Undernutrition and severe acute malnutrition in children

#### What you need to know Undernutrition contributes to nearly 45% of all deaths in children under 5 years old globally.1 Low and middle income countries are worst affected.2 Treatment services are estimated to reach less than 15% of undernourished children.3 Healthcare providers can play a crucial role in identifying undernutrition in children and ensuring appropriate care and referral. We provide an overview of assessment and initial management of undernutrition in children under 5 years of age. For the purpose of this paper, we focus on severe acute malnutrition, when children are at increased risk of medical complications unless diagnosed and managed promptly. Undernutrition results from insufficient intake of energy foods (carbohydrates, fats), proteins, and micronutrients (vitamins and minerals).4 Energy and protein malnutrition can manifest clinically as marasmus, kwashiorkor, and marasmic-kwashiorkor (see fig 1⇓ and fig 2⇓). The current World Health Organization guidelines subsume these entities into the blanket term “severe acute malnutrition,” and its variants with or without medical complications.5 Acute malnutrition results from hunger or disease, or both, and is associated with rapid weight loss or failure to gain weight. Box 1 outlines the subclinical and clinical forms of undernutrition. Iron, iodine, vitamin …