More evidence is needed to understand the causes of severe acute malnutrition and develop effective interventions. To address this gap, the authors conducted a case control study in Nepal to identify determinants of severe acute malnutrition in children, including social and material factors. Findings highlight a relationship between mothers’ socioeconomic status and the incidence of SAM in children. Providing services to improve socioeconomic status could help reduce severe acute malnutrition. The results also suggest that promoting handwashing with soap, exclusive breastfeeding, and complementary feeding are ideal low-cost interventions.