Criteria for discharge from a malnutrition treatment program

Discharge criteria: All of the following should be present

Infant <6 months of age^*

Feeding well on the breast or replacement feeds
Adequate weight gain, eg:
- Sustained weight gain for at least 2 consecutive weekly visits
- Weight-for-age or weight-for-length Z-score ≥–2

Child (6 to 59 months of age)

WHZ ≥–2 for at least 2 visits^¶
MUAC ≥12.5 cm for at least 2 visits^¶
No edema for at least 2 visits
Infections have been evaluated and treated appropriately, and other conditions have been or are being addressed
Full immunization program started, with plans for follow-up

Parent or caregiver

Able to care for the child
Has access to and can prepare appropriate foods
Has learned how to give home treatment for diarrhea, fever, and acute respiratory infections
Understands the signs of more severe illness that requires medical assistance

Community services

Health worker available in the community to ensure follow-up of the child and support for the mother
Chronic medical problems associated with nutritional status (eg, HIV, tuberculosis, or congenital heart disease) have been referred to appropriate health services
Any social barriers to health (food insecurity or other challenges) have been referred to appropriate community social services

HIV: human immunodeficiency virus; MUAC: mid-upper arm circumference; WHZ: weight-for-height Z-score.

* Ongoing follow-up care is important for infants <6 months of age because they remain vulnerable even after the acute problem that led to their admission has resolved. The frequency and site of follow-up depend on the context and available resources.

¶ The 2023 World Health Organization Guideline recommends both WHZ and MUAC as anthropometric criteria for discharge but recognizes that some children will gain a significant amount of weight during treatment and appear to have made significant clinical improvement while only achieving 1 of these anthropometric criteria (WHZ or MUAC). In that case, it is still reasonable to discharge them from care as recovered if they have completed the maximum duration of care that is used locally for the malnutrition treatment program (usually 12 to 16 weeks). Percentage weight gain and absolute weight gain should not be used as criteria for discharge.

Reference:

Guideline: Updates on the management of severe acute malnutrition in infants and children. World Health Organization 2013. https://www.who.int/publications/i/item/9789241506328 (Accessed on July 18, 2024).

Adapted from: Management of severe malnutrition: A manual for physicians and other senior health workers. World Health Organization 1999. https://www.who.int/publications/i/item/9241545119 (Accessed on July 18, 2024).

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Criteria for discharge from a malnutrition treatment program