In Severe Acute Malnutrition (SAM), the WHO criteria for inpatient admission include which of the following weight-for-height (WFH) thresholds?

• A WFH < -3 SD (z-score) with bilateral pitting oedema
• B WFH < -3 SD (z-score) OR MUAC < 11.5 cm in children 6–59 months, with or without medical complications ✓
• C MUAC < 12.5 cm alone is sufficient for inpatient admission
• D Weight-for-age < -3 SD (underweight)

Explanation

WHO 2013 SAM guidelines define SAM in children 6–59 months as: (a) WFH/WFL ≤ -3 SD (z-score), OR (b) MUAC < 11.5 cm, OR (c) bilateral pitting nutritional oedema (kwashiorkor) — any one criterion is sufficient for SAM diagnosis. Inpatient (F-75/F-100) management is required when SAM is accompanied by medical complications (anorexia, dehydration, fever, hypothermia, hypoglycaemia, severe anaemia, pneumonia) or bilateral oedema (+++ grade). Uncomplicated SAM (passing appetite test) can be managed as outpatient with RUTF. Weight-for-age z-score is used for undernutrition but MUAC and WFH are preferred for SAM diagnosis.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.