How WHO Identifies High-Risk Children for Special Foods in Moderate Wasting Care

The World Health Organization's Technical Brief on Moderate Wasting in Infants and Young Children

The World Health Organization's (WHO) 2025 technical brief, supported by research contributions from multiple institutions, provides a comprehensive account of the criteria for identifying infants and young children with moderate wasting who should receive specially formulated foods (SFFs).

Why Universal Supplementation Isn't the Answer

The document begins by emphasizing the need for a targeted approach to supplementation, as universal provision risks displacing breastfeeding and home diets, imposes financial burdens, and may undermine programme scalability.

• Displacing breastfeeding and home diets
• Imposing significant financial burdens
• Undermining programme scalability

Who Should Be Prioritized for Supplementation

Individual risk factors include:

• MUAC of 115–119 mm
• Weight-for-age z-score below 3
• Being under two years old
• Failure to recover after counselling alone
• Relapse into moderate wasting
• A history of severe wasting or co-morbidities, such as HIV, tuberculosis, or disabilities

High-Risk Contexts and the Case for Broader Coverage

In high-risk contexts, including humanitarian crises, widespread food insecurity, poor water and sanitation conditions, low socioeconomic status, or high seasonal prevalence of wasting, WHO advises that all moderately wasted children be considered for SFFs.

• Humanitarian crises
• Widespread food insecurity
• Poor water and sanitation conditions
• Low socioeconomic status
• High seasonal prevalence of wasting

How WHO Chose the Risk Factors

The Guideline Development Group reviewed randomized controlled trials comparing SFFs with counselling alone and judged the benefits of SFFs to be moderate, with moderate certainty.

• Randomized controlled trials
• Benefits of SFFs: moderate, with moderate certainty

Recommendations on Product Type and Dosage

WHO recommends:

• Lipid-based nutrient supplements, such as RUSF or RUTF
• Improved fortified blended foods
• SFFs providing 40–60% of daily energy requirement

Implementation Considerations

The document emphasizes the importance of shaping implementation by local feasibility, acceptability, and equity considerations.