SAM in infants <6 months is rare. An organic cause or failure to thrive should be considered and treated. Admit the infant with SAM if any of the following are present:

  • General danger signs or serious condition
  • Recent weight loss or failure to gain weight
  • Ineffective breastfeeding (attachment, positioning, or suckling) directly observed for 15-20 minutes
  • Any pitting bilateral oedema of feet
  • Any medical problem needing more assessment
  • Any social issue needing detailed assesssment or intensive support e.g depression of caretaker


Initial Phase

  • Admit child
  • Give parenteral antibiotics to treat possible sepsis and appropriate treatment for other medical complications
  • Re-establish effective breastfeeding by mother or give infant formula, safely prepared and used
  • In infants with SAM and oedema, give infant formula (preferably) or if not available, F-75 or diluted F-100
    (use 1.5 litres instead of 1 litre)
  • For infants with SAM and NO oedema, give expressed breast milk; if not possible, give commercial infant
    formula, F-75 or diluted F-100 in this order of preference
  • Assess the physical and mental health of mothers or caretakers. Provide relevant treatment and support


  • Infants can be transferred to outpatient care if:
    • All clinical conditions, medical complications and oedema are resolved, or if child is clinically well and alert
    • Child is breastfeeding effectively or feeding well
    • Weight gain is satisfactory, e.g., above median WHO growth velocity standards or >5 g/kg per day for 3
      successive days
  • Before discharge, verify immunisation status, link mothers and caregivers with community follow-on
    support and ensure that child is breastfeeding well, has an adequate weight gain and has WFL ≥-2 Z scores