Overview of acute malnutrition in children
On August 18, 2020, the Ministry of Health issued Decision No. 4487/QD-BYT on guidelines for the diagnosis and treatment of acute malnutrition in children aged 0 to 72 months. This pathological condition is characterized by rapid weight loss due to a severe deficiency of macronutrients and micronutrients. Early detection and timely intervention not only help reduce mortality but also create a solid foundation for the child’s future physical and intellectual development, especially during the critical window of 24 to 59 months of age when children are perfecting their motor and cognitive skills.
Clinical and subclinical diagnostic criteria
The diagnosis of acute malnutrition is classified into two levels: moderate and severe. Doctors must rely on three core anthropometric indicators along with specific clinical manifestations. For severe acute malnutrition, diagnostic criteria include a weight-for-height Z-score below 3SD, a mid-upper arm circumference (MUAC) of less than 115mm for children aged 6 to 59 months, or the presence of bilateral pitting nutritional edema.
For moderate acute malnutrition, the diagnosis is confirmed when the weight-for-height Z-score is between -3SD and below -2SD, or the MUAC is between 115mm and below 125mm. In addition to anthropometry, doctors need to further evaluate vital signs, dehydration status, respiratory or gastrointestinal infections, and perform subclinical tests such as complete blood count and blood glucose to detect medical complications early.
Treatment principles and protocols
Treatment protocols are individualized based on severity and accompanying complications. Children with severe acute malnutrition and medical complications (such as shock, severe dehydration, pneumonia, or refusal to feed) must be treated as inpatients in hospitals. This phase prioritizes stabilizing vital signs, treating infections, preventing hypoglycemia and hypothermia, and initiating nutritional rehabilitation using specialized therapeutic milk formulas like F-75 and F-100.
Conversely, children with uncomplicated severe acute malnutrition and those with moderate acute malnutrition can be managed and treated in the community as outpatients. The core intervention solution is the use of Ready-to-Use Therapeutic Food (RUTF). Children need to be provided with an adequate daily amount of RUTF combined with continued breastfeeding and appropriate complementary feeding based on their age.
Monitoring, evaluation, and preventive counseling
During outpatient treatment, children should be periodically re-evaluated on a weekly or bi-weekly basis. Medical staff will check weight, mid-upper arm circumference, and RUTF consumption levels. A child is considered recovered and discharged from the program when the Z-score is greater than or equal to -2SD and there is no edema for at least two consecutive weeks. Furthermore, nutritional counseling for parents regarding child-rearing methods, maintaining food safety, and full vaccination is mandatory to prevent the risk of disease recurrence.
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