In the assessment of protein-energy malnutrition, the Waterlow classification uses two indices. A child with height-for-age < −2 SD (stunted) but weight-for-height in the normal range is classified as:
- A Acute malnutrition (wasting) without stunting
- B Chronic malnutrition (past malnutrition) without current acute malnutrition ✓
- C Both acute and chronic malnutrition
- D Normal nutritional status (compensated)
Explanation
Waterlow classification uses: (1) height-for-age to assess chronic/past malnutrition (stunting — reflects longstanding nutritional deficit affecting linear growth); (2) weight-for-height to assess acute/current malnutrition (wasting — reflects recent acute deficit depleting body mass). A child with low height-for-age but normal weight-for-height has stunting (chronic past malnutrition) but is not currently wasted — this indicates past nutritional deprivation that has been corrected but linear growth deficit persists. Wasting reflects recent acute crisis; stunting reflects cumulative chronic deprivation.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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