e-Library of Evidence for Nutrition Actions (eLENA)

Treatment of hypothermia in children with severe acute malnutrition

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.

Severely malnourished children are particularly vulnerable to hypothermia, where the body’s core temperature drops below the required temperature for normal functions. Hypothermia in malnourished children often suggests coexisting hypoglycaemia or serious infection.

The treatment or prevention of hypoglycaemia and hypothermia should be included in the initial treatment a severely malnourished child receives when first admitted to hospital.

WHO recommendations

WHO recommends re-warming the child by:

  • clothing the child (especially the head), covering with a warmed blanket, and placing the child near a heater (not pointing directly at the child) or incandescent lamp; or
  • putting the child in skin-to-skin contact on the mother’s bare chest or abdomen and covering them with a warmed blanket and/or warm clothing.

All malnourished children with hypothermia should also be treated for hypoglycaemia and receive broad-spectrum antimicrobials for serious systemic infection.


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


Clinical trials

Last update:

21 December 2016 14:54 CET

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%