e-Library of Evidence for Nutrition Actions (eLENA)

Treatment of hypoglycaemia in children with severe acute malnutrition

In children who are 6–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference. Severe acute malnutrition affects an estimated 19 million children under 5 years of age worldwide and is estimated to account for approximately 400,000 child deaths each year.

All severely malnourished children are at risk of developing hypoglycaemia - or low blood sugar - which can rapidly lead to death if not treated. Hypoglycaemia may be caused by a serious systemic infection or can occur when a malnourished child has not been fed for 4–6 hours.

The treatment or prevention of hypoglycaemia and hypothermia should be included in the initial treatment a severely malnourished child receives when first admitted to hospital.

WHO recommendations

All severely malnourished children are at risk of hypoglycaemia and, immediately on admission, should be given a feed, or glucose or sucrose solution.

If the child is conscious and able to drink, glucose or sucrose should be given orally or by nasogastric tube followed by small and frequent feedings with F75 therapeutic milk.

If the child is unconscious, glucose should be given intravenously, or glucose or sucrose by nasogastric tube. When the child regains consciousness, small and frequent feedings with F75 therapeutic milk should be started.

All malnourished children with suspected hypoglycaemia should also be treated with broad-spectrum antimicrobials for serious systemic infection.


This is a summary of one of several WHO recommendations on the management of SAM in infants and children. The full set of recommendations can be found in 'Full set of recommendations' and in the guidelines and guidance documents under ‘WHO documents’ below.

WHO documents

WHO documents

GRC-approved guidelines
Other guidance documents


Clinical trials

Last update:

24 August 2016 16:57 CEST

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

Essential Nutrition Actions

This intervention is a component of managing children with SAM, which is an Essential Nutrition Action targeting the first 1000 days of life.

Global targets

Implementation of this intervention may contribute to the achievement of the following targets:

Global nutrition targets

Target 6: Reduce and maintain childhood wasting to less than 5%