Appropriate diets for the rehabilitation of malnourished children in the community setting.

The treatment of severe PEM includes--as appropriate in individual patients--fluid and electrolyte therapy, antimicrobial drugs, dietary management, and social and behavioral counseling. Except in the case of severe anorexia or life-threatening infections or dehydration, nutritional rehabilitation can be completed in the community setting, using centrally-processed or locally-prepared food mixtures and, when necessary, supplemental vitamins, minerals, and trace elements. Energy intakes should be maximized to promote rapid recovery, and protein: energy ratios must be increased according to the expected rate of weight gain. Nutrient: energy densities should meet or exceed the RDAs. Cultural and economic factors must be considered in the formulation of mixed diets, and organoleptic characteristics of the enhanced recipe(s) must be appropriate for young children. Selected issues concerning implementation of a community-based rehabilitation program are discussed.