Chapter 11. Management of Severe and Moderate Acute Malnutrition in Children

Acute malnutrition, or wasting, represents a significant public health concern across lowand middle-income countries, affecting millions of children and significantly increasing their risk of death. Over a tenth of all under-five deaths can be attributed to acute malnutrition. There are a range of strategies that can prevent the development of wasting by modifying one or more of the risk factors. These strategies dovetail into general strategies for promoting optimal growth and nutrition and include promotion of good nutritional intake through exclusive breastfeeding, optimal infant and young child feeding practices, micronutrient supplementation, and general food supplementation where needed. Improving water, sanitation and hygiene (WASH) and managing common childhood illnesses, such as diarrhea and pneumonia, also represent important strategies for preventing the development of acute malnutrition. The application of such preventive strategies is context specific and will vary depending on factors such a food security, conflict, economic stability and cultural norms. Meanwhile, the recommendations for treatment of severe acute malnutrition (SAM) are relatively more straightforward. The standard practice has been to treat all children with severe acute malnutrition in inpatient facilities; however, this is shifting to an approach that focuses on active case finding and treatment of uncomplicated cases in a