Therapeutic feeding of children 6–59 months of age with severe acute malnutrition and acute or persistent diarrhoea
In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.
Diarrhoea is common in malnourished children and can result in decreased absorption of nutrients and significant water loss which can lead to dehydration, shock and ultimately death. Both acute and persistent (i.e. three or more loose or watery stools in a day, for more than 14 days) diarrhoea can worsen the harmful effects of severe acute malnutrition if left untreated. Episodes of prolonged diarrhoea are also associated with increased morbidity and mortality from other diseases, adverse neurodevelopment and stunting.
Although treatment and prevention of dehydration are essential, care of severely malnourished children must focus on the most effective and safest therapeutic feeding approach to resolve diarrhoea while meeting their nutritional needs.
Children who are 6–59 months of age with severe acute malnutrition who present with either acute or persistent diarrhoea, can be given ready-to-use therapeutic food in the same way as children without diarrhoea, whether they are being managed as inpatients or outpatients.
Because ready-to-use therapeutic food does not contain water, children should also be offered safe drinking water to drink at will. Breastfeeding should be continued and offered ad libitum.
This is a summary of one of several WHO recommendations on the management of SAM in infants and children. The full set of recommendations can be found in 'Full set of recommendations' and in the guidelines and guidance documents under ‘WHO documents’ below.
Updates on the management of severe acute malnutrition in infants and children
Pocket book of hospital care for children: second edition. Guidelines for the management of common illnesses with limited resources
Other guidance documents
Community-based management of severe acute malnutrition. A joint statement by the World Health Organization, the World Food Programme, the United Nations System Standing Committee on Nutrition and the United Nations Children's Fund
The treatment of diarrhoea: a manual for physicians and other senior health workers
Management of severe malnutrition: a manual for physicians and other senior health workers
Systematic reviews used to develop the guidelines
Systematic review of the care of children with diarrhoea in the community-based management of severe acute malnutrition
The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review