Also known as nutritional edema and edematous malnutrition, bilateral pitting edema identifies a type of severe acute malnutrition (SAM) known as kwashiorkor. It is identified when thumb pressure, applied to the tops of both feet for three seconds, leaves an indentation in the foot after the thumb is lifted. It is considered mild when it is only in both feet (can include ankles) (Grade +); moderate when it is in both feet, lower legs, hands, or lower arms (Grade ++); and severe when it is in both feet, legs, hands, arms, and face (Grade +++).
