Clinical Management of a Child with Severe and Moderate Acute Malnutrition (SAM and MAM)

Definition and Classification of Malnutrition in Children

Malnutrition in children is broadly classified into two categories: Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM). SAM is characterized by extreme wasting, defined by a weight-for-height Z-score below -3 or the presence of bilateral pitting edema. MAM is less severe, typically identified with a Z-score between -3 and -2.

Etiology and Risk Factors

• Inadequate dietary intake
• Chronic infections and illnesses
• Poor socio-economic conditions
• Maternal malnutrition and inadequate breastfeeding

Clinical Management of SAM

Initial Stabilization

Children with SAM require urgent medical attention, including treatment of dehydration, infections, and hypoglycemia. WHO guidelines recommend oral rehydration solutions (ORS) and antibiotic therapy.

Nutritional Rehabilitation

Therapeutic feeding with Ready-to-Use Therapeutic Foods (RUTF) is essential. Gradual reintroduction of nutrient-rich food improves recovery.

Clinical Management of MAM

Children with MAM benefit from supplementary feeding programs with energy-dense meals containing proteins, micronutrients, and fats to enhance nutritional status.

Prevention Strategies

• Exclusive breastfeeding for the first six months
• Timely introduction of complementary feeding
• Community-based nutrition programs
• Healthcare interventions targeting maternal nutrition