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Nutrition

Assessing Malnutrition in Children (6m-5y)

Methods for assessing acute malnutrition in children aged 6 months to 5 years using anthropometry (WFH/L, MUAC), oedema check, and appetite testing, leading to classification of Severe Acute Malnutrition (SAM) or Moderate Acute Malnutrition (MAM).

Also known as: Nutritional Assessment Child, SAM/MAM Diagnosis

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Referral and warning signs

When to refer

Complicated SAM -> Inpatient. Uncomplicated SAM -> OTC. MAM -> SFP/Counseling.

Red flags

  • Bilateral pitting oedema
  • MUAC < 115 mm
  • WFH/L < -3 Z-score
  • Any General Danger Sign
  • Failed Appetite Test

Signs and symptoms

  • Not applicable - Describes assessment methods.

Risk factors

  • See NUT004.

Diagnosis

Clinical assessment

Systematic Assessment: 1. Check for Bilateral Pitting Oedema (press feet 3s). 2. Measure MUAC (<115mm SAM, 115-<125mm MAM). 3. Measure Wt & Ht/Lt -> Calculate WFH/L Z-score (<-3z SAM, -3 to <-2z MAM). 4. Look for Visible Severe Wasting. 5. Check for Medical Complications (IMCI Danger Signs). 6. Perform Appetite Test (if SAM & no complications) using RUTF. History (feeding, illness, TB/HIV).

Investigations

  • Anthropometry (Wt, Ht/Lt, MUAC).
  • Oedema check.
  • Appetite Test.
  • IMCI danger sign assessment.
  • Consider HIV test, TB screen, stool analysis.

Diagnostic criteria

SAM: Oedema OR MUAC<115 OR WFH/L<-3z. Complicated SAM = SAM + Complication/Failed Appetite. Uncomplicated SAM = SAM + No Complication + Passed Appetite. MAM: MUAC 115-<125 OR WFH/L -3 to <-2z (No Oedema/SAM).

Management

Non-pharmacological management

  • See NUT006 (MAM), NUT007 (Complicated SAM), NUT008 (Uncomplicated SAM).

Pharmacological treatment

  • See NUT006 (MAM), NUT007 (Complicated SAM), NUT008 (Uncomplicated SAM).

Monitoring

  • Depends on management pathway.

Complications

  • See NUT004.

Prevention

  • See NUT004.

Patient education

  • How status assessed.
  • Explanation of SAM/MAM.
  • Importance of management plan.

Uganda-specific notes

MUAC widely used for screening. WFH/L needs equipment/training. Appetite test crucial for inpatient vs outpatient decision.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 19, Section 19.2.1.2 (Assessing Malnutrition, Diagnostic criteria table)

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 17, Section 17.5 (Growth Charts / MUAC info)

  • Integrated Management of Acute Malnutrition Guidelines, MOH Uganda

    (Detailed assessment protocols)

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