If a child aged six months or above has a MUAC less than 11 cm or pitting oedema of both feet and has no medical complications, you should assess the child’s appetite.

An appetite test is not needed when the child has any one of the following: medical complications that require in-patient care, pneumonia, persistent diarrhoea, watery diarrhoea, dysentery, malaria, measles, low body temperature or high fever, open skin lesions or signs of vitamin A deficiency.

The appetite test

The appetite test has a number of steps you should follow:

1. The appetite test should be conducted in a separate quiet area.
2. You should explain to the caregiver the purpose of the appetite test and how it will be carried out.
3. The caregiver, where possible, should wash their hands.
4. The caregiver should sit comfortably with the child on their lap and either offer the child ready-to-use therapeutic food (RUTF) such as Plumpy’nut® or BP-100® from the packet, or put a small amount on her finger and give it to the child.
5. The caregiver should offer the child the RUTF gently, encouraging the child all the time. If the child refuses, then the caregiver should continue to quietly encourage the child and take time over the test. The test usually takes 15‒30 minutes but may take up to one hour. The child must not be forced to take the RUTF.
6. The child needs to be offered plenty of water to drink from a cup when taking the RUTF.

You interpret the result of the appetite test in the following way:

Pass: a child that takes at least the amount shown in the table below below passes the appetite test. You should:

• Explain to the caregiver the choices of treatment and decide with the caregiver whether the child should be treated as an out-patient or an in-patient (nearly all caregivers will opt for out-patient treatment).
• Refer the child to the Out-patient Therapeutic Programme (OTP) for registration and initiation of treatment.

Fail: a child that does not take at least the amount of RUTF shown in the table below should be referred for in-patient care. You should:

• Explain to the caregiver the reasons for recommending in-patient care; decide with the caregiver whether the child will be treated as an in-patient or an out-patient.
• Refer the child to the nearest therapeutic feeding unit (TFU) or hospital.

The appetite test should always be performed carefully. You should always offer treatment as an in-patient for children who fail their appetite tests. If there is any doubt, however, then you should refer the child for in-patient treatment until their appetite returns.