How to Assess for Bilateral Pitting Oedema


Look and feel for a pit in each foot. Oedema in the feet only

is classified as mild (+) oedema. If there is no oedema in

the feet, STOP. Nutritional oedema always spreads from the

feet upwards.

If oedema is present in the feet look for oedema in the lower

legs. Use the same technique as for the feet checking both

sides. Bilateral pitting oedema in the feet AND the lower legs

is classified as moderate (+2) oedema.

If oedema is present in the feet and lower legs, check the

hands. Use the same technique. If there is oedema in the

feet, lower legs, and hands this oedema is also classified

as moderate (+2) oedema.

If moderate oedema is diagnosed, check for oedema around

the eyes (periorbital oedema). Do no not press on the eyes

to look for pitting. If there is oedema around the eyes this is

classified as severe (+3) oedema. Children with +3 oedema

are at risk of mortality and are always treated in the NRU.


Extracted with permission from Ministry of Health. 2016. Guidelines for Community-Based Management of Acute Malnutrition. 2nd Edition. Lilongwe, Malawi: MOH. Annex 1-5. p28.