e-Library of Evidence for Nutrition Actions (eLENA)

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.

WHO recommendations

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 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%