Table 4

Including children living with disabilities for future severe malnutrition guidelines: suggested areas for inclusion

Suggested areas for inclusionIncluded in 2013 WHO SAM guideline updateIncluded in x number of guidelines analysed for this study
Link of disability with malnutritionBrieflyBriefly acknowledge link: 6/60 (10%)
Acknowledge disability as a possible reason for malnutrition treatment failure or non-response: 39/60 (65%)
Proactive screening for disability and developmental delayNoProactively screen:
3/60 (5%)
Disability yes/no on physical assessment form:
42/60 (70%)
Multidisciplinary team management (as available speech and language therapy, dieticians, physiotherapists, occupational therapy, psychologists, nurses, medical team including neurology and gastroenterology, social services)NoOutlining multidisciplinary approach: 1/60 (1.5% 26 )
Suggesting disability as a reason for inpatient treatment: 18/60 (30%)
Disability-specific feeding advice, medical advice (as context-appropriate, possibly including advanced feeding techniques, eg, percutaneous gastrostomy)No Specific feeding advice:
2/60 (3% 26 29 )
Noting disability (eg, cleft lip/palate) as possible indication for nasogastric tube feeding: 43/60 (72%)
Continued support within the home (eg, home visits, home adaptations)No 1/60 (1.5%28)
Referral mechanismsNo 18/30 (30%)—mostly unspecific (‘referral to specialists’)
Counselling and advice for caregivers (including management of expectations)No 4/60 (7%)
Monitoring and evaluationNo 3/60 (5%)
Consideration of children living with disabilities in nutrition emergencies, malnutrition prevention strategiesNo 1/60 (1.5% 29 )
Linking to local and context-specific organisations/groups providing additional supportNo 3/60 (5%): ‘refer to appropriate support services’ (few specifics)
Linking to other relevant guidanceNo 1/60 (1.5% 26 linking to a cerebral palsy feeding and nutrition review42)
  • SAM, severe acute malnutrition.