“The guidelines are critical because many national health plans currently overlook children with severe acute malnutrition. This can be fatal. If these children don’t get the right medical and nutritional care, very often they die,” said Dr. Francesco Branca, Director of the Department of Nutrition for Health and Development at the World Health Organization (WHO).According to WHO, severe acute malnutrition is when children suffer severe wasting that may or may not be accompanied by swelling of the body from fluid retention. It occurs when infants and children do not have adequate energy, protein and micronutrients in their diet, combined with other health problems such as recurrent infections. It is diagnosed when the circumference of the upper arm is less than 115 millimetres or when the weight for height of a child is severely reduced.The updated WHO guidelines recommend that children with severe acute malnutrition who do not have health complications that require hospitalization, receive special, high-energy food and antibiotics to treat infection. This allows them to recover at home with their families. “It’s generally better for children and better for their families if they’re treated as outpatients,” said Dr. Elizabeth Mason, Director of WHO’s Department of Maternal, Newborn, Child and Adolescent Health. “It can be easier for families who need to continue providing and caring for other children, and it allows vulnerable, malnourished children to stay home and avoid the risk of getting hospital infections.”The new guidelines also address how to treat children with severe acute malnutrition for HIV and offer recommendations on treating severely malnourished infants under six months.They supersede WHO’s 1999 guidelines which recommended that all severely malnourished children be hospitalized, given fortified formula milk and appropriate treatment including antibiotics. While the proactive use of antibiotics is important because the immune system of a child who is severely malnourished can virtually shut down, the new recommendation advocates this specifically for children with severe acute malnutrition – not those who are simply undernourished.“Widespread use of antibiotics among children who do not need them would increase the risk of infections becoming resistant to lifesaving antibiotics – a situation that would harm the health and survival of all children,” WHO pointed out.Another new aspect relates to the treatment of severely malnourished children with HIV. The 1999 guidelines did not recommend HIV testing of children with severe acute malnutrition. At that time, there was poor availability and little experience of treating children with antiretroviral drugs. “Circumstances today are very different,” WHO noted. “We now know that antiretrovirals significantly increase survival of children with HIV, and access to these drugs is improving.”The new guidelines recommend that children with severe acute malnutrition in countries where HIV is common be routinely tested for the virus, and those who are positive should start on antiretroviral drugs as well as special foods and antibiotics to treat their severe malnutrition.Also addressed for the first time are the needs of infants under the age of six months with severe acute malnutrition. WHO recommends that all babies under six months are exclusively breastfed for optimal nutrition and protection against infections, adding that this is particularly important for babies who are severely malnourished. “If there is no realistic prospect of a severely malnourished baby being breastfed, the family may need breast milk from another woman, e.g. a family member, a neighbour, a wet nurse or a milk bank. If this is not possible, they will need infant formula and support to prepare and use it safely,” said WHO.