Moderate Acute Malnutrition

Moderate acute malnutrition in children 6 to 59 months is wasting that has not reached the threshold for severe acute malnutrition. It is generally defined by MUAC 11.5 to below 12.5 cm or weight for height or length Z score from minus 3 to below minus 2, without bilateral nutritional oedema.

Without intervention, moderate wasting increases infection risk and can progress to severe wasting.

Children may appear thin but remain active and clinically stable.

Features include:

• Reduced muscle and fat stores
• Poor weight gain
• Recurrent infection
• Reduced appetite
• Micronutrient deficiency
• Developmental or feeding concerns

Bilateral nutritional oedema means the child should be classified as severe acute malnutrition rather than moderate disease.

Measure MUAC and weight for height or length.

Assess:

• Growth trajectory
• Dietary intake
• Breastfeeding and complementary feeding
• Household food security
• HIV and TB risk
• Chronic diarrhoea
• Recurrent infection
• Congenital or chronic disease

Do not assume every wasted child has purely dietary malnutrition. Cardiac, gastrointestinal, endocrine, infectious and neurological disease may present with poor growth.

• Manage predominantly as an outpatient when the child is clinically stable, has no oedema and has adequate appetite.

• Provide targeted nutritional support using locally recommended supplementary foods or nutrient dense family foods, with adequate protein and micronutrient content.

• Continue breastfeeding.

• Diagnose and treat infections, anaemia, parasitic disease and other underlying contributors.

• Review weight, MUAC, appetite and clinical state regularly.

• Failure to improve, progressive weight loss, MUAC falling below 11.5 cm, development of nutritional oedema or medical complications requires escalation to severe acute malnutrition management.