e-Library of Evidence for Nutrition Actions (eLENA)

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.

WHO recommendations

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.

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%