7.3.1  Visible severe wasting in infants less than six months of age

An infant with visible severe wasting has marasmus, a form of severe malnutrition. A child has this sign if he is very thin, has reduced subcutaneous fat, and looks like skin and bones. Some children are thin but do not have visible severe wasting. A child with visible severe wasting needs urgent treatment and you should refer him to a hospital.

Subcutaneous means ‘under the skin’.

To look for visible severe wasting, remove the child’s clothes. Look for severe wasting of the muscles of shoulders, arms, buttocks and legs. Look to see if the outline of the child’s ribs is easily seen. Look at the child’s hips. They may look small when you compare them with the chest and abdomen. Look at the child from the side to see if the fat of the buttocks is missing. When wasting is extreme, there are many folds of skin on the buttocks and thighs. It looks as if the child is wearing baggy pants. The illustrations and photo in Figure 7.1 show you how a child with visible severe wasting looks.

The face of a child with visible severe wasting may still look normal. The child’s abdomen may be large or distended.

An infant with visible severe wasting.
Figure 7.1  Infant with visible severe wasting. (Photo: IMCI and OTP Training Guides, Ethiopia)

7.3  Assessing for malnutrition

7.3.2  The mid upper arm circumference (MUAC)