To assess the implementation of WHO guidelines for managing severely malnourished hospitalized children, a case-series study was performed with 117 children from 1 to 60 months of age. A checklist was prepared according to steps in the guidelines and applied to each patient at discharge, thus assessing the procedures adopted during hospitalization. Daily spreadsheets on food and liquid intake, clinical data, prescribed treatment, and laboratory results were also used. 36 steps were evaluated, 24 of which were followed correctly in more than 80% of cases; the proportion was 50 to 80% for seven steps and less than 50% for five steps. Monitoring that required frequent physician and nursing staff bedside presence was associated with difficulties. With some minor adjustments, the guidelines can be followed without great difficulty and without compromising the more important objective of reducing case-fatality.