Query (height gain during recovery from SAM)

In our facility-based SAM treatment center, we have observed that over the treatment period, along with the weight, the height of a child increases too. At the end of 8 weeks, when the new W/H z-score is considered, some children still seem to be SAM, even after gaining considerable weight. What is the interpretation?

1. The height is measured incorrectly

2. There is no reason to consider the new W/H score

or ... any other

Comments

Height gain during recovery

It may be that height was measured incorrectly or the W/H z-score was calculated wrongly. Both are easy to do.

The observation of height gain (and associated W/H "loss") during treatment was (as far as I know) first reported in the 1970's by John Seaman. Three things are probably operating:

1. The recovering / recovered child is less weak than previously and is standing more upright. This means that height will appear to increase.

2. Data from famine situations and from labour camps providing minimal “starvation” rations demonstrate that height is lost during starvation and gained during recovery from starvation.

3. The child has recovered and you are observing catch-up growth. The child is doing exactly what a child should be doing (i.e. gaining weight and gaining height).

All these suggest that what you see is a mark of recovery. If the child is clinically well and has demonstrated sustained weight gain then discharge with (e.g.) two weeks of RUTF or into a SFP should be safe.