NURTURE CENTER TO PREVENT CHILDHOOD MALNUTRITION
First Foods. Breastmilk and complementary foods consumed during the first two years of life.
The risk of dying from hunger is much greater for children than adults. Each year there are about 49 million deaths throughout the world. Nearly one-third of these deaths occur among children under 5 years of age who die from infection and malnutrition.
Lack of exclusive breastfeeding is a significant cause of infection in early infancy and can result in malnutrition. Breastmilk, the universal First Food, meets all of a child's nutritional needs from birth to about six months of age.
Children are particularly vulnerable to malnutrition during the weaning process, defined as the transition from breastmilk as the sole source of nourishment to the usual family diet.
By six months of age, most babies need other foods in addition to breastmilk. The foods offered to infants are often contaminated and woefully inadequate in calories, protein, and micronutrients. The result: growth faltering and malnutrition.
If global efforts to reduce malnutrition and mortality are to succeed, they must focus on breastfeeding promotion, enhanced weaning diets, and improved feeding practices.
PROBLEMS DURING WEANING
Sub-optimal breastfeeding practices
Poor quality of weaning diets (too few calories, protein, and/or micronutrients)
Detrimental feeding practices
Early or delayed introduction of complementary foods
While adequate food may be available for adults in poor communities, too often their children are underfed or offered foods with too much bulk or too much water.
Poorly nourished children in many developing countries eat similar amounts of food as well nourished children. However, there is a vast difference in food quality, as illustrated by the energy (caloric) intake in the figure at the right.
Too much bulk.
Too little variety.
In many cultures, the weaning diet consists of a starchy staple. In order to meet daily energy requirements, a toddler weighing 10 kilograms would have to eat 1 kilogram of cooked rice or some other starchy staple. Given their small stomach sizes, young children cannot consume such large quantities of food.
Amount of Food Consumed and Caloric Intake of Infants in the U.S. Peru and Bangladesh
Ref: DHHS, 1986; US Ages 6-11 mo.Too much water.
Kanashiro et al, 1990; Peru 7-9.9 mo.
Brown et al, 1982; Bangladesh 5-17 mo.
Many thin porridges and soups served as First Foods fail to provide sufficient calories. A study in Tanzania found that a child would have to consume 4-5 liters of the traditional liquid gruel to meet the child's daily energy needs!
Too little protein.
Too few micronutrients.
Weaning diets are often deficient in protein and micronutrients such as vitamin A, iron, and zinc. Absence of micronutrients can diminish a child's appetite and immunity to infection and can result in blindness, stunted growth, mental and physical handicaps, and death.
Enhancing weaning diets
· Inform parents of the amounts and types of foods appropriate for children
· Motivate caregivers to use indigenous ingredients (such as oil and green leafy vegetables) and local processing techniques (roasting, fermentation, and malting) to make traditional weaning foods safer and more nutritious
· Support community-based
projects to improve the availability of adequate First Foods
Malnutrition is more than a food issue; it is also a feeding issue. Various behaviors, traditional beliefs about food, and feeding practices affect childhood nutrition.
Timing: too early or too late introduction of complementary foods.
Both early and delayed introduction of semi-solid foods can result in malnutrition. Breastmilk is the complete, perfect food for infants during the first six months, yet breastmilk is frequently replaced in early infancy with contaminated and nutritionally inferior substitutes. If the introduction of complementary foods is delayed beyond six months, breastmilk may not satisfy a child's nutritional requirements.
Given their small stomach sizes, young children need to be fed frequently during the day to ensure adequate food consumption. Labor, time, and resource constraints (lack of fuel, refrigeration, and low-cost processed foods) are often obstacles to frequent feedings.
Numerous studies report a positive correlation between nutritional status and active feeding by the caregiver. Children are more likely to thrive if the caregiver interacts with the child during feeding, sees how much food is consumed, and encourages the child to eat.
Improving feeding practices
· Develop social marketing campaigns to educate parents about good feeding practices
· Remove obstacles to frequent feeding by supporting community-based production of weaning food, nutritious snacks for young children, fuel efficient stoves, refrigeration units, and small feeding bowls
Many children cannot compensate for early poor feeding. The
two girls in the photo above are the same age, but the girl on the right is
stunted and underweight for her age.
A major cause of diarrheal diseases and associated malnutrition in infants and toddlers is contamination of feeding bottles, breastmilk substitutes, and weaning foods. Weaning food contamination is usually the result of insufficient cooking or inadequate storage and reheating of food.
Ensuring food safety
· Promote exclusive breastfeeding during the first six months and continued breastfeeding during the weaning process
· Educate caregivers in safe food preparation, food handling, and personal hygiene
· Improve water sup-lies and
Birth to about 6 months
6 months - 24 months
· Only breastmilk
Prepared by Nurture/Center to Prevent Childhood Malnutrition, 3333 K St. NW, Suite 101, Washington, DC 20007 USA; Fax (202) 298-7988