Dear colleague,

Very interesting question.  About a year ago, I was looking for information regarding CMAM for children with disabilities, and was not successful in finding anything. We came up with a few parameters to consider regarding disability inclusion in CMAM, but this did not include recommendations regarding benchmarks for outcomes. 

I have no recommendations based on positive outcomes or scientific data.  I limit all children to 12 weeks of SAM treatment, with the option of returning 4 weeks after stopping for re-enrollment. for 12 more weeks.  this comes from 1000's patient care experiences.

Mark Manary

Thanks Colleen for your response. Am eager to know the parameters you came up with regarding disability inclusion in CMAM, if you could kindly share...

Thanks Mark Manary for the response..Interesting.

Hi Anonymous,

You raise an important issue that is long overdue in being addressed in guidance. A recent article by Engl et al reviews the guidance (or lack of) for the treatment of children with disabilities with wasting.

Children living with disabilities are neglected in severe malnutrition protocols: a guideline review https://adc.bmj.com/content/archdischild/early/2022/02/03/archdischild-2021-323303.full.pdf

CMAM guidelines in the public domain may be found here: https://acutemalnutrition.org/en/resource-library

A child with disabilites that is not recovering well likely requires additional assessment and support at home. It can take up to 15 times longer to feed a child with disabilities and neuromuscular issues with food manipulation and swallowing may compound the day-to-day practical difficulties faced by the carer. Additional assessment by a doctor or specialist should be able to identify issues with feeding / swallowing. The carer should also be referred to social services or civil society organisations that may be able to provide ongoing physical and psychosocial support.

Research, expert advice in developing guidance and an update to guidance that supports the rights of people and children living with disabilities with wasting is long overdue. This needs to not only look at the suitability / practiccability of admission and discharge criteria but also at specific elements of care and support during treatment. In many guidelines, the criteria for inpatient care also include 'carers who require additional support' - if the child is not recovering well, or is not recovered after 12 weeks then you should consider treatment under observation in inpatient care before discharging the child unrecovered. In any case, the carer and child should be referred to ongoing medical / social services and to specialist civil society groups if these are available.

Thank you Paul for the response ... Quite informative