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18 November, 2019 00:00 00 AM / LAST MODIFIED: 18 November, 2019 12:38:18 AM

Severe Acute Malnutrition [SAM] among children from mothers’ perspective

Ganga Bhavani
Severe Acute Malnutrition [SAM] among children from mothers’ perspective

It is a known fact that malnutrition is one of the major causes for mortality and morbidity of under- five children especially in developing countries. The prevalence of malnutrition among under- five children ranges from 35 to 45 percent according to surveys.

The first 1000 days of a child’s life are very important for survival. Early part of child’s life needs an optimal supply of energy and nutrients to the body. Therefore, adequate and balanced supply of nutrients is highly required for growth and development of the child. Inadequate nutrition or malnutrition can affect the health, growth and development of the child.

Malnutrition impairs the intelligence, educability and productivity of the baby. It also leads to a high risk of chronic non communicable diseases in the later life. It is essential for mothers to know what type of food needs to be given to children with economical considerations to save the children from Severe Acute Malnutrition or SAM. SAM is the life threatening condition for children.


Severe acute malnutrition is defined by WHO as a very low weight for height (below -3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional edema.

SAM children suffer from low birth weight related complications, severe growth retardation, micro nutrient- vitamin deficiencies, protein energy deficiency, at high risk for hypoglycemia, infections, anemia and communicable childhood diseases.

Causes of SAM: Severe acute malnutrition is caused by a significant imbalance between nutritional intake and individual needs. It is most often caused by both quantitative (number of kilocalories/day) and qualitative (vitamins, minerals micro and macro nutrients etc.) deficiencies.

Maternal related causes of SAM include – mothers’ age, education, socio economic position, Low Hemoglobin’s levels during pregnancy, ill health, malnutrition of mother, high risk pregnancy, communicable diseases and STDs during pregnancy.

 Neonatal causes of SAM include – Intra uterine growth retardation, prematurity, low birth weight, neonatal infections, neurological deficiencies, gastro enter logical birth defects, congenital anomalies and genetic related diseases.

How mothers can identify SAM children: Mothers are the first and foremost important person in a child’s life. Any abnormality in a child is identified by mother better than any other family member. Mothers can identify SAM children:

1. If the child has bilateral pitting edema, muscle wasting.

2. Poor feeding, poor cry no appetite, dehydration-sunken eyes, dry, cold and clammy skin.

3. Lethargy, weakness, less energy levels, semi consciousness-signs of hypoglycemia

4. Growth retardation, development delays- delays in speech and walk

5.  Weight is less than age, no weight gain

6. Height is less than age, weak extremities.

7.  Mid Upper arm circumference is less than normal.

What doctors do for treatment of children with Severe Acute Malnutrition

World Health Organization’s 10-Step Plan for the Management of Severe Acute Malnutrition


What Mothers have to do

Identifying that child has nutritional deficiency defect is the primary concern of the mother.

Taking the child to hospital and getting the opinion of the doctors regarding child’s health is important to mother. Mother must be ready for emergency treatment of the child.

The most dangerous conditions of hypoglycemia, dehydration, electrolyte imbalances and severe anemia are treated on priority basis in the hospital. After stabilizing the child’s condition usually Appetite test is done. If the child’s appetite test is positive and child has some appetite, the child can be treated in out- patient department [OPD], if appetite test is negative and child has no appetite, hospitalization and nutritional treatment is necessary.  

Mothers must know that in hospital SAM children are given nutritional support apart from treatment in pediatric ward or in Nutrition Rehabilitation Center [NRC]. Simultaneously mothers get educated regarding the diet to be given to the child. NRC staff train the mothers in menu preparation for SAM children.

Child is treated by the health care team, consisted of Child health specialist, nurse, and nutritionist, social worker or community health worker. Before discharge, mothers have to get education regarding how to look her child at home.

Mothers are advised to follow strictly the diet regime of the child and have to attend the follow up schedules of her child to prevent relapse and recurrence of Severe Acute Malnutrition [SAM]

What the family of SAM child have to do for child and mother

It is stressful for the entire family to deal with hospitalization and treatment of the child. Every member of the family must understand that mother need not be blamed for child’s condition as if she is not feeding the child adequately. Family cooperation is the most essential factor for the recovery of child and well being of mother.

 Family members have to protect the child from infections and relapses of the common child hood diseases by following the hygienic practices at home.  

Every member of the family need to understand that malnourished and hospitalized child affects mental health of mother and leads to maternal depression. It is imperative for the family to be supportive to the mother especially during the hospitalization of the child.

Hope every mother will get a happy and healthy child.




Copyright © All right reserved.

Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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