# Situation: The nurse supervises barangay nutrition scholars (BNS) and barangay health workers (BHWs) during growth monitoring and child health activities for children under 5 years of age. A 20-month-old boy has these findings: length-for-age -2.3 z, weight-for-length -1.1 z, weight-for-age -1.8 z, mid-upper arm circumference (MUAC) 122 mm, and no edema. How should the nurse classify his nutritional status?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629632  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The nurse supervises barangay nutrition scholars (BNS) and barangay health workers (BHWs) during growth monitoring and child health activities for children under 5 years of age.

A 20-month-old boy has these findings: length-for-age -2.3 z, weight-for-length -1.1 z, weight-for-age -1.8 z, mid-upper arm circumference (MUAC) 122 mm, and no edema. How should the nurse classify his nutritional status?

## 보기

1. Stunted, with moderate acute malnutrition **✔ 정답**
2. Stunted, with no acute malnutrition
3. Underweight, with moderate wasting
4. Normal, since his weight-for-age is above -2 z

**정답: 1**

## 해설

Each indicator is applied separately. Length-for-age below -2 z means stunting (chronic malnutrition). Although his weight-for-length is normal, a MUAC of 115 up to 125 mm classifies moderate acute malnutrition on its own. His weight-for-age of -1.8 z is not underweight.

## 심화 해설

The child’s nutritional status is classified by applying each anthropometric indicator independently, because each one captures a different dimension of malnutrition. A single normal value does not cancel out an abnormal finding on another measure.

Step 1: Interpret length-for-age

Length-for-age is -2.3 z. The threshold for stunting is below -2 z. Because this child falls below that cutoff, he is classified as stunted, which reflects chronic malnutrition or long-term linear growth failure. Stunting is a structural, cumulative deficit and is not reversed quickly by short-term feeding.

Step 2: Interpret weight-for-length

Weight-for-length is -1.1 z, which is above the -2 z threshold used to define wasting. By this indicator alone, the child does not have acute malnutrition. However, weight-for-length is not the only criterion for acute malnutrition.

Step 3: Interpret MUAC independently

The mid-upper arm circumference is 122 mm. In community-based screening, MUAC is used as a standalone diagnostic tool for acute malnutrition. The standard cutoffs are:

| MUAC range | Classification |
| --- | --- |
| 115–125 mm | Moderate acute malnutrition (MAM) |
|

## 임상 시나리오

Classifying Child Malnutrition in Community ScreeningApply each anthropometric indicator independently
Stunting is classified when length-for-age is below -2 z. This child has -2.3 z, indicating chronic malnutrition.

MUAC is a standalone criterion for acute malnutrition. A MUAC of 122 mm falls within 115-125 mm, classifying moderate acute malnutrition.

A normal weight-for-length of -1.1 z does not cancel the abnormal MUAC finding. Weight-for-age of -1.8 z is above -2 z, so the child is not underweight.

CautionDo not use one normal indicator to rule out malnutrition. Always check MUAC even when weight-for-length is normal, because they identify different children.

## 핵심 개념

- **Stunting** — Length/height-for-age below -2 z, indicating chronic malnutrition or long-term linear growth failure.
- **Wasting** — Weight-for-length/height below -2 z or MUAC below 125 mm, indicating acute malnutrition.
- **MUAC** — Mid-upper arm circumference; 115-125 mm indicates moderate acute malnutrition, below 115 mm severe acute malnutrition.
- **Underweight** — Weight-for-age below -2 z; a composite indicator reflecting both acute and chronic malnutrition.
- **Moderate acute malnutrition** — MUAC 115-125 mm or weight-for-length between -3 and -2 z without edema.

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