Children who have an appetite (pass the appetite test) and are clinically well and alert should be treated as outpatients for uncomplicated severe acute malnutrition. Children who have severe oedema +++ or a poor appetite (fail the appetite test) or present with one or more general danger signs or medical conditions requiring admission should be treated as inpatients.

► On admission, a child with complicated severe acute malnutrition should be separated from infectious children and kept in a warm area (25–30 °C, with no draughts) or in a special nutrition unit if available, and constantly monitored.

Facilities and sufficient staff should be available to ensure correct preparation of appropriate therapeutic foods and to feed the child regularly, day and night. Accurate weighing machines or MUAC tapes are needed, and records of the feeds given and the child’s weight or anthropometric measurements should be kept so that progress can be monitored.