Chapter Notes

Introduction

Nutrition is the process by which our body gets and uses nutrients from the food we eat for growth, repair, and overall well-being. For children, who are growing continuously, nutrition is especially critical. Their nutritional needs change depending on their growth rate and body weight at different stages.

Physical and mental development happens very rapidly during childhood. Any nutritional deficiency at this stage can lead to lifelong impairments. On the other hand, adequate nutrition helps children reach their full potential.

Adequate nutrition contributes to:

• Proper functioning of body organs and systems.
• Better cognitive performance (thinking and learning).
• A stronger ability to fight diseases and heal.
• Higher energy levels.
• A pleasant and positive attitude.

Nutrition, Health and Well-being During Infancy (BIRTH-12 MONTHS)

Infancy is a period of incredibly rapid growth, especially from birth to six months. An infant's nutritional needs are very high to support this growth.

Key Growth Milestones in Infancy:

• Weight: Doubles in the first six months and triples by one year.
• Length: Increases from about 50-55 cm at birth to 75 cm by the end of the first year.
• Head and Chest Circumference: Both increase significantly.

To support this phenomenal growth, infants need energy and specific nutrients:

• Protein: For muscular growth.
• Calcium: For building healthy bones.
• Iron: For growth and the expansion of blood volume.

Dietary requirements of infants

For the first four to six months, a well-nourished mother's breast milk (about 850 ml per day) provides all the nutrients an infant needs. The mother's own diet is crucial; she should eat foods rich in protein, calcium, and iron and drink plenty of fluids.

Breast feeding

Mother's milk is the perfect food for a newborn. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months, meaning the baby doesn't even need water.

• Colostrum: This is the yellowish fluid produced in the first two to three days after birth. It is extremely important because it is rich in antibodies that protect the baby from infections.

Benefits of breast feeding:

• For the baby:
  • It is perfectly tailored to meet the infant's nutritional needs.
  • Nutrients are in the right proportion and are easily absorbed (e.g., emulsified fat).
  • It protects against gastro-intestinal, chest, and urinary infections due to antibodies that provide natural immunity.
  • It is hygienic and always available at the right temperature.
• For the mother:
  • It is a convenient method of feeding.
  • It provides protection against breast and ovarian cancers and weak bones.
  • It helps build a strong emotional bond between mother and child.

Feeding the low birth weight infant

A baby weighing less than 2.5 kgs at birth is considered low birth weight. These babies often have poor sucking reflexes and a small stomach, but they have very high calorie needs. Their mother's milk is the best food because it contains essential amino acids, calories, and fats, and its anti-microbial properties protect them from infections.

Complementary foods

Complementary feeding is the process of introducing other foods alongside breast milk, typically starting around six months of age. These foods are called complementary foods.

Guidelines for complementary feeding:

• Introduce only one new food at a time.
• Start with small quantities and gradually increase them.
• Do not force a child to eat a food they dislike; try again later.
• Avoid spicy and fried foods.
• Encourage variety to make new foods more acceptable.

Some low cost complementary foods: These are often made from locally available cereals, pulses, and groundnuts, which are roasted and mixed in specific proportions. Examples include:

• Balahar: A mix of whole wheat, groundnut, and bengal gram flours.
• Poshak: A mix of cereal (like wheat or rice), a pulse (like chana), groundnut, and jaggery.
• Amritham: A mix of wheat, bengal gram, soya, groundnut flours, and beet sugar.

Immunisation

Good health also depends on protection from diseases. Immunisation is the process of protecting children from various diseases through vaccines.

A vaccine contains an inactive form of a germ (bacterium or virus). When injected, it doesn't cause the disease but stimulates the body’s white blood cells to produce antibodies. These antibodies then protect the child if they are ever exposed to the actual germ.

National Immunisation Schedule for Infants:

• Birth: BCG (for TB), OPV (Oral Polio Vaccine), HEP B (Hepatitis B)
• 6, 10, and 14 weeks: OPV, PENTA (DPT, HEP B, HiB)
• 9 months: MR (Measles, Rubella)

Common health and nutrition problems in infants

Malnutrition (both under- and overnutrition) is a major national problem, often caused by poverty, illiteracy, and poor access to healthcare. Common deficiency diseases in childhood include:

• Protein Energy Malnutrition (PEM): Leads to poor growth and infections like diarrhoea.
• Anemia: Caused by iron deficiency.
• Nutritional blindness: Caused by Vitamin A deficiency.
• Rickets: A bone-related disease due to a lack of Vitamin D and calcium.
• Goitre: Enlargement of the thyroid gland due to iodine deficiency.

Infections like diarrhoea are very common and can cause dehydration (loss of water and electrolytes), a major cause of infant mortality. The problem worsens when malnutrition and infection exist together.

Nutrition, Health and Well-being of Preschool Children (1-6 YEARS)

During the preschool years, the rapid growth of infancy slows down, but children are very active and energetic. This is a crucial time for establishing healthy eating habits that can last a lifetime.

Nutritional needs of preschool children

The nutritional needs of preschoolers are similar to those of the rest of the family, but the amounts differ based on their age, size, and activity level.

Guidelines for healthy eating for preschoolers

• Make mealtime a family time: Eating together in a pleasant atmosphere helps children learn good eating habits by imitation.
• Offer variety and child-sized portions: Encourage them to try different foods and finish what's on their plate.
• Maintain regular meal and snack times: This helps the child feel hungry at the right times.
• Introduce new foods with familiar ones: Balance textures and colors to make meals interesting.
• Serve easy-to-eat foods: Finger foods like small sandwiches, chapatti rolls, or idlis are great options.
• Never bribe or punish a child to eat: This can create negative associations with food.

Planning balanced meals for preschool children

The diet of a preschool child should focus on three key aspects:

1. Variety: Different textures, tastes, and colors to broaden their eating experience.
2. Balance: A mix of complex carbohydrates, lean proteins, and essential fats.
3. Moderation: Limiting sweets, ice creams, and fast foods that are high in fat and refined flour.

Because preschoolers have small stomachs, healthy snacks between meals are important to provide the necessary calories and nutrients.

Feeding children with special needs

Feeding children with special needs requires patience and attention to three main aspects:

1. Observations: Watch the child's abilities, food preferences, and allergies to help them get adequate nutrition.
2. Developing eating skills: Be patient, as they may need more time to eat. Encourage self-feeding skills and use positive reinforcement. Adaptive equipment may be helpful.
3. Special diets: Some children may need modified diets. For example, liquids may need to be thickened for a child who has trouble swallowing, or allergenic foods must be removed completely.

Immunisation

Preschoolers require further vaccinations to protect them from communicable diseases.

• 15-18 months: MMR (for measles, mumps, and rubella)
• 16 months - 2 years: DPT and OPV booster doses
• 2 years: Typhoid Vaccine
• 5 years: DT (Diphtheria, Tetanus)
• 18, 24, 30, 36 months: Vitamin A drops

Health, Nutrition and Well-being of School-age Children (7-12 YEARS)

During the school-age years, growth is slower and more gradual compared to infancy. However, children are extremely active. From around 9-10 years old, boys and girls begin to show different growth patterns.

Nutritional requirement of school children

Though growth is slow, high activity levels mean that energy needs remain crucial.

• Up to age 9: Nutritional requirements are similar for boys and girls.
• Ages 10-12:
  • Girls: Need increased amounts of protein, iron, and calcium to support bone growth and prepare for menarche.
  • Boys: Need more calories to build reserves for the adolescent growth spurt.

Planning diets for school-age children

Planning meals for this age group involves a few key principles:

• Aim for variety: No single food provides all nutrients, so eating a variety of foods is the best way to ensure good nutrition.
• Ensure good nutrition: Encourage eating vegetables, fruits, and whole grains. Using iodised salt is a simple way to prevent iodine deficiency.
• Limit saturated fat, salt, and sugar: Diets high in these can increase the risk of obesity, dental cavities, and high blood pressure.
• Ensure eating breakfast: Skipping breakfast can negatively affect a child's physical and mental performance at school.
• Involve children in meal planning: This makes healthy eating more interesting and teaches them about making good food choices.

Factors that influence diet intake of preschool-age and school-age children

Even with careful planning, several factors can influence what a child eats.

• Family environment: Children learn their eating habits from their family. Eating together in a positive atmosphere encourages good habits.
• Media: TV commercials and celebrity endorsements strongly influence children's food choices, often promoting foods high in sugar, fat, and salt.
• Peers: As children start school, their friends' eating habits become very influential. They may be more willing to try new foods if their friends are eating them.
• Socio-cultural Influences: Children learn to enjoy the typical foods of their region and culture by eating with their family.
• Erratic Appetite: It is normal for a child's appetite to vary from one meal to the next. This is usually temporary and shouldn't be a cause for worry.

Healthy habits

Beyond a balanced diet, school-age children need to develop other healthy habits:

• Establish sensible eating habits: Avoid mindless munching in front of the TV.
• Encourage physical activity: Aim for 45-60 minutes of moderate activity daily. Limit screen time and encourage sports.
• Ensure food safety: Teach children to wash their hands and food before eating and to eat in hygienic conditions.
• Ensure control over quantity intake: Allow children to gauge their own hunger. Forcing them to eat more can override their natural feeling of fullness.

Health and nutrition issues of school age children

India faces a dual problem of both undernutrition and overnutrition.

• Obesity: This is a growing risk, especially among children from higher socioeconomic groups. It is largely caused by diets high in fatty foods and sugar, combined with a non-active lifestyle. This rise in childhood obesity is also leading to an increase in Type II diabetes and hypertension among young people.
• Under nutrition: This remains a serious problem among lower socio-economic groups. Malnourished children from poor families often go to school hungry, which affects their performance and puts them at risk of illness.

The Mid-day Meal Scheme (MDMS) is a government program that provides free lunch to school children. It has shown excellent results by:

• Improving classroom performance and attention spans.
• Increasing school enrolment and reducing drop-out rates.
• Reducing the gender gap in education by boosting female attendance.

Key terms and their meaning

• Complementary feeding: The inclusion of other foods in an infant's diet in addition to breast milk.
• Malnutrition: A condition that refers to both undernutrition (lack of nutrients) and overnutrition (excess of nutrients).
• Obesity: A condition where excess fat is deposited in the body, causing body weight to rise above normal levels. It is caused by consuming more calories than are used by the body.
• Hypertension: High blood pressure.
• Diabetes: A condition caused by a deficiency of insulin, leading to high blood glucose levels.