1. PSYCHOSOCIAL CARE IN NUTRITION PROGRAMS PSP Castelldefels 2010

2. Main Principle of Malnutrition & Intervention HARDLY EVER ONE UNIQUE CAUSE SYSTEMIC APPROACH!

3. MAIN CAUSES OF MALNUTRITION Child development ( Growth & Development ) Resources Caretaker -Knowledge -Control resources -Workload -Mental Health -Social support Food-Production-Income-Property Health-WatSan-Medical-Security Child care practices -Care for women & children-Hygiene -Food preparation-Feeding practices Food intake Access to Health Care Unicef extended model 2006

4. Konrad Lorenz on imprinting, John Bowlby ’s Attachment theory, and Spitz ‘s hospitalism

5. Severe food shortage Lack of nutrious food Insufficient care / stimulation Poor health MalnutritionPsychosocial deprivation Developmental delays and Mental health problems WHO 2006 Mental Health and Psychosocial Well–Being among Children in Severe Food Shortage Situations

6. Nutritional Problems and mental health problems Nutritional problems and psychosocial stimulation and social difficulties Nutritional problems and developmental problems

7. CAREGIVER – CHILD LINK Attachment mother-child Attachment mother-child Insecurity: insisting on closeness Insecurity: insisting on closeness Anger, refusal food (anorexia) Anger, refusal food (anorexia) Separation mother-child Separation mother-child (Kwashiorkor) Family, other caregivers support Family, other caregivers support Role model (mother or other family) Role model (mother or other family) Cultural factors Cultural factors (ancestors, reincarnation..) PLEASE NOTE: CHILD-CAREGIVER RELATIONSHIP OFTEN STRAINED BEFORE MALNUTRITION

8. INDICATORS FOR INTERVENTION Caretaker:-Rejects the child, no pleasure in breastfeeding -Always wants to go out, no time with child -Complaints about the child -Alone / Not talking to others -Looks sad or cries -Age (absence of role model) Child: -Never Smiles, not drawing attention -Always lying down -Always lying down -Not playing -Not playing -Relapses/ no weight gain -Relapses/ no weight gain Special groups:-Widows -Geographically isolated caretaker -High child mortality in family

9. Malnutrition behavioural symptoms Phase 1 -Apathy, no interest -Regression behaviour -Hostility, Irritability -Clinging to mother -Eye-contact reduced -Anorexia Phase 2 -Emotional distortion - stop in development -Incontinence, -Repetitive play, words Phase 3 -Completely peaceful -Disconnected (closed eyes, food refusal, no reaction to auditive stimuli)

10. PSYCHOSOCIAL CARE IN NUT MAIN OBJECTIVES Improving caretaker-child relationship Stimulating the child Extra-care to caretakers with Mental Health problems Education regarding appropiate feeding practices to caretakers

11. Discussion What have you been observing yourself in nut programs? What can we put in place to address those issues? -Hospitalisation -Ambulatory Care

12. ITFC, Hospi, Stab centres Reception, triage Observation mother – child interaction: holding and feeding practices Appetite test Stimulation mother-child interaction: holding, touching, looking, talking Emotional support to mothers

13. Psychomotor stimulation of children Information and education to mothers Breast feeding group Playground Preparation to dismissal

14. Ambulatory Observation mother child relationship at admission Detection of most vulnerable Home visits Weekly, bi-weekly check up and food distribution Observation of meals taken on the spot Breast feeding group