e-Library of Evidence for Nutrition Actions (eLENA)

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.

WHO recommendations

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.

WHO documents

WHO documents

GRC-approved guidelines
Other guidance documents


Systematic reviews used to develop the guidelines
Clinical trials

Last update:

24 August 2016 17:01 CEST

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

Essential Nutrition Actions

This intervention is a component of managing children with SAM, which is an Essential Nutrition Action targeting the first 1000 days of life.

Global targets

Implementation of this intervention may contribute to the achievement of the following targets:

Global nutrition targets

Target 6: Reduce and maintain childhood wasting to less than 5%