In general, in the management of acute infections, a child can be considered ready for discharge after the clinical condition has improved markedly (afebrile, alert, eating and sleeping normally), and oral treatment has been started.
A decision on when to discharge should be made on an individual basis, taking into consideration factors such as:
- the family’s home circumstances and how much support is available to care for the child
- the staff’s judgement of the likelihood that the treatment course will be completed at home
- the staff’s judgement of the likelihood that the family will return immediately to hospital if the child’s condition worsens.
The timing of discharge of a child with severe acute malnutrition is particularly important and is discussed in Chapter 7. In each case, the family should be given as much warning as possible of the discharge date, so that appropriate arrangements can be made to support the child at home.
If the family removes the child prematurely against the advice of the hospital staff, counsel the mother on how to continue treatment at home, and encourage her to bring the child for follow-up after 1–2 days and to make contact with the local health worker for help in the follow-up care of the child.