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Care priority and warning signs
Care priority
Routine Management / Feeding Counselling
Red flags
- Falling growth pattern on growth chart (even if still above cut-offs).
- Presence of stunting (low height-for-age) - address through long-term feeding/health advice.
- Identified feeding problems.
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 >= -2 Z-score OR MUAC is >= 125mm.
- Assess feeding if child < 2 years old or if there are concerns (see page 25).
Classification
- (WFH/L >= -2 Z-score) OR (MUAC >= 125 mm [if >=6m]) AND No Oedema -> NO ACUTE MALNUTRITION
Key features
- Absence of bilateral pitting oedema.
- WFH/L Z-score >= -2.
- OR MUAC >= 125 mm (in child >= 6 months).
- Indicates adequate nutritional status in terms of acute malnutrition (wasting). Child may still be stunted.
- Focus is on maintaining good practices and preventing future malnutrition.
Management
Non-pharmacological management
- If child is less than 2 years old: Assess feeding practices (Page 25) and counsel the mother on age-appropriate feeding (Pages 26-28) to ensure continued adequate growth and development.
- If feeding problem identified: Counsel mother specifically on addressing the problem (Page 27). Follow up for feeding problem in 7 days.
- Promote continued good practices.
Pharmacological treatment
- Give Mebendazole 500mg single dose if child >= 1 year and not dewormed in past 6 months (Page 20).
- Ensure routine Vitamin A supplementation is up to date (Page 20).
Follow-up
- No specific follow-up required for nutritional status unless a feeding problem was identified (follow up in 7 days for feeding problem).
- Routine health checks and growth monitoring should continue.
- Advise mother when to return immediately if child becomes sick (Page 30).
Counselling points
- Praise the mother for good feeding practices if applicable.
- Provide age-appropriate feeding counselling, especially if child < 2 years, reinforcing key messages.
- Advise on giving Mebendazole if indicated.
- Advise on importance of continued growth monitoring.
- Advise WHEN TO RETURN IMMEDIATELY if child develops any danger signs or becomes unwell.
Differential diagnosis
- Moderate Acute Malnutrition
- Severe Acute Malnutrition
- Stunting
Prevention
- Continued optimal infant and young child feeding practices.
- Prevention and management of childhood illnesses.
- Routine immunizations and micronutrient supplementation.
- Regular growth monitoring.
References
IMCI Chart Booklet - Page 6, Page 20 (Mebendazole, Vit A), Page 25 (Feeding Assesment/Follow-up), Pages 26-28 (Feeding Recs), Page 30 (Return Advice)