Title of Paper: Nutrition and Growth
Type of Paper: Paper produced by UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP, and the World Bank
- Malnutrition is defined as an improper amount of energy (calories), proteins, carbohydrates, fats, vitamins, minerals, or other nutrients needed to maintain healthy functioning of the body’s organs and tissues.
- Malnutrition can occur from being overnourished or undernourished; however, malnutrition due to undernutrition is more prevalent in most parts of the world.
- Children need a caring and protective environment in which caregivers ensure they are well-nourished and receive a healthy diet.
Risk Factors for Malnutrition:
- Risk factors for undernutrition, especially in children, include:
- Lack of food
- Recurrent illness and/or diarrhea
- Inappropriate feeding practices
- Lack of care
- Poor hygiene
- Children with chronic diseases (e.g., HIV)
- Children with disabilities, who may need special attention to ensure they receive adequate nutrition
- Low birth weight
- Risk for undernutrition is greatest during the first two years of life.
- Children are the most vulnerable to becoming malnourished when they live in conditions that provide inadequate food and have a high risk for illness or diarrhea. When children become sick, they lose energy and proteins, minerals, and nutrients quickly.
- Overnutrition occurs when children eat large quantities of food high in energy (calories). These foods are often inadequate in other nutrients, such as vitamins and minerals.
- Young children grow rapidly, and growth should be monitored regularly. When growth is monitored regularly, warning signs for malnutrition include not gaining weight or growing in height.
- Use of growth charts:
- Every child should have his or her own growth chart which tracks the child’s growth every time he or she is measured.
- For each measurement (e.g., height or weight), the child’s growth should be marked with a dot and the dots should then be connected with a line. If the line goes up, a child is growing well. If the line stays flat or goes down, a child is not growing well and there is need for concern.
- Weight gain is the most important indicator that a child is healthy.
- From birth until 1 year of age, an infant should be weighed at least monthly.
- From 1 to 2 years of age, a child should be weighed at least every 3 months.
- Good nutrition and hygiene are important for linear growth.
- Low-birthweight babies are at risk for being stunted and may need special attention with feeding.
- Very thin or swollen children need special medical care.
- Inadequate nutrition combined with illness or infection can quickly make a child dangerously malnourished, leading to severe acute malnutrition.
- In children over 6 months of age, ready-to-use therapeutic foods (RUTF) are often used to treat severe acute malnutrition.
Feeding and Dietary Recommendations:
- During the first 6 months of life, breastfeeding is the only source of nutrition (i.e, the only food and drink) an infant needs. If a breastmilk substitute is used, it should be fed from a clean, open cup, rather than from a bottle
- After 6 months of age, infants need a variety of foods in addition to breastmilk for healthy growth and development.
- Breastfeeding should be continued until 2 years of age
- Other foods given in addition to breastmilk provide protein, energy, vitamins, minerals, and other nutrients.
- Introducing semi-solid and solid foods after 6 months:
- If introduction to semi-solid or solid foods is done too late, children may not be getting adequate nutrition.
- Start with soft, mushy foods, and move to more solid foods gradually.
- The consistency of the food should be adapted to the child’s eating abilities and nutritional requirements. Generally, infants are able to eat the following:
- At 6 months of age: pureed, mashed foods, thick soups, porridges
- By 8 months of age: finger foods
- By 12 months of age: the same foods the rest of the family is eating.
- Avoid giving small foods that could cause choking, such as nuts, grapes, raw carrots, etc.
- General feeding practices for children over 6 months of age include:
- Frequent and small amounts of food, increasing the amounts as they grow.
- Children’s stomachs are small, and they cannot eat as much as an adult at one meal. However, the nutritional requirements to support growth are great, so they need to be fed frequently.
- An increasing variety of foods as they grow and develop.
- New foods should be offered gradually.
- A variety of foods should include vegetables and fruits, meats, poultry, fish, eggs, and dairy products.
- Foods that promote growth and provide energy are important and include:
- Beans, nuts, meat, fish ,eggs, dairy products, grains, and pulses
- Animal source foods are important to include daily. This may be difficult, and fortified foods or vitamin and mineral supplements may be needed.
- Small amounts of oil.
- Highly processed fatty foods and sugary foods are not recommended because they do not contain many important nutrients (e.g., vitamins and minerals) and will promote too much weight gain proportionate to height.
- Vitamin A, iron, and iodine are important nutrients for growing and developing children.
- Age-appropriate feedings:
- Between the ages of 6 to 8 months of age:
- Infants need to eat 2 – 3 times per day in addition to breastfeeding.
- At each meal, initially 2-3 spoonfuls of food is adequate, and this amount should increase gradually to ½ cup (250 ml).
- After 9 months of age:
- Infants need to eat 3 – 4 times per day in addition to breastfeeding.
- Additional snacks (e.g., fruit or bread with nut paste) may be needed 1 – 2 times per day.
- Amount of food per meal:
- 9-12 months of age: ½ cup
- 12-23 months of age: ¾ to 1 cup of “family foods”
- 2 years and older: at least 1 cup, and if the child finishes his or her food and wants more, more food needs to be offered.
Other Feeding Practices and Considerations:
- Feeding times are important for learning, love, and interaction, which promote physical, social, and emotional growth and development. Caregivers should interact and talk to the infants during feeding interactions.
- Good hygiene, safe water, and proper handling, preparation and storage of foods are critical to prevent contamination of food and consequential illness and diarrhea, which causes nutrient-loss and impaired growth.
- Food needs to be kept clean, including cooking or cleaning raw foods, eating cooked foods immediately, and storing and thoroughly heating leftover foods.
- Safe, clean water needs to be used.
- Feces need to be disposed of in a latrine, toilet, or buried. Hands must be washed thoroughly with soap and water after the use of the latrine or toilet. If this is not done, children may get worms or other sicknesses.
- When children are ill:
- They need additional fluids and should be encouraged to eat regular meals.
- Infants who are breastfeeding need to breastfeed more frequently.
- After an illness, energy and nutrients loss during the illness need to be replenished by offering children more food to eat.
- Children with developmental delays or disabilities may need more help and time for feeding.
- If the child refuses to eat and/or does not like the taste of a food, other foods should be offered.
- A child should have his or her own bowl to eat from. If meals are served from a common dish, young children may not get enough food. It is also difficult to monitor the food a child eats when eating from a common dish.
- For, children who are not growing properly, the cause for inadequate growth needs to be identified and addressed. Potential problems include:
- Child needs larger servings.
- Child needs more nutritious foods.
- Child needs more frequent meals.
- Child is sick.
- Child may need special care or assistance with eating.
- Safety and hygiene needs to be improved.
- Child needs more attention and interaction, especially during mealtimes.
Health Consequences of Malnutrition:
- More than one-third of child deaths are caused by malnutrition, specifically underweight.
- Underweight “weakens” the body’s immune system and resistance to illness.
- Malnutrition during the first two years of life slows growth and development, which is often irreversible.
UNICEF, WHO, UNESCO, et al. Nutrition and growth. Facts for life. 4th ed. New York: United Nations Children’s Fund; 2010:61-75.