Management of Malnutrition in Children Under Five Years

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Management of Moderate Acute Malnutrition in Children Under Five Years

Admission

• The following anthropometric measurements should be taken before admission:
   
  • Mid-Upper Arm Circumference (MUAC) screening (for children with length > 65 cm)

 and/or

• Weight-for-Height (W/H) or Weight-for-Length (W/L)
   
• Bilateral oedema
   

• The following are common criteria in use for admission:
  
  Children aged 6 months to 18 years:
   
  •  W/H or W/L < 80% (WHO/NCHS table)

 or

• Mid-Upper Arm Circumference (MUAC) < 125 mm with a length > 65 cm

 or

• Discharged from OTP

Note: Oedema is always a sign of severe acute malnutrition

Pregnant and lactating women:

• Mid-Upper Arm Circumference (MUAC) < 210 mm and in second or third trimester (visibly pregnant)

or

• Mid-Upper Arm Circumference (MUAC) < 210 mm and the baby is under six months of age

Note: The admission criteria for management of moderately malnourished may vary depending on the type of services available.
 

• All patients referred for moderate malnutrition should be provided with a systematic medical examination and given routine medicine. Children with moderate malnutrition and with severe medical complications should be admitted as in-patients and treated following the standard WHO medical treatment protocols. Children with moderate malnutrition and no medical complications should be admitted in the supplementary feeding program, if available.
   
• Patients that have been referred by the community or by peripherals health units but do not fulfil the criteria for MAM should be counselled and advised on appropriate feeding and caring practices. It is important that caregivers turned away receive some tangible benefit (e.g. a "protection ration" or soap) from coming to the treatment-centre.
   
• Where supplementary feeding is not available, caregivers should still be encouraged to bring back their moderately malnourished children for regular surveillance through weighing, Mid-Upper Arm Circumference (MUAC) screening, oedema checking and assessment of standard clinical signs. Health and nutrition education including cooking demonstrations should be made available on site to show the components of a balanced meal, cooking times and the consistency of the porridge.
   
• Where supplementary feeding is not available but general food distribution programs are in place, households with children and/or pregnant/lactating women with moderate malnutrition should be prioritized in receiving the food ration until the discharge criteria are met.

02 January, 2009