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18. Measuring oedema (water retention) in children

18. Measuring oedema (water retention) in children

Last update: 2022-09-14

What is oedema? 

  • Oedema occurs when too much water gathers and remains in the tissues of the body (water retention). Oedema causes swelling and puffiness.

Why is measuring oedema important?

  • Swelling or oedema in both feet (bilateral oedema) is a sign of severe acute malnutrition (SAM). This form of malnutrition is sometimes called Kwashiorkor.

What you need to know

  • Oedema starts in the feet but can spread to the whole body. The higher the swelling progresses up the body (for example, up towards the arms, hands or face), the more serious it is.
  • The quicker oedema is identified, the easier it is to treat. 
  • All children with bilateral oedema need urgent therapeutic care. 
  • Find out the location of the closest services that treat svere acute malnutrition (SAM) and how children can be referred to them.

How to test for oedema

  1. Remove the child’s shoes and socks. Press both your thumbs on the top of each foot for three seconds. Keep a firm, constant pressure. 
  2. Remove your thumbs. If a pit or dip remains in the skin of both feet after three seconds, the child may have oedema. 

Any child found to have oedema should be referred to a health facility as soon as possible.

Signs that a child has oedema (Kwashiorkor)

  • Pitting oedema occurs on the feet and, in severe cases, sometimes on the legs and face. 
  • The child often seems sad or sick and does not move very much. 
  • The child is tired and has lost his or her appetite. 
  • The skin is often cracked and sore. 
  • The hair is dry and thin, breaks easily, and is reddish in colour. 
  • The child cries a lot.

What you can do

  • Explain to community leaders and parents that swelling of the feet is a serious sign of malnutrition and can be treated.
  • Explain the importance of treating malnutrition.
  • Find and refer children with nutritional oedema to the closest health facility or nutrition centre as soon as possible.

Community messages 

  • Find out the local word for a child with oedema and use it to help find cases. 
  • Inform the community that oedema is a nutritional problem and can be treated. 
  • Emphasize the importance of obtaining treatment and explain the different causes of malnutrition. 
  • Emphasize that families need to be involved in treatment, prevention and identification.


Measuring oedema in children