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Care priority and warning signs
Care priority
Routine Management / Nutritional Counselling / Possible SFP
Red flags
- Deterioration to SAM criteria (WFH/L <-3, MUAC <115mm, or develops oedema).
- Significant weight loss.
- Development of danger signs or intercurrent illness.
- Persistent lack of improvement despite counselling/support.
Assessment
- Confirm absence of Oedema of both feet.
- Look/Feel: Determine Weight-for-Height/Length (WFH/L) Z-score.
- Look/Feel: Measure MUAC (in mm, if child >= 6 months).
- Confirm WFH/L is between -3 and -2 Z-score OR MUAC is 115mm up to (but not including) 125mm.
- Assess feeding practices (see page 25).
Classification
- (WFH/L between -3 and -2 Z-score) OR (MUAC 115mm up to 125mm [if >=6m]) AND No Oedema -> MODERATE ACUTE MALNUTRITION
Key features
- Moderate wasting defined by WFH/L Z-score between -3 and -2 OR MUAC 115mm - 124mm (for >=6m).
- Absence of bilateral pitting oedema.
- Absence of SAM criteria.
- Management focuses on nutritional support through counselling and potentially supplementary foods.
Management
Non-pharmacological management
- Assess the child's feeding practices in detail (See page 25).
- Counsel the mother on improving feeding based on assessment findings and age-appropriate recommendations (See pages 26-28): Increase frequency of meals, ensure nutrient-dense and energy-dense foods, improve meal quality, ensure responsive feeding.
- If a Supplementary Feeding Program (SFP) is available, refer child according to local criteria (may involve provision of fortified blended foods like CSB++ or lipid-based nutrient supplements).
- Advise on hygiene and prevention of infections.
Pharmacological treatment
- Give Mebendazole 500mg single dose if child >= 1 year and not dewormed in past 6 months (Page 20).
- Check for TB: Assess symptoms, contact history (Page 9). Refer for TB investigation if indicated.
- Provide routine micronutrient supplementation as per national guidelines (e.g., Vitamin A).
Follow-up
- Follow up in 30 days (or sooner based on clinical judgment/local SFP protocol).
- At follow-up (Day 30):
- Reassess nutritional status (Weight, Height/Length, MUAC, Oedema).
- Reassess feeding practices.
- If deteriorated to SAM -> Manage as SAM (Complicated or Uncomplicated).
- If still MAM: Continue counselling, reinforce messages, continue SFP if enrolled. Ask mother to return again in one month.
- If improved (No longer MAM): Praise mother, encourage continued good feeding practices. Discharge from specific MAM follow-up unless SFP protocol requires longer monitoring.
- If feeding problem identified at initial or follow-up visit, follow up in 7 days for feeding problem specifically.
- Advise mother when to return immediately.
Counselling points
- Explain that the child is moderately malnourished and needs improved feeding to grow well.
- Provide specific, practical feeding advice based on assessment and local foods (frequency, quantity, quality, responsive feeding).
- If referring to SFP, explain the program.
- Advise on giving Mebendazole if indicated.
- Advise on hygiene and preventing illness.
- Advise WHEN TO RETURN IMMEDIATELY: Child develops danger signs, seems sicker, develops swelling of feet, significant weight loss.
- Advise on follow-up appointment in 30 days.
Differential diagnosis
- Severe Acute Malnutrition
- No Acute Malnutrition
- Stunting (may co-exist)
- Underlying chronic illness causing poor growth (e.g., TB, HIV, heart disease)
Complications
- Progression to Severe Acute Malnutrition
- Increased susceptibility to infections
- Stunting (impaired linear growth)
- Micronutrient deficiencies
Prevention
- Optimal infant and young child feeding practices.
- Prevention and management of childhood illnesses.
- Micronutrient supplementation.
- Food security.
- Maternal health and nutrition.
References
IMCI Chart Booklet - Page 6, Page 9 (TB), Page 20 (Mebendazole, Vit A), Page 25 (Feeding Assessment/Follow-up), Pages 26-28 (Feeding Recs), Page 30 (Return Advice)