Management of infants under 6 months of age with severe acute malnutrition
In infants who are under 6 months of age, severe acute malnutrition is defined by a very low weight-for-length or the presence of bilateral pitting oedema. Severe acute malnutrition is increasingly being recognized in infants under 6 months of age and is often associated with higher mortality in young infants than in older infants and children.
In addition to causative factors such as low birth weight, persistent diarrhoea and chronic underlying diseases or disability, the development of severe acute malnutrition in infants under 6 months of age commonly reflects suboptimal feeding practices, especially breastfeeding practices.
There are important physiological differences between young infants and older children that may require modified management approaches or clinical interventions. Clinical signs of infection and hydration status may also be more difficult to identify and interpret in the younger infant. WHO has developed a set of recommendations for the identification and management of severe acute malnutrition in infants who are under 6 months of age.
Infants who are under 6 months of age with severe acute malnutrition should receive the same general medical care as infants with severe acute malnutrition who are 6 months of age or older.
Feeding approaches for infants who are under 6 months of age with severe acute malnutrition should prioritize establishing, or re-establishing, effective exclusive breastfeeding by the mother or other caregiver.
Infants under 6 months of age can be discharged from all care when they are: i) breastfeeding effectively or feeding well with replacement feeds, ii) have adequate weight gain and iii) have a weight-for-length ≥ –2 Z-score of the WHO Child Growth Standards median.
This is a summary of WHO recommendations on the management of infants under 6 months of age with severe acute malnutrition. The full set of recommendations can be found 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
Management of the child with a serious infection or severe malnutrition. Guidelines for care at the first-referral level in developing countries
Management of severe malnutrition: a manual for physicians and other senior health workers
Systematic reviews used to develop the guidelines
Inpatient treatment of severe acute malnutrition in infants aged <6 months
The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review