Intended for healthcare professionals

Rapid response to:

Clinical Review

Management of the severely malnourished child: perspective from developing countries

BMJ 2003; 326 doi: (Published 18 January 2003) Cite this as: BMJ 2003;326:146

Rapid Response:

A long-awaited guideline

Dear Editor,

This is an excellent and enlightening review which highlights the importance of following a standardised treatment guideline for a worldwide prevalent cause of childhood mortality. Childhood mortality is highest in developing nations because malnutrtion is a contributory factor in most deaths in children in such countries.

Even as late as 5 years back paediatricians in most parts of India mainly stressed on intake of carbohydrate and protein to treat acute severe malnutrition. This article highlights the importance of vitamins, minerals and micronutrients as essential supplements to optimise recovery process. It also emphasises the importance of graded increase in the amount of calorie and protein intake to give the body system time to adjust to increase metabolic load.

The article also stresses the use of low sodium oral rehydration solution for treatment of dehydration in the severely malnourished children which, again had not been a routine practice few years back. Low sodium oral rehydration solutions has proven to be effective and safe in studies from Bangladesh.

I believe the recommendations and guidelines provided by this article will be welcome by all paediatricians who deal with malnourished children. The recommendations are very sensible and though may not be classified as strongly evidence-based, they are from large group observational studies. Malnutrition is primarily a disease of developing nation and realistically there is not a lot of financial support to get the benefit from sophesticated scientific researches. Therefore, it might be a good idea to follow the given recommendations until further evidence-based research is available.

Competing interests:  
None declared

Competing interests: No competing interests

23 January 2003
Ambalika De
Staff Grade Paediatrician
George Eliot Hospital. Nuneaton. CV10 7DJ