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.
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.
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
WHO Integrated management of childhood illness: caring for newborns and children in the community
WHO child growth standards and the identification of severe acute malnutrition in infants and children: a joint statement by the World Health Organization and the United Nations Children’s Fund
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
Utilization of mid-upper arm circumference versus weight-for-height in nutritional rehabilitation programmes: a systematic review of evidence