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

IMCI: integrated management of childhood illness; MUAC: mid-upper arm circumference; SAM: severe acute malnutrition.

* Admit to hospital if the child is having a seizure now or if there is a history of either more than 1 seizure or a prolonged seizure (>15 min).

¶ Feeding difficulties include 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 caregiver disability or mental health challenges 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

§ For this age group, indicators of adequate weight gain depend on the context but may include sustained weight gain for at least 2 consecutive weekly visits and/or weight-for-age or weight-for-length Z-score ≥–2.

¥ These infants remain vulnerable even after the acute problem that led to their admission has resolved; therefore, regular follow-up is recommended until at least 6 months of age. The frequency and site of follow-up depend on the context.