Acute Malnutrition Management in Children

What Is Acute Malnutrition?

Acute malnutrition, also called wasting, is a rapid decline in weight relative to height. In children under five, it is usually defined by a weightforheight Zscore (WHZ) below 2 standard deviations, by a midupperarm circumference (MUAC) less than 115mm, or the presence of oedema. It reflects a severe deficit of energy and protein that can develop in weeks or months and is a leading cause of morbidity and mortality worldwide.

Primary Causes

• Insufficient food intake caused by poverty, food insecurity, or feeding difficulties.
• Frequent or severe infections diarrhoea, pneumonia, malaria, and measles increase metabolic demand.
• Inadequate infant and young child feeding practices late initiation of breastfeeding, poor complementary feeding.
• Underlying chronic conditions congenital heart disease, cystic fibrosis, HIV infection.
• Socioeconomic factors maternal illiteracy, lack of access to health services, displacement.

Screening and Diagnosis

Early detection is essential. Community health workers and primarycare facilities should screen all children aged 659 months using:

• MUAC a quick tape measurement; MUAC <115mm indicates severe acute malnutrition (SAM).
• Weightforheight plotted on WHO growth charts; WHZ <2SD (moderate) or <3SD (severe).
• Oedema assessment bilateral pitting oedema in the feet is classified as SAM regardless of anthropometry.

Management of Severe Acute Malnutrition (SAM)

Treatment follows the WHO Sixstep protocol, adapted to the care setting.

1. Stabilisation (Inpatient care)

Indicated for children with medical complications, very low MUAC (<70mm), WHZ <4SD, or those unable to feed safely.

2. Transition (Inpatient or outpatient)

When the child is clinically stable, appetite is good and oedema has resolved, switch to highercalorie F100 (100kcal/100ml) or readytouse therapeutic food (RUTF).

3. Rehabilitation (Outpatient)

Children without complications can receive outpatient care (CMAM CommunityBased Management of Acute Malnutrition). Core components are:

• RUTF sachets (500kcal/day) administered weekly.
• Weekly monitoring of MUAC, weight, and clinical status.
• Treatment of infections, deworming, vitamin A, and immunisations.
• Nutrition counselling for caregivers.

4. Discharge

Discharge criteria:

• MUAC 125mm for two consecutive visits.
• Weightforheight 2SD.
• No medical complications.
• Caregiver demonstrates appropriate feeding practices.

PostTreatment Followup

Children are at high risk of relapse. Recommended followup schedule:

• 2 weeks after discharge check weight and MUAC.
• 1 month reinforce feeding practices and screen for illness.
• 3 months ensure growth trajectory is on track.

Any deterioration should trigger reassessment and possible readmission.

Prevention Strategies

Addressing acute malnutrition requires both immediate and longterm actions.

NutritionSpecific Interventions

• Promotion of exclusive breastfeeding for the first 6months.
• Timely introduction of safe, diverse complementary foods.
• Micronutrient supplementation (vitaminA, zinc).
• Provision of readytouse supplementary foods (RUSF) for atrisk groups.

NutritionSensitive Interventions

• Improving household food security through agriculture and livelihoods programmes.
• Ensuring access to clean water, sanitation and hygiene (WASH).
• Strengthening maternal education and empowerment.
• Social protection schemes such as cash transfers or food vouchers.

HealthSystem Strengthening

• Training healthworkers in CMAM protocols.
• Integrating malnutrition screening into routine childhealth visits.
• Maintaining reliable supply chains for therapeutic foods and medicines.
• Establishing robust data collection for monitoring and evaluation.

Key Takeaways

• Acute malnutrition is a rapid, lifethreatening condition that must be identified early.
• MUAC <115mm, WHZ <3SD, or bilateral oedema define severe cases.
• The WHO sixstep protocol (stabilise, transition, rehabilitate, discharge) is the cornerstone of treatment.
• Communitybased management with RUTF is effective for uncomplicated SAM.
• Prevention combines optimal infant feeding, food security, WASH, education, and strong health services.