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WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years. Geneva: World Health Organization; 2023.

Cover of WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years

WHO guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition) in infants and children under 5 years.

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Glossary

Admission

refers to a child being registered and entering inpatient care as a patient. This is distinguished from the term “enrolment”, which is used for outpatient care.

Anthropometric recovery

refers to weight-for-height (WHZ)/weight-for-length (WLZ) z-score equal to or greater than 2 standard deviations (SD) below the WHO child growth standards median (WHZ or WLZ ≥ −2) and a mid-upper arm circumference (MUAC) equal to or greater than 125 mm (in children 6–59 months) observed for at least 2 consecutive outpatient care visits. Before any decisions can be made regarding exit from nutritional treatment these anthropometric measurements need to be accompanied by an assessment of nutritional oedema: a child must also be free of nutritional oedema for at least two consecutive visits to meet exit criteria.

Blanket approach

is an approach to supplementation in which all children or households within a certain population or geographic region are given this intervention, in contrary to targeting of certain children or households.

Child

is defined as a person less than 19 years old.

Community health worker (CHW)

is a type of health associate professional who provide health education, referral and follow up, case management, and basic preventive health care and home visiting services to specific communities. Community health workers provide support and assistance to individuals and families in navigating the health and social services system. Occupations included in this category normally require formal or informal training and supervision recognized by the health and social services authorities. Providers of routine personal care services and traditional medicine practitioners are not included.

Discharge

refers to a child finishing their inpatient care and leaving to go back home. This is distinguished from the term “exit” which is used for outpatient care.

Enrolment

refers to a child being registered into outpatient care where nutritional supplementation or treatment is provided on a regular basis (see outpatient care). This is different to the term “admission” which is used for inpatient care.

Exit

refers to a child finishing their nutritional treatment or supplementation and no longer attending outpatient care. This is distinguished from the term “discharge” which is used for inpatient care.

Food insecurity

means the lack of regular access to adequate nutrient-dense foods for healthy growth and development, which could be from food being unavailable and/or from insufficient resources to obtain food (as defined by the Food and Agriculture Organization of the United Nations).

Fortified blended foods (FBFs)

are combinations of partially precooked and milled cereals, soya, beans, pulses fortified with micronutrients. Improved FBFs refer to products with added sugar, oil, and/or milk over and above what was in the original specifications for these products. Examples of FBFs include Super Cereal (with added sugar but without milk) and Super Cereal plus (with added milk and sugar).

Health associate professionals

perform technical and practical tasks to support diagnosis and treatment of illness, disease, injuries and impairments, and to support implementation of health care, treatment and referral plans usually established by medical, nursing and other health professionals. Appropriate formal qualifications are often an essential requirement for entry to these occupations; in some cases relevant work experience and prolonged on-the-job training may substitute for the formal education. Health associate professionals include community health workers, nursing associate professionals, midwifery associate professionals, etc.

Health professionals

include doctors, nurses, midwives, physiotherapists, dentists, paramedical practitioners, etc. They study, advise on or provide preventive, curative, rehabilitative and promotional health services based on an extensive body of theoretical and factual knowledge in diagnosis and treatment of disease and other health problems. They may conduct research on human disorders and illnesses and ways of treating them, and supervize other workers. The knowledge and skills required are usually obtained as the result of study at a higher educational institution in a health-related field for a period of 3–6 years leading to the award of a first degree or higher qualification.

Health workers

are divided up into five main categories: health professionals, health associate professionals, personal care workers in health services, health management and support personnel, and other health service providers not elsewhere classified. Health workers make up the health workforce and are people engaged to deliver health care to individuals and populations as part of the health system.

Infant

is a child less than 12 months of age.

Inpatient care

refers to medical care, nutritional supplementation or treatment, and feeding support (for both breastfed and non-breastfed infants) which is delivered in a health facility involving the child staying for one or more nights in the health facility itself.

Mother/caregiver

is a term used predominantly in relation to infants less than 6 months of age to highlight the importance of providing services for the mother/caregiver-infant pair together with a holistic approach encompassing all their physical and mental health and nutrition needs and recognizing the interdependence of this unit, especially in the early months of an infant’s life.

Neonate

is a child less than 28 days of age.

Non-specially formulated foods

are defined as foods that have not been not been specifically designed, manufactured, distributed and used for special medical purposes or for special dietary uses, as specified by Codex Alimentarius. They are predominantly foods that are available in the market and/or household and are typically consumed by the child and their family.

Nutrient-dense foods

are those high in nutrients relative to their energy content; they have a relatively high content of vitamins, minerals, essential amino acids and healthy fats. Examples of nutrient-dense foods include animal-source foods, beans, nuts and many fruits and vegetables.

Nutritional supplementation (for moderate wasting)

is the term used to describe the regular outpatient services, whereby infants and children with moderate wasting receive medical care and nutritional supplementation to achieve clinical and anthropometric recovery, as well as referring them to ongoing appropriate preventative and supportive services if needed and possible.

Nutritional treatment (for severe wasting and/or nutritional oedema)

is used to describe the regular outpatient services, and potentially inpatient services (if needed), whereby infants and children with severe wasting and/or nutritional oedema receive therapeutic milk or ready-to-use therapeutic food (RUTF) to help achieve anthropometric recovery and the resolution of nutritional oedema. Nutritional treatment should always be delivered alongside medical care and referral to appropriate preventive and supportive services as needed.

Outpatient care

refers to medical care, nutritional supplementation or treatment (for children 6–59 months) and feeding support (for both breastfed and non-breastfed infants) which is delivered in a health facility and which does not require an overnight stay, but involves regular appointments (often referred to as visits) with a health worker until the child reaches clinical and anthropometric recovery. This health worker could be a health professional such as a doctor or nurse, or a health associate professional such as a community health worker.

Psychosocial stimulation

can be defined as the sensory information received from interactions with people and environmental variability that engages a young child’s attention and provides information; examples include talking, smiling, pointing, enabling, and demonstrating, with or without objects. This also includes responsive feeding as a part of responsive caregiving.

Ready-to-use supplementary food (RUSF)

is a fortified lipid-based paste/spread used for the supplementation of children with moderate wasting. It should not be used for the nutritional treatment of severe wasting and/or nutritional oedema.

Ready-to-use therapeutic food (RUTF)

is a food for special medical purposes and includes pastes/spreads and compressed biscuits/bars used for the nutritional treatment of children with severe wasting and/or nutritional oedema (as defined by Codex Alimentarius).

Referral

refers predominantly to a child being referred to inpatient care from outpatient care. A malnourished child might however also get referred to other services such as HIV orTB (tuberculosis) for follow-up.

Specially formulated foods (SFFs)

are defined as foods that have been specifically designed, manufactured, distributed, and used for either: special medical purposes or for special dietary uses, as defined by Codex Alimentarius.

Targeted approach

is an approach to supplementation in which a specific subset of children or households within a certain population or geographic region are prioritized for this intervention, in contrary to a blanket approach, where the intervention is given to all children or households.

Transfer (from inpatient to outpatient care)

describes the patient movement when a child is discharged from inpatient care to finish their nutritional treatment in outpatient care. They usually go home from the hospital and then attend an outpatient centre/clinic for nutritional treatment at a later date and then regularly until clinical and anthropometric recovery.

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