Management of severe acute malnutrition in children 6–59 months of age with oedema
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.
Oedema is a swelling caused by the accumulation of fluid in the body tissues and can be categorized as
- Mild (+): oedema in both feet/ankles
- Moderate (++): oedema in both feet plus lower legs, hands or lower arms
- Severe (+++): generalized oedema including both feet, legs, hands, arms and face
Children with severe acute malnutrition who have severe oedema (+++) have an increased risk of mortality compared to children with severe acute malnutrition but with lesser degrees of oedema.
Children 6–59 months of age with severe acute malnutrition who have severe oedema (+++), even if they present with no medical complications and have appetite, should be admitted for inpatient care.
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
Management of severe malnutrition: a manual for physicians and other senior health workers
Systematic reviews used to develop the guidelines
Management of oedematous malnutrition in infants and children aged >6 months: a systematic review of the evidence