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# Acute malnutrition in children under five: detection, the appetite test and follow-up (Res. 2350 de 2020)

- Assessment

Weight for length, arm circumference and oedema find acute malnutrition; the appetite test decides home or hospital care.

Updated Nov 13, 2026

## Key points

- Weight for length/height (W/H) below −2 SD and down to −3 SD: moderate acute malnutrition; below −3 SD: severe acute malnutrition.
- Mid-upper arm circumference below 11.5 cm in children aged 6 to 59 months predicts risk of death from malnutrition; it complements, never replaces, weight and length.
- Bilateral pitting oedema of nutritional origin is severe acute malnutrition whatever the weight.
- Appetite test: only with ready-to-use therapeutic food, only from 6 to 59 months and 4 kg or more; positive allows outpatient care, negative means hospital care.
- Outpatient follow-up is weekly until discharge criteria; recovery requires W/H of −1 SD or more, no oedema for two consecutive visits and a stable child (Res. 115 de 2026).

## What it is

Acute malnutrition in a child under five is an emergency in Colombia: the guideline adopted by Resolución 2350 de 2020, partly modified by Resolución 115 de 2026, treats its care as urgent care that needs no prior authorisation. Nurses find these children in every contact, in the clinic and in the community, by measuring well and looking for oedema. They also help with the appetite test, which decides whether the child can recover at home with ready-to-use therapeutic food, and they follow the child and the family until recovery.

## Reference values

- W/H ≥ −2 to
- Calibrated scale and infantometer or stadiometer, as Res. 2465 de 2016 describes.
- Flexible, non-stretch arm tape with millimetre marks.
- WHO growth charts adopted in Colombia, and the AIEPI recording form.
- A quiet, separate space and the therapeutic food sachet for the appetite test, under medical supervision.

## How to measure it (and why)

- Weigh and measure the child with the standard technique and plot W/H — W/H is the indicator that defines acute malnutrition.
- Measure the arm at the midpoint between shoulder and elbow of the non-dominant arm, tape neither tight nor loose — technique errors change the result.
- Press the top of both feet with the thumbs for three seconds; a pit that stays confirms oedema — bilateral oedema means acute malnutrition.
- Look for complications: danger signs, diarrhoea, fast breathing, low temperature, skin lesions, pallor — they call for hospital care.
- For the appetite test, explain its purpose and help the carer wash hands — the child must eat willingly, in a calm setting.
- The carer sits comfortably with the child on the lap and offers the food with a spoon, without forcing — forced eating gives a false result.
- Watch for 15 minutes and record how much is eaten against the table for age and weight — the minimum amount decides positive or negative.
- Teach home care and return signs, and set the weekly follow-up — loss of appetite can be the first sign of a complication.

## How to read it

- Each follow-up includes review of the previous plan, 24-hour diet recall, illness in the last two weeks, physical exam, appetite test and anthropometry, including arm circumference.
- Refer to hospital if the child in outpatient care shows altered consciousness, hypoactivity or convulsions, diarrhoea, persistent vomiting, fast breathing for age, new or increasing oedema, or temperature below 35.5 °C or above 38 °C.
- Also refer for a medical or social condition that puts care at risk, such as abandonment or a carer's disability or mental illness.
- Support breastfeeding, safe water and hand washing, and check vaccination at every visit.

## Next step: when to call for help

- Moderate or severe acute malnutrition, or oedema: inform the doctor the same day; this is urgent care that needs no authorisation.
- Negative appetite test, danger signs or complications: tell the doctor at once for hospital care.
- Weight loss or no gain over the last two visits, or a carer who needs extra support: report and plan closer follow-up.
- Record the case for the surveillance system according to the institutional protocol.

## Test yourself

Think of the answer, then tap the question to see it.

## Which weight-for-length value defines severe acute malnutrition in Colombia?

Weight for length or height below −3 standard deviations.

## From what age is the arm circumference used, and what value signals risk?

From 6 to 59 months; below 11.5 cm predicts risk of death from malnutrition.

## What does a negative appetite test mean?

The child ate less than the expected minimum or refused the food, so care must be in hospital.

## In whom should the appetite test not be done?

In infants under 6 months and in children over 6 months who weigh less than 4 kg.

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## Elsewhere in DurgiPedia

- [Severe acute malnutrition: marasmus and kwashiorkor](https://durgical.com/en/general-pathology/severe-acute-malnutrition-marasmus-and-kwashiorkor/)

## Connections

## Related 2

- [Growth and development monitoring in children](https://durgical.com/en/nursing/growth-and-development-monitoring-in-children/)
- [Weight, height and daily weights](https://durgical.com/en/nursing/weight-height-and-daily-weights/)

## Related conditions 1

- [Failure to thrive (faltering growth)](https://durgical.com/en/conditions/failure-to-thrive/)

[← All of nursing](https://durgical.com/en/nursing/)

Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Lineamiento para el manejo integrado de la desnutrición aguda moderada y severa en niños y niñas de 0 a 59 meses de edad (Resolución 2350 de 2020)](https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/SA/lineamiento-manejo-desnutricion-resolucion-2350.pdf) (Ministerio de Salud y Protección Social de Colombia, 2021); [Resolución 115 de 2026, por la cual se modifica parcialmente la Resolución 2350 de 2020 y su anexo técnico](https://www.minsalud.gov.co/Normatividad_Nuevo/Resolucion%20No%20115%20de%202026.pdf) (Ministerio de Salud y Protección Social de Colombia, 2026); [Resolución 2465 de 2016 (indicadores antropométricos, patrones de referencia y puntos de corte)](https://www.minsalud.gov.co/Normatividad_Nuevo/Resolucion%202465%20de%202016.pdf) (Ministerio de Salud y Protección Social de Colombia, 2016).

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Source: https://durgical.com/en/nursing/acute-malnutrition-in-children-under-five-detection-the-appetite-test-and-follow/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/acute-malnutrition-in-children-under-five-detection-the-appetite-test-and-follow/