For a healthy child

Whenever we talk about kids, what do you picture? A lovely kid with chubby cheeks, sweet smile and shiny hair. Unfortunately, more than fifty percent of India’s kids do not have the features. These kids have hollow cheeks, dry, undernourished hair, cracked lips and vacant eyes. These are the victims of a demon called malnutrition. It is not some ordinary demon, but the dementor from ‘Harry Potter’ which sucks the hope and happiness from this kids, and makes them cranky, and listless. Those of you who think that malnutrition is over-rated, let me tell you, India has the highest prevalence of underweight children in the world, almost double than Sub-Saharan Africa. Malnutrition in India can not be ignored, and is also prevalent among affluent family though less than the poverty stricken.

 

What is malnutrition?

• Malnutrition means imbalanced nutrition; it can be undernutrition or overnutrition.
• It is an inadequate or excess intake of carbohydrates, proteins, fats and other micro-nutrients to meet the daily nutritional requirements of an individual.
• It may exist if the daily diet includes the wrong balance of basic food groups.
• Malnutrition causes adverse effects on both physical and mental development

Children and malnutrition:

Poor fetal growth in the first two years of the child’s life can lead to irreversible damage for future development. This is the period for intervention to prevent malnutrition for the healthy development of a child. Malnutrition both protein-energy malnutrition and micronutrient deficiencies directly affects children’s physical and cognitive growth and increases susceptibility to infection and diseases. The first six years of a child’s life constitute the critical period, when foundations are laid for cognitive, motor development, emotional language and cumulative lifelong learning.

Physical development of the child is assessed by the following methods:

• Height-for-age
  Inadequate height-for-age indicates stunting. Stunting takes into account chronic malnutrition as it reflects inadequate nutrition over a long period of time.
• Weight-for-height
  The weight-for-height index measures body mass in relation to body length and
  describes current nutritional status. Inadequate weight-for-height indicates wasting which may reflect onset of malnutrition.
• Weight-for-age -
  Inadequate weight-for-age indicates underweight. It represents both acute and chronic malnutrition.

Malnutrition covers inadequate intake of both macronutrients like proteins, carbohydrates and fats, and micro-nutrients which include minerals (like iron, iodine...) and vitamins. When people consider food for the poor, more emphasis is given to prevent starvation. But, to be healthy people need not only food, but a food enriched with vitamins and minerals.

Courtesy: Ministry of statistics and programme implementation website, Source: NFHS, 2005-06, Ministry of Health and family welfare

 

Anaemia:

Anaemia, a condition with low haemoglobin in the blood is a serious concern in a country like India. It generally occurs due to low intake of iron. Anaemia not only impairs the development of the child, but makes him/her susceptible to infectious diseases.

According to NFHS 3 (2005-06), 76.4% of children (6-59 months) in the lowest wealth index are suffering from anaemia whereas 56.2% children of the highest wealth index are suffering from anaemia. This proves that affluence alone cannot rule out anaemia among children.

Meat is the best source of iron for the non-vegetarians. For the vegetarians, spinach, almonds, peanuts, and beans are good sources of iron.

Milk is a good source for all nutrients but it is a poor source for iron. Excessive intake of milk, if consumed to the exclusion of other foods can lead to iron defiency.

Micronutrients:

Most of the kids dislike vegetables, hence defiency of micronutrients can be a concern even in affluent families. Vegetarian children are likely to be deficienct in Vit B12 which is found exclusively in non-vegetarian food.

Vitamin D is freely available in nature. When we were kids, deficiency of vit. D was seldom. However, recently, I have seen many cases of vit. D deficiency in my pedo patients as well as kids in my family. The reason is, back in my childhood days, kids used to play in the open ground thereby vit. D was easily available. Sunlight is the major source of vit. D to humans. Now-a-days, kids play in play centres, in malls, and hardly get any sunlight. The best way to remedy this is let the kids play outside in the sun.

There is one more concern which I have observed. When kids are fussy about food, parents rely on supplements to fill their need for micronutrients. Remember that supplements are called supplements for a reason. They should be used supplementary to food not as a substitute.

Dietary practices causing dietary inadequacy:
(For families which are affluent enough to afford food) (as summarized by Burton)

1. Omitted, small or poorly chosen breakfast.
   
2. Lunches eaten away from home are generally inadequate.
   
3. Failure to eat enough meat (for non-vegetarians), vegetables and fruits.
   
4. Children spend lunch money on candies and soft drinks which constitute empty calories.
   
5. Choice of food is left to the kid (no adult guidance)
   

Govt. Initiatives to combat malnutrition:

• Mid-day meal programme
  
• Information, education, and communication (IEC) campaign:
  This campaign was started in Nov. 2012. The four stages of the campaign are:
  

1. Stage 1- Create Awareness
2. Stage 2 – Clarion
   This stage called for a community pledge “Malnutrition Quit India”
3. Stage 3 – Action Points
   Four critical practices 'Chaar Baatein' were taught that safeguard a child from malnutrition.
   a) Pregnant women must eat healthy.
   b) Mother’s first milk is the best for the child.
   c) Exclusive breast feeding for first six months.
   d) Seventh month onward complementary foods should be introduced.
4. Stage 4 – Community using Tools/Services
   
   

   

   Courtesy: IEC campaign (Ministry of women and child development's Nutrition Resource Platform)

   
   

    
   State governments have also implemented many schemes to combat malnutrition. The innovative scheme which deserves a mention is ‘Akshaya Patram ’ scheme of Karnataka and Tamil Nadu.
   Karnataka started Akshaya patram initiative to enhance participation in ICDS. An inexhaustible pot is hanged in AWCs where community, children coming to AWCs, parents can donate anything in kind like vegetables, toys etc.
   Similarly, in Tamil Nadu, mothers of children coming to AWCs are encouraged to send their children with one vegetable each and drop it in the common container (Akshaya Patram) which is used for cooking meals provided at the AWC.
   
   
   In spite of the govt. initiatives, malnutrition in India is still a critical issue. Poverty, lack of education and awareness are no doubt the main hurdle to the campaigns. Though, we as writers can write about these issues, the real problem is the concerned people are the ones who can’t benefit from it. (Most of them are illiterate). We need to break our cocoons, and get through to these people by direct communication. In a democracy, people can’t rely on the government for every single thing. It is our duty to help the fulfillment of the policies which are aimed for betterment of our country.
   
   
   Besides, even the educated people in India are ignorant. Most of the parents aren’t aware of what a balanced diet actually constitutes. Overnutrition can be as harmful as underutrition. The balanced diet should contain adequate food from all the four basic food groups. The most important duty of a parent is to oversee that their child eats a balanced diet with adequate nutrients, ample fibres, iodised salt, and without junk food.
   
   
   The information for mothers to prevent malnutrition is available on Ministry's Nutrition Resource Platform (NRP)
   www.poshan.nic.in
   www.akshayaposhan.gov.in

Resources:

www.wcd.nic.

http://mospi.nic.in

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This post is part of Shankhnaad for happy children. To know more about the initiative check Happy children equals a happy world.