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
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.