeutic milk is formulated with a precise scientific rationale to ensure the best possible outcome for a severely malnourished child. At this stage, a child's metabolism is severely impaired, and feeding them a normal, high-protein diet too quickly could lead to refeeding syndrome, a potentially fatal complication. F-75's low protein, low-sodium, and high-carbohydrate content gently reintroduces nutrients, allowing the body to stabilize before the intensive refeeding phase begins. The careful addition of specific vitamins and minerals, like zinc, copper, and vitamin A, addresses widespread deficiencies without overwhelming the compromised organs. The transition to F-100 then provides the necessary energy and protein in a concentrated, digestible form to fuel rapid and safe catch-up growth. For more detailed product specifications, authoritative bodies such as UNICEF provide public documentation detailing the nutritional composition of these life-saving formulas.
Administration and Safety Considerations
Administering therapeutic milk requires careful adherence to established protocols to ensure patient safety and effectiveness. Health workers in hospitals and therapeutic feeding centers follow strict guidelines for mixing and feeding.
Best Practices for Therapeutic Milk Administration:
- Hygienic Preparation: The powder must be mixed with previously boiled water that has been cooled to the correct temperature (below 70°C) to prevent bacterial growth.
- Precise Mixing: Using the provided scoop and following the exact ratios is crucial to ensure the correct energy density and nutritional balance.
- Regular Feeding: Feeds are typically given every 2-3 hours, both day and night, in controlled, measured amounts.
- Monitoring and Supervision: The child's progress is continuously monitored by medical professionals, with dosages adjusted based on weight and clinical signs.
- Not for Home Use: Therapeutic milk, particularly F-75, is not intended for long-term feeding or for use in the community due to the high risk associated with improper preparation and the need for constant medical oversight.
Conclusion
Therapeutic milk, in its distinct F-75 and F-100 forms, is an indispensable medical tool in the fight against severe acute malnutrition. By following a structured, two-phase treatment protocol, it allows critically ill children to be safely stabilized and then aggressively rehabilitated under medical supervision. While innovations like RUTF have expanded treatment options to a community-based setting, therapeutic milk remains the gold standard for complicated cases requiring inpatient care. Its careful formulation and controlled administration are a testament to the scientific and humanitarian efforts dedicated to saving the lives of the world's most vulnerable children.
