General information on child nutrition

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General information on child nutrition
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• OBJECTIVES
• SKILL DEVELOPMENT FOR
• WEIGHING PREGNANT WOMEN AND PRESCHOOL CHILDREN
• DETECTION OF UNDERNUTRITION AND GROWTH FALTERING
  IN CHILDREN
• NUTRITION AND HEALTH EDUCATION FOR PREVENTION
  AND MANAGEMENT OF UNDERNUTRITION IN CHILDREN

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• Why focus on under-nutrition in early childhood?
  
• Under-nutrition in early childhood will
• adversely affect their growth, development and
  health status during childhood and adolescence
• influence their nutrition and health status
  through out their life span
• may render them more susceptible to
  over-nutrition and non communicable disease risk
  in adult life

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Over years there has been a decline in severe and
moderate under nutrition (weight-for-age and
height- for-age) but not in wasting
(weight-for-height).
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• Over the last 15 years there has been a decline
  in stunting and underweight.
• In the last five years there had been no decline
  in underweight rates (NFHS2-NFHS3), stunting
  rates had shown substantial decline and wasting
  rates have shown an increase.

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Under-nutrition rates in Delhi has not shown
any reduction in the last two decades. Several
small and medium sized states have lower
undernutrition rates than Delhi
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• Beginning of under-nutrition in utero
• Nutritional status during infancy
• Nutritional status in early childhood
• Detection of undernutrition

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Under-nutrition begins in utero
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• One third of Indian infants weigh below 2.5kg at
  birth.
• Prevalence of preterm births is about 12.
• Majority of LBW babies are mature but had poor
  intrauterine growth.

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Birth weight and maternal nutrition
Source Tenth Five Year Plan 2002

• Low maternal pre-pregnancy weight low weight
  gain in pregnancy result in lower birth weight.
• Increased food intake (?Food grain supplements to
  underweight women) and reduction in work load can
  improve pregnancy weight gain birth weight.

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• Anaemia begins in childhood, worsens during
  adolescence in girls and gets aggravated in
  pregnancy.

• Anaemic women deliver infants with lower birth
  weight. Effective treatment of anaemia improves
  birth weight.

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• Antenatal care for improving birth weight
• Weigh all pregnant women
• Provide advise regarding diet and physical
  activity based on their nutritional status,
• Identify those weighing lt 45 kg NE to increase
  dietary intake and/or reduce physical activity.
  If needed provide monthly food grain supplements
  so that they can consistently improve food intake
  throughout pregnancy,
• Provide universal adequate antenatal care,
• Identify and treat anaemic women appropriately
• Detect and treat antenatal problems,
• All these can be effectively implemented through
  convergence between ICDS NRHM.
• This opportunity should be fully utilised.

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Nutritional status during infancy
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DLHS 2002-04
Most women exclusively breast feed in the first
three months. Exclusive breast feeding provides
adequate nutrients, prevents infection and
promotes normal growth. As a result prevalence
of under-weight in first three months is 30
(same as low birth weight prevalence).
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• After 3 months underweight rate rises due to
  early introduction of milk supplements and higher
  morbidity rates due to infections,
• Between 6 and 11 months underweight rate further
  rises to 45 - partly due to inadequate
  complementary feeding and partly due to increase
  in morbidity due to infections.

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Birth weight and growth during infancy
Birth weight is a major determinant of growth in
infancy and childhood. Infants whose birth weight
was low, have a lower growth trajectory.
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Nutritional status in early childhood
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Progressive increase in the underweight rates in
12 to 24 months of age is attributable to
decreasing breast milk intake and inadequate
intake of family food, Nutrition education that
children in 12- 23 month age group should
continue to be breast fed and given modified
family food 4-5 times a day, will go a long way
in reducing the under-nutrition in this age group.
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Mean Energy Consumption - NNMB 2000
Age groups Males Males Males Females Females Females
Age groups Kcals RDA RDA Kcals RDA RDA
Pre-school 889 1357 65.5 897 1351 66.4
School Age 1464 1929 75.9 1409 1876 75.1
Adolescents 2065 2441 84.6 1670 1823 91.6
Adults 2226 2425 91.8 1923 1874 102.6
The gap between RDA and the actual energy intake
is greatest in preschool children and lowest in
adults. Lack of knowledge and poor child feeding/
caring practices rather than poverty appear to be
the major factors for low energy intake in
children.
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Dietary Intake Adult Male Adult Female Preschool Children
Adequate Adequate Adequate
- Adequate Adequate Inadequate
--- Inadequate Inadequate Inadequate
Over years there has been an increase in the
number of households where adults are getting
adequate food but children are not. There is an
urgent need to focus on nutrition and health
education on child feeding caring practices to
improve dietary intake in preschool child.
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• Prevention of under nutrition in 060 months
• Nutrition education is the critical intervention
• Exclusive breast feeding for first six months,
• Appropriate adequate complementary feeding 3-5
  times a day from six months of age,
• Continued breast feeding and feeding family food
  4-5 times a day upto 24 months,
• Feeding 2-5 year old children 4-6 times a day
  from family food consisting of cereals, pulses
  and vegetables.
• Advise regarding timely immunisation, measures to
  prevent infections, care during illness and
  convalescence.

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Detection of undernutrition
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• DETECTION OF UNDER NUTRITION
• At least once in three months all children should
  be weighed (provision for functional balances).
• All AWW should be trained in
• checking the accuracy of the balance,
• correctly weighing the children,
• plotting the weight in the childs card (cards
  should be made available for every child), and
  assessing childs nutritional status
• informing the mother about the childs
  nutritional status, and
• providing her appropriate advise on feeding and
  care, based on the age, feeding practices and
  nutritional status of the child.

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• Assessment of nutritional status
• Weight-for-age is most widely used index for
  assessment of nutritional status in children in
  all settings hospitals to anganwadi.
• In India, three standards for weight for age are
  being used for assessing reporting
  under-nutrition
• IAP standards currently used in ICDS programme,
• WHO/NCHS standards Used in NNMB, NFHS and DLHS,
• WHO (2006) used in NFHS-3 and DLHS 2.

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Prevalence of moderate and severe undernutrition
in
DLHS using WHO (2006), NCHS and IAP norms
70
60
50
40

30
20
10
0
0-2
3-5
6-8
9-11
12-14
15-17
18-20
21-23
24-35
36-60
Age in months
WHO
NCHS
IAP
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Prevalence of under-nutrition 0-12 and 13-60
months (All India DLHS 2 - NIHFW)
60
50
40
30

20
10
0
WHO 2006
NCHS
IAP
WHO 2006
NCHS
IAP
lt1yr
gt13 mths
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• There are substantial differences in prevalence
  of under-nutrition as assessed by the three
  standards
• These vary with age of the child.
• Use of multiple standards in different reporting
  systems has created a lot of confusion.
• Government of India has decided to hence forth
  use the WHO 2006 standards in ICDS as well
  as health care settings .

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NORMAL
MODERATE UNDERNUTRITION
SEVERE UNDERNUTRITION
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• To sum up
• Low birth-weight rate in India is 30 could be
  reduced through better antenatal care
• Prevalence of under-weight in first three months
  is 30- exclusive breast-feeding prevents
  deterioration in nutritional status.
• After 3 months underweight rate rises due to
  introduction of milk supplements infections.
• Between 6 and 11 months underweight rate further
  rises to 45 - due to inadequate complementary
  feeding infections.
• Poor infant feeding and caring practices are
  major determinants of underweight in infancy
  nutrition education and health care can prevent
  the rise in under-nutrition rates.

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• Progressive increase in the underweight rates in
  12 to 24 months of age mainly attributable to
  inadequate intake of family food due to poor
  child feeding practices. Nutrition education to
  correct these faulty habits is the critical
  intervention needed.
• Further rise in under-nutrition rates is mainly
  due to poor intra-family distribution of food
  nutrition education to parents that children
  have small stomach capacity and have to be fed
  5-6 times a day to fully get adequate food intake
  will improve dietary intake and nutritional
  status .