F-75 and F-100 therapeutic milks are crucial for treating severe acute malnutrition (SAM) in children, with F-75 used for initial stabilization and F-100 for the rehabilitation and catch-up growth phase.
Understanding F-75 and F-100
F-75 and F-100 are specialized therapeutic milk formulas used in the management of severe acute malnutrition (SAM). These ready-to-use therapeutic foods (RUTFs) are designed to provide specific nutritional support tailored to different phases of recovery, focusing on either stabilization or rapid weight gain.
When to Administer F-75
F-75, also known as starter formula, is given during the initial stabilization phase of treatment for a child with severe acute malnutrition. This phase focuses on correcting metabolic disturbances, fluid imbalances, and preventing further complications, rather than rapid weight gain.
Key Scenarios for F-75 Administration:
- Severe Wasting and/or Oedema: If the child presents with severe wasting (very low weight-for-height) and/or nutritional oedema (swelling, often in the feet, indicative of severe malnutrition), it is essential to begin with F-75. This approach is cautious and prioritizes the child's fragile metabolic state.
- Initial Hospitalization/Treatment: F-75 is typically initiated upon a child's admission to a therapeutic feeding unit or hospital setting for SAM.
- Electrolyte Imbalances: It helps gradually restore electrolyte balance and prevents refeeding syndrome.
- Fragile State: Children in this phase are often very weak, prone to infections, and may have compromised organ function. F-75's lower protein and electrolyte content minimizes stress on their system.
Practical Considerations for F-75:
- Small, Frequent Feeds: F-75 is given in small, frequent amounts, usually every 2-3 hours, to avoid overwhelming the child's digestive system.
- Close Monitoring: Continuous monitoring of vital signs, oedema levels, and general condition is vital.
- Addressing Complications: During this phase, any concurrent medical issues like infections, dehydration, or hypothermia are also managed.
When to Transition to F-100
Once a child has been stabilized with F-75, they are ready to transition to F-100, which marks the beginning of the rehabilitation or catch-up growth phase. F-100 is higher in energy and protein, designed to promote rapid weight gain.
Signs for Readiness to Transition to F-100:
The transition from F-75 to F-100 is indicated by several key improvements in the child's condition:
- Very Hungry (Good Appetite): The child shows a significant increase in appetite and actively seeks food.
- Reduced or Minimal Oedema: Swelling, if present, has either completely resolved or is significantly reduced. This is a critical indicator of metabolic improvement.
- Tolerating F-75 Well: The child has consistently tolerated F-75 feeds with no adverse reactions.
- Little Watery Diarrhoea: Diarrhoea, if present, has significantly decreased in frequency and severity, indicating improved gut function.
- Alertness and Activity: The child appears more alert, active, and generally healthier.
Practical Considerations for F-100:
- Increased Quantity: F-100 is typically given in larger volumes and less frequently than F-75, as the child's digestive system can handle more.
- Weight Monitoring: Regular weight checks are crucial to monitor catch-up growth.
- Continued Support: While F-100 promotes growth, continued medical supervision, hygiene, and psychosocial support are essential for full recovery.
- Transition to RUTF: After successfully gaining weight on F-100, children may transition to ready-to-use therapeutic food (RUTF) for community-based treatment or continued outpatient care, allowing them to recover at home with parental supervision. Examples include products like Plumpy'Nut, which offer similar nutritional density to F-100 in a solid form.
Summary Table: F-75 vs. F-100
| Feature | F-75 (Stabilization Formula) | F-100 (Catch-Up Formula) |
|---|---|---|
| Primary Goal | Stabilize medical condition, correct metabolic imbalances. | Promote rapid weight gain and catch-up growth. |
| Energy Density | Lower (e.g., 75 kcal/100 ml) | Higher (e.g., 100 kcal/100 ml) |
| Protein/Fat | Lower in protein and fat, higher in carbohydrates. | Higher in protein and fat. |
| Electrolytes | Carefully balanced to avoid refeeding syndrome. | Higher electrolyte content to support growth. |
| When to Use | Initial phase for severe wasting, oedema, or clinical complications. | Once stable, oedema reduced, good appetite, tolerating F-75 well. |
| Typical Phase | Phase 1: Stabilization | Phase 2: Rehabilitation |
| Indications | Severe wasting, nutritional oedema, poor appetite, clinical complications (e.g., severe diarrhoea, hypothermia). | Child is very hungry, reduced/minimal oedema, tolerating F-75 well with little watery diarrhoea, alert. |
Important Considerations for SAM Treatment
- Medical Supervision: The administration of F-75 and F-100 must always be under strict medical supervision, typically in a facility following established protocols such as those by the World Health Organization (WHO).
- Hygiene: Meticulous hygiene practices during preparation and feeding are critical to prevent infections.
- Psychosocial Support: Emotional support and stimulation are just as important as nutritional care for the child's overall recovery and development.
- Monitoring Progress: Regular monitoring of weight, height, oedema, and clinical signs helps ensure the treatment is effective and guides transitions between phases.
The structured approach using F-75 followed by F-100 ensures that severely malnourished children receive appropriate nutritional support at each stage of their recovery, minimizing risks and maximizing the chances of successful rehabilitation.
