Current approaches to the assessment, management and prevention of wasting and nutritional oedema in children

Abstract

Acute malnutrition in under 5s, manifest by wasting and nutritional oedema, remains a persistent global challenge with the greatest burdens in Asia and Sub-Saharan Africa. This article outlines practical, evidence-based approaches to diagnosis, management and prevention based on the 2023 WHO guidelines. Current terminology and classification of wasting and nutritional oedema and key pathophysiological mechanisms are described. A systematic management approach distinguishes between uncomplicated and complicated severe acute malnutrition. The cornerstones of community-based therapeutic care for uncomplicated cases are the use of ready-to-use therapeutic food and close monitoring. Acute malnutrition with complications such as poor appetite and infections require admission. To account for the reductive adaptation that occurs in malnutrition and avoid the risks of rapid re-feeding, inpatient management occurs in 2 phases: stabilization that addresses immediate life-threatening issues and complications followed by nutritional rehabilitation with preparation for discharge. Infants under 6 months are an especially vulnerable group requiring specialized approaches characterized by integrated care that recognizes the interdependence of children and caregivers. Prevention strategies emphasize multisectoral approaches aligned with the Global Action Plan for Child Wasting. By implementing these evidence-based approaches, health professionals can significantly improve outcomes for children with or at risk of wasting and nutritional oedema particularly in low resource settings and make an essential contribution to global efforts to achieve many of the Sustainable Development Goals.