The World Health Organization (WHO) has developed guidelines for management of pediatric patients with severe malnutrition. One issue is whether the patient can be managed at home or being admitted to the hospital.
Patient selection: 6 to 59 months old with malnutrition having a mid-upper arm circumference < 115 cm and/or weight-for-height to length ratio Z score less than -3
Criteria for outpatient therapy of malnutrition - all of the following:
(1) presence of an appetite
(2) clinically alert
(3) clinically well
Criteria for inpatient therapy of malnutrition - one or more of the following:
(1) severe bilateral edema (3+)
(2) poor appetite
(3) one or more of the Integrated Management of Childhood Illness (IMCI) danger signs
IMCI danger signs - Indications for bringing a sick child back immediately for an assessment:
(1) the child is unable to drink or breastfeed
(2) the child the child has diarrhea and is drinking poorly
(3) the child has become sicker
(4) the child has developed a new onset of fever
(5) the child has bloody diarrhea
(6) the child is breathing rapidly
(7) the child is having difficulty breathing
