Poor indicator to response during treatment of malnutrition includes –
Guidelines on Hospital based management of severely malnourished children

The curent guidelines recommended in-patient (hospital) management of all severely malnourished children are divided into ten essential steps:


Treat/prevent hypoglycemia
Treat/prevent hypothermia
Treat/prevent dehydration
Correct electrolyte imbalance
Treat/prevent infection
Correct micronutrient deficiencies
Start cautious feeding
Achieve catch-up growth
Provide sensory stimulation and emotional support
Prepare for follow-up after recovery.

Monitoring progress  during treatment

Good weight gain is >10 g/kg/day and indicates a good response. It is recommended to continue with the same treatment.
Moderate weight gain is 5-10 g/kg/day; food intake should be checked and the children should be screened for systemic infection.
Poor weight gain is < 5g/kg/day, screening for inadequate feeding, untreated infection, tuberculosis and psycho-logical problems is recommended.

Indicators of failure to respond 

Primary failure to respond is indicated by:
Failure to regain appetite by day 4.
Failure to start losing edema by day 4.
Presence of edema on day 10.
Failure to gain at least 5.g/kg/day by day 10.
Secondary failure to respond is indicated by
failure to gain at least 5g/kg/day for 3 consecutive days during the rehabilitation phase.

Criteria for discharge


Severely malnourished children are ready for discharge when the following criteria have been 'Wiled:


The absence of infection.
The child is eating at least 120-130 cal/lcg/day and receiving adequate micronutrients.
There is consistent weight gain (or at least 5 g/kg/day for 3 consecutive days) on exclusive oral feeding.
WFH is 90% of NCHS median; The child is still likely to have a low weight-for-age because of stunting.
The absence of oedema.
Completed immunization appropriate for age.
Caretakers are sensitized to home care.
Presence of edema on day 10
Failure to gain at least 5g/kg/day by day 10
Failure to gain at least 5g/kg/day for 3 consecutive days during the rehabilitation phase
All of these