A 6-month-old infant's growth is assessed. Birth weight was 3.2 kg. Current weight is 5.9 kg. Weight-for-age z-score is -2.3 (moderate underweight). However, the child appears energetic, has appropriate length for age (LAZ 0), and MUAC is 12.5 cm. The MOST APPROPRIATE classification of nutritional status in this child is:

• A Severe acute malnutrition (SAM)
• B Moderate acute malnutrition (MAM)
• C Global acute malnutrition (GAM) requiring RUTF immediately
• D Underweight without wasting — likely stunting or constitutional small stature ✓

Explanation

Acute malnutrition (wasting) is defined by weight-for-height z-score (WHZ) or MUAC, not weight-for-age alone. This child has a normal LAZ (normal length for age), which means the low WAZ reflects low weight-for-height in absolute terms; however, a MUAC of 12.5 cm (>11.5 cm) does not meet SAM criteria. The discordance between low WAZ but normal LAZ suggests the child may be proportionately small (underweight without wasting). SAM requires WHZ <-3 or MUAC <11.5 cm or bilateral pitting edema; MAM requires WHZ -3 to -2 or MUAC 11.5–12.5 cm. RUTF is indicated for SAM, not MAM or underweight.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.