e-Library of Evidence for Nutrition Actions (eLENA)

Identification of severe acute malnutrition in children 6–59 months of age

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.

Early identification of severe acute malnutrition is important for initiating treatment and minimizing the risk of complications. This can be done in both community and health-care settings using appropriate indicators.

WHO recommendations

In community settings, trained community health workers and community members should measure the mid-upper arm circumference of infants and children who are 6–59 months of age, while in primary health-care facilities and hospitals, health-care workers should assess the mid-upper arm circumference or the weight-for-height/weight-for-length status. In both settings infants and children should be examined for bilateral pitting oedema.

Infants and children who are 6–59 months of age and have a mid-upper arm circumference <115 mm, or a weight-for-height/length < –3 Z-scores of the WHO Child Growth Standards median, or have bilateral pitting oedema, should be referred for full assessment at a treatment centre for the management of severe acute malnutrition.

Children who have appetite (pass the appetite test) and are clinically well and alert should be treated as outpatients.


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%