7.4.7. Initial re-feeding

In the initial phase, re-feeding should be gradual.

Treatment

The essential features of initial feeding are:

frequent (every 2–3 h) oral small feeds of low osmolality and low lactose

nasogastric feeding if the child is eating ≤ 80% of the amount offered at two consecutive feeds

calories at 100 kcal/kg per day

protein at 1–1.5 g/kg per day

liquid at 130 ml/kg per day or 100 ml/kg per day if the child has severe oedema

in addition, if the child is breastfed, encourage continued breastfeeding, but make sure the prescribed amounts of starter formula are given:

Days Frequency Volume/kg feed Volume/kg per day

1–2 2h 11 ml 130 ml

3–5 3h 16 ml 130 ml

≥6 4h 22 ml 130 ml

Table 22Volumes of F-75 per feed for malnourished children (approximately 130 ml/kg per day)

Child's weight (kg)

2-hourly (ml/feed) 3-hourly (ml/feed)

4-hourly (ml/feed)

2.0 20 30 45

Child's weight (kg)

2-hourly (ml/feed) 3-hourly (ml/feed)

4-hourly (ml/feed)

2.2 25 35 50

2.4 25 40 55

2.6 30 45 55

2.8 30 45 60

3.0 35 50 65

3.2 35 55 70

3.4 35 55 75

3.6 40 60 80

3.8 40 60 85

4.0 45 65 90

4.2 45 70 90

4.4 50 70 95

4.6 50 75 100

4.8 55 80 105

5.0 55 80 110

5.2 55 85 115

Child's weight (kg)

2-hourly (ml/feed) 3-hourly (ml/feed)

4-hourly (ml/feed)

5.4 60 90 120

5.6 60 90 125

5.8 65 95 130

6.0 65 100 130

6.2 70 100 135

6.4 70 105 140

6.6 75 110 145

6.8 75 110 150

7.0 75 115 155

7.2 80 120 160

7.4 80 120 160

7.6 85 125 165

7.8 85 130 170

8.0 90 130 175

8.2 90 135 180

8.4 90 140 185

Child's weight (kg)

2-hourly (ml/feed) 3-hourly (ml/feed)

4-hourly (ml/feed)

8.6 95 140 190

8.8 95 145 195

9.0 100 145 200

9.2 100 150 200

9.4 105 155 205

9.6 105 155 210

9.8 110 160 215

10.0 110 160 220

Note:  If staff resources are limited, give priority to 2-hourly feeds for only the most s