Admission and discharge criteria for children 6 to 59 months of age with severe acute malnutrition in a resource-limited setting

MUAC: mid-upper arm circumference; SAM: severe acute malnutrition; IMCI: integrated management of childhood illness.
* Severe edema is defined as generalized edema including both feet, legs, hands, arms, and face. Moderate edema involves both feet plus lower legs, hands, or lower arms. Mild edema involves both feet only.
¶ Admit if the child is having a convulsion now or if there is a history of either more than one convulsion or a prolonged convulsion (>15 min).
Δ The decision to transfer a child from inpatient to outpatient care should be determined by the clinical condition and not on the basis of specific anthropometric outcomes, such as a specific MUAC or weight-for-height/length Z-score.
◊ The anthropometric indicator that is used to confirm SAM should also be used to assess whether a child has reached nutritional recovery (ie, if MUAC was used to identify that a child has SAM, then MUAC should be used to assess and confirm nutritional recovery). Similarly, if weight-for-height is used to identify that a child has SAM, then weight-for-height should be used to assess and confirm nutritional recovery. Percentage weight gain should not be used as a discharge criterion.