Nutritional oedema, manifested as bilateral pitting oedema, is a sign of severe acute malnutrition. Nutritional oedema always starts from the feet and extends upwards to other parts of the body. Children with nutritional oedema are at high risk of mortality hence require immediate therapeutic care.
This tutorial describes how to check nutritional oedema.
1. Press both feet with thumbs
Using both thumbs of your hands, apply normal pressure on top of both feet of the child for about three seconds as shown below. You can estimate three seconds by counting ‘one thousand and one, one thousand and two, one thousand and three’ in English. It takes roughly 3 seconds to be able to say these words.
2. Release pressure from feet
After three seconds, release the pressure you are applying on the child’s feet. Observe the resulting effect on the child’s feet.
If there is oedema, an impression remains on both feet for a few seconds as shown below.
If no impression remains on both feet, then the child doesn’t have nutritional oedema.
3. Move up to check on the lower legs
If there is nutritional oedema present on the feet, perform the same test described in Step 2 but now move up to the lower legs.
4. Move up to the upper body and/or face
If there is nutritional oedema present on the lower legs, perform the same test described in step 2 but now move up to the upper body and/or the face.
Steps 3 and 4 are performed to be able to grade or classify the level of nutritional oedema the child is suffering from (if present).
|Level of Oedema||Grade|
|Oedema below the ankles||+|
|Odema in both feet and legs, below the knees||++|
|Odema on both feet, legs, arms and sacral pad and eye lids||+++|