Early Detection and Referral of Children with Malnutrition
Detection and Referral of Children with Acute Malnutrition
Screening for Acute Malnutrition
Acute malnutrition is a result of recent (short-term) deficiency of protein, energy together with minerals and vitamins leading to
loss of body fats and muscle tissues. Acute malnutrition presents with wasting (low weight-for-height) and /or presence of pitting oedema of both feet.
Screening for Acute Malnutrition should be done at any contact points; children wards, immunization points, community out-reaches,
ART sites, young child clinics, counselling units and psycho social groups. Community-based service providers can also perform
malnutrition screening provided that they are adequately trained and equipped.
Screening for acute malnutrition includes
- Use and interpretation of Mid-Upper Arm Circumference (MUAC) Tape
- Checking for bilateral pitting oedema
NOTE: Children with confirmed bilateral oedema are directly identified to be severely malnourished and are recorded has having nutritional oedema.
Recognizing Visible clinical Signs
Marasmus signs
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- Prominent bones (ribs)
- Skinny limbs
- Loose skin (on lifting)
- Loose skin around the buttocks (buggy pants)
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Kwashiorkor
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- Presence of bilateral pitting oedema
- Hair changes (brownish, scanty, straight)
- Skin changes (dermatosis)
- A large, protuberant belly
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Checking for Bilateral pitting oedema
Apply gentle thumb pressure to both feet for 3 seconds. If a shallow print or pit remains on both feet when the thumb is lifted,
then the child presents oedema. Only children with bilateral oedema are recorded as having nutritional oedema. These children are at
high risk of mortality and need to be treated in a therapeutic feeding program urgently.
Nutritional oedema always starts from the feet and extends upwards to other parts of the body.
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Nutritional oedema can only be confirmed by testing with finger pressure.
You can not tell by just looking |
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Correct testing for oedema with finger pressure
Normal thumb pressure should be applied to both feet for three seconds
(Source: Protocol for the management of Severe Acute Malnutrition, Ethiopian Federal MOH, February 2007) |
How to classify oedema
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- No oedema: 0
- Oedema below the ankles: +
- Odema in both feet and legs, below the knees: ++
- Odema on both feet, legs, arms and sacral pad and eye lids:+++
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Mid-upper Arm Circumference (MUAC) for children 12-59 months
MUAC is a quick and simple way to determine whether or not a child is malnourished using a simple colored plastic strip. MUAC is
suitable to use on children from the age of 12 months up to the age of 59 months. However, it can also be used for children over six months with length above 65 cm.
Steps for taking the MUAC measurement of a child
- Determine the mid-point between the elbow and the shoulder (acromion and olecranon) as shown on the picture below.
- Place the tape measure around the LEFT arm (the arm should be relaxed and hang down the side of the body).
- Measure the MUAC while ensuring that the tape neither pinches the arm nor is left loose.
- Read the measurement from the window of the tape or from the tape.
- Record the MUAC to the nearest 0.1 cm or 1mm.
- If using a 3-colour tape:
a measurement in the green zone means the child is properly nourished;
a measurement in the yellow zone means that the child is at risk of malnutrition;
a measurement in the red zone means that the child is acutely malnourished.
If using a 4-colour tape:
a measurement in the green zone means the child is properly nourished;
a measurement in the yellow zone means that the child is at risk of malnutrition;
a measurement in the orange zone means that the child is moderately malnourished;
a measurement in the red zone means that the child is severely malnourished.
- Repeat the measurement two times to ensure an accurate interpretation.
4-colour Mid-Upper Arm Circumference (MUAC) tape
click here for a larger image
02 January, 2009
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