Admission and discharge criteria for infants <6 months of age with severe acute malnutrition in a resource-limited setting

SAM: severe acute malnutrition; IMCI: integrated management of childhood illness; WHO: World Health Organization.
* 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).
¶ Ineffective feeding is difficulty with attachment, positioning, or suckling, determined by direct observation of a feed for 15 to 20 minutes, ideally in a supervised and separated area.
Δ Issues may include disability or depression of the caregiver or other adverse social circumstances.
◊ The infant should be transferred from inpatient to outpatient care only if all of the following conditions are met:

• All clinical conditions or medical complications are resolved
• Infant has good appetite and is clinically well and alert
• Weight gain on exclusive breastfeeding or replacement feeding is satisfactory^§
• Immunizations and other routine interventions are up to date
• Mother or caregiver(s) are linked with appropriate community-based services for follow-up and support

§ Adequate weight is defined as growth velocity more than 5 g/kg/day for at least 3 successive days or growth velocity above the median for WHO standards.