Assess the nutritional status of the child using the available anthropometric equipment and clinical examination. Classify the degree of malnutrition, identify severe malnutrition, and explain your immediate management priorities to the examiner.

Assessment: Measure weight, length/height and mid-upper arm circumference (MUAC); plot appropriate WHO growth indices.

Clinical signs: Look for visible wasting, bilateral pitting nutritional edema and signs of vitamin or mineral deficiency.

Classification: In children aged 6–59 months, severe acute malnutrition (SAM) is identified by weight-for-height/length Z-score <−3, MUAC <11.5 cm or bilateral nutritional edema.

Priority: Assess appetite, hypoglycemia, hypothermia, dehydration, infection and danger signs; arrange urgent hospital assessment for complicated SAM, with nutritional rehabilitation and follow-up.

1. Prepare: Introduce yourself, confirm the child’s age, explain the assessment to the caregiver, obtain consent and perform hand hygiene.
2. Measure weight: Use a calibrated scale with minimal clothing; record weight in kilograms.
3. Measure length/height: Measure recumbent length below 24 months and standing height from 24 months onward, using the appropriate measuring board.
4. Measure MUAC: In children aged 6–59 months, locate the midpoint between the acromion and olecranon of the left arm. Measure circumference with the arm relaxed, without compressing the tissues.
5. Examine nutritional signs: Inspect for wasting, loss of subcutaneous fat, muscle wasting, hair or skin changes and mucosal deficiencies. Apply gentle thumb pressure to both feet for approximately 3 seconds to detect bilateral pitting edema.
6. Interpret and classify: Plot WHO weight-for-length/height and other age-appropriate growth indices. For 6–59 months, MUAC 11.5–<12.5 cm or weight-for-height Z-score −3 to <−2 indicates moderate acute malnutrition without edema; MUAC <11.5 cm, weight-for-height Z-score <−3 or bilateral nutritional edema indicates SAM.
7. Identify priorities: Assess clinical stability and appetite. Complicated SAM requires hospital stabilization; clinically stable uncomplicated SAM may receive supervised outpatient nutritional treatment with follow-up.

Exam Pearl: Bilateral pitting nutritional edema is sufficient to identify SAM, even if MUAC or weight-for-height does not meet the severe wasting threshold. Edema can mask weight loss.

WHO — Child Growth Standards: Anthropometry Training Video

Practical demonstration of pediatric weight, length/height measurements and equipment calibration.

▶ Open WHO Training Video Resource