Editing Kwashiorkor (section)

== Treatment ==
[[WHO]] guidelines outline 10 general principles for the inpatient management of severely malnourished children.<ref name="WHO 10665/95584"/><ref>{{Cite web|url=https://www.who.int/nutrition/publications/guide_inpatient_text.pdf|archive-url=https://web.archive.org/web/20060327201732/http://www.who.int/nutrition/publications/guide_inpatient_text.pdf|url-status=dead|archive-date=27 March 2006|title=Guidelines for the inpatient treatment of severely malnourished children|last=Ashworth|first=Ann| name-list-style = vanc |date=2003|website=WHO}}</ref>

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

Both clinical subtypes of severe acute malnutrition (kwashiorkor and marasmus) are treated similarly.<ref name="Smith Yatsunenko Manary 2013"/><ref name="WHO 10665/95584"/> Upon initial treatment, children with kwashiorkor may experience weight loss as their edema resolves.<ref name="Grover & Ee 2009">{{cite journal |last1=Grover |first1=Zubin |last2=Ee |first2=Looi C. |title=Protein Energy Malnutrition |journal=Pediatric Clinics of North America |date=October 2009 |volume=56 |issue=5 |pages=1055–1068 |doi=10.1016/j.pcl.2009.07.001 |pmid=19931063 }}</ref> Therefore, after concerns of [[refeeding syndrome]] have passed, children may require 120-140% of their estimated caloric needs to achieve catch-up growth.<ref name="Grover & Ee 2009"/>

The cause, type, and severity of malnutrition determine what type of treatment would be most appropriate.<ref name="Dipasquale Cucinotta Romano 2020">{{cite journal |last1=Dipasquale |first1=Valeria |last2=Cucinotta |first2=Ugo |last3=Romano |first3=Claudio |title=Acute Malnutrition in Children: Pathophysiology, Clinical Effects and Treatment |journal=Nutrients |date=12 August 2020 |volume=12 |issue=8 |pages=2413 |doi=10.3390/nu12082413 |pmid=32806622 |pmc=7469063 |doi-access=free }}</ref> For primary acute malnutrition, children with no complications are treated at home and are encouraged to either continue breastfeeding (for infants) or start using ready-to-use therapeutic foods (for children).<ref name="Dipasquale Cucinotta Romano 2020"/> For secondary acute malnutrition, the underlying cause needs to be identified to appropriately treat children. Only after the primary disease is determined can an appropriate dietary plan be made, as fluid, vitamins, and macronutrients may need to be considered to not exacerbate the cause of malnutrition.<ref name="Dipasquale Cucinotta Romano 2020"/> For example, it is important to recognize that supplementation with key micronutrients like vitamin A, zinc, and iron may be necessary for children during recovery.<ref>{{Cite journal |last1=Michael |first1=Husheem |last2=Amimo |first2=Joshua O. |last3=Rajashekara |first3=Gireesh |last4=Saif |first4=Linda J. |last5=Vlasova |first5=Anastasia N. |date=2022-05-02 |title=Mechanisms of Kwashiorkor-Associated Immune Suppression: Insights From Human, Mouse, and Pig Studies |journal=Frontiers in Immunology |language=English |volume=13 |doi=10.3389/fimmu.2022.826268 |doi-access=free |issn=1664-3224 |pmc=9108366 |pmid=35585989}}</ref> Micronutrient deficiencies are common in malnourished children and contribute to immune dysfunction.<ref>{{Cite journal |last1=Michael |first1=Husheem |last2=Amimo |first2=Joshua O. |last3=Rajashekara |first3=Gireesh |last4=Saif |first4=Linda J. |last5=Vlasova |first5=Anastasia N. |date=2022-05-02 |title=Mechanisms of Kwashiorkor-Associated Immune Suppression: Insights From Human, Mouse, and Pig Studies |journal=Frontiers in Immunology |language=English |volume=13 |doi=10.3389/fimmu.2022.826268 |doi-access=free |issn=1664-3224 |pmc=9108366 |pmid=35585989}}</ref> Specific vitamin A supplementation is particularly important for preventing further damage to the liver and skin.<ref>{{Cite journal |last1=Michael |first1=Husheem |last2=Amimo |first2=Joshua O. |last3=Rajashekara |first3=Gireesh |last4=Saif |first4=Linda J. |last5=Vlasova |first5=Anastasia N. |date=2022-05-02 |title=Mechanisms of Kwashiorkor-Associated Immune Suppression: Insights From Human, Mouse, and Pig Studies |journal=Frontiers in Immunology |language=English |volume=13 |doi=10.3389/fimmu.2022.826268 |doi-access=free |issn=1664-3224 |pmc=9108366 |pmid=35585989}}</ref>

[[Therapeutic food|Ready-to-use therapeutic foods]] (RUTFs) and [[F-100 and F-75 (foods)|F-75 and F-100 milks]] were created to provide appropriate nutrition and caloric intake to those experiencing malnutrition. F-75 milk would be ideal when trying to reintroduce food into a malnourished person, and F-100 milk would be used to aid in weight gain. While RUTFs and F-100 milk were made to have the same nutritional value, RUTFs are beneficial as they are dehydrated and do not require much preparation.<ref name="Bhutta Berkley Bandsma 2017"/>

It is also important to note that infections are common in children with severe malnutrition and can further complicate treatment.<ref>{{Cite journal |last1=Williams |first1=Phoebe C. M. |last2=Berkley |first2=James A. |date=2018-12-21 |title=Guidelines for the treatment of severe acute malnutrition: a systematic review of the evidence for antimicrobial therapy |journal=Paediatrics and International Child Health |language=en |volume=38 |issue=sup1 |pages=S32–S49 |doi=10.1080/20469047.2017.1409453 |issn=2046-9047 |pmc=5972636 |pmid=29790840}}</ref> Routine antibiotics, even in the absence of clinical infection, are generally given as a [[Prophylactic antibiotic|prophylactic]] measure, especially in regions with a high risk of infectious diseases.<ref>{{Cite journal |last1=Williams |first1=Phoebe C. M. |last2=Berkley |first2=James A. |date=2018-12-21 |title=Guidelines for the treatment of severe acute malnutrition: a systematic review of the evidence for antimicrobial therapy |journal=Paediatrics and International Child Health |language=en |volume=38 |issue=sup1 |pages=S32–S49 |doi=10.1080/20469047.2017.1409453 |issn=2046-9047 |pmc=5972636 |pmid=29790840}}</ref> However, due to concerns about antibiotic resistance, there is debate over their routine use.<ref>{{Cite journal |last1=Williams |first1=Phoebe C. M. |last2=Berkley |first2=James A. |date=2018-12-21 |title=Guidelines for the treatment of severe acute malnutrition: a systematic review of the evidence for antimicrobial therapy |journal=Paediatrics and International Child Health |language=en |volume=38 |issue=sup1 |pages=S32–S49 |doi=10.1080/20469047.2017.1409453 |pmid=29790840 |pmc=5972636 |issn=2046-9047}}</ref>