1. NUTRITION IN INFANCY AND CHILDHOOD By Dr. Sarder Mahmud Hossain, Ph.D

2. Objective Identify the Nutritional Problems & Changing Nutritional Needs in Infancy & Childhood.

3. 1.Chronic Energy Deficiency and Under nutrition. 2.Micro-nutrient Deficiencies. 3.Anemia due to Iron and Folate Deficiency. 4.Vitamin A Deficiency. 5.Iodine Deficiency Disorders. 6.Chronic Excess Energy and Obesity. Major nutrition-related public health problems

4. Major nutrition-related public health problems-contd a.Low birth weight – why is it remaining unchanged? b.Why are we unable to ensure exclusive breast feeding for the first six months ? c.Timely appropriate & adequate complementary feed. d.What is responsible for low dietary intake and high under-nutrition rates in preschool child ?

5. e.What can we do to reduce anaemia in children? f.Massive dose Vit A -Where do we go now ? g.Can we achieve universal access to iodized salt by 2010? h.What should we do to tackle over- nutrition ? j.What are the priority areas for R&D? Major nutrition-related public health problems-contd

6. Trend of Low Birth Weight in Bangladesh Life expectancy at birth— a. In 1981---55 Years b. In 2002---65 Years----(SVRS, 2002) Infant Mortality Rate (IMR)--- a.In 1981---111/1000 of live births b.In 2003---53/1000 of live births--(BBSSVRS, 2003).—Country Health System Profile

7. Trend of Low Birth Weight in Bangladesh-contd Maternal Mortality Rate--- a. In 1992—4.7/ 1000 of live births. b. In 2002---3.9/ 1000 of live births. (SVRS, 2002). Food supply and nutritional status— a. From 1993-1995---50% b. In 2005--------------40% c. Underweight ≤ 5 yrs (W/A)— (1). Severe---12.8% (2). Moderate—47.5%

8. Trend of Low Birth Weight in Bangladesh-contd Food supply and nutritional status— a. From 1993-1995---50% b. In 2005--------------40% c. Underweight ≤ 5 yrs --(W/A)— (1). Severe---12.8% (2). Moderate—47.5% (3). Severe---16.9%---(H/A) (4). Moderate—43%

9. IDDs-------------- 69% a. The total goiter rate is 47.1%. b. Visible Goiter --- 8.8%. c. Cretinism—0.5%, In 1993. Anaemia in pregnant women---- 1982/83 a.Anaemia in Adult women---74% b.Anemia in children ≤5 -------73% The fig remained unchanged till 1990-95.

10. Life style with risk factors 1.Regular Smokers (male)---- 41% 2.Regular Smokers (Female)--4.3%

11. LBW in Rural Bangladesh LBW---24%, 2005 (Oxford University Press) LBW doubles the neonatal mortality rate (NMR) in periurban setting of Bangladesh. The group of infants most likely to benefit from improvements in low-cost essential care for the newborn accounted for almost 61% of neonatal mortalities in the cohort.

12. Birth weight and health In Bangladesh a little less than one third of all infants weigh less than 2.5 kg at birth. Low birth weight is associated with ---  Low growth trajectory.  ?Increased risk of obesity, diabetes and coronary heart disease in later life.

13. Child Nutrition Begins with Maternal Nutrition

14. Energy requirement 1.Infants--- a.0-6 months---108 kcal/Kg --650 kcal/day. b.7-12 months—98 Kcal/kg—850Kcal/day. 2.Children----- a.1-3 y---102 Kcal/kg--------1300 kcal/d. b.4-6y—90 Kcal/Kg----------1800 " c.7-10 y---70 Kcal/Kg--------2000 "

15. Stages of Family-contd The stages do not occur in exactly the same way in all families. Some families can be in two stages at one time. For example, the same family could be living with an adolescent and launching an older child.

16. Stages of Family-contd Because we have much more knowledge about families and about nutrition, we need to consider both for the well-being of each family member. Follow the recommendations from both the food pyramid and the dietary guidelines. Many health problems are linked to nutrition. Exercise is important throughout the life cycle.

17. Preschool Children(4-6 yrs) Sweets should be limited in a preschool child’s diet; nutrient-rich foods can be used to satisfy hunger. After the age of one, a child’s growth rate slows and with it, the appetite; Children develop tastes for certain foods at an early age. The eating habits and attitudes children learn are likely to last a lifetime. It is important to start healthy eating habits early.

18. Some suggestions to help encourage young children to eat a variety of foods are: Invite a friend to eat; you’ll be amazed how much they eat when their friends are eating. When introducing a new food, refer to it as a grown-up food. Serve it to the child only if he or she requests it after seeing how much you enjoy it. Serve young children’s meals on their own small-sized dishes. Give them tiny servings, so they can have satisfaction of eating everything on the plate..

19. Some suggestions to encourage young children to eat a variety of foods are-contd Serve finger foods often. Children like to choose from a variety of foods, as in a buffet. Children will usually eat the foods they have helped prepare. Vary meal situations - picnic in front of the fireplace, park, etc. Children usually prefer raw vegetables to cooked. Avoid making dessert a reward for vegetable eating. Relax and let mealtime be a time for everyone to enjoy. Use snacks to improve food habits.

20. Some children need snacks Some children have the capacity to go easily from one meal to the next without hunger. Others actually experience real hunger within two to three hours after eating, especially if they are growing rapidly. If no nutritious snack is offered, this hunger may eventually be satisfied by soft drinks, candy, or other non-nutritious food. Timing is important; a snack should be offered when children are hungry but not so close to mealtime that it spoils their appetites for the next meal.

21. Children Follow the recommended number of servings and serving sizes for children. Serving sizes/portions for children are smaller than adults. Need a variety of nutrient-dense foods in small frequent amounts. Expose to new and a wide variety of foods. Introduce new foods one at a time. Taste buds are very sensitive. Avoid sweet foods as snacks. Make foods interesting and inviting for children; color, texture, shape, size and temperature.

22. Key messages Malnutrition is estimated to be an ‘underlying cause’ of about 60% of childhood deaths in Bangladesh. This attribution as an ‘underlying cause’ hides the observation that, if malnutrition had been corrected, the child would not have died. There have been slow improvements in overall nutrition indicators in Bangladesh.

23. Key messages-contd Exclusive breastfeeding is widely recommended, but poorly practiced in Bangladesh. Many small- scale interventions have effectively improved rates of exclusive breastfeeding, but none has been effectively brought to scale. Children in Bangladesh ‘fall off the growth curve’ when they start to take complementary foods. Improving growth during this time will require efforts to improve complementary feeding behaviours. Families have been receptive to these changes when introduced through small-scale education.

24. Under nutrition in Preschool children Role of poverty and poor caring practices Screening, early detection and effective management can change the scenario

25. Micronutrient deficiencies All effort for combating anaemia Review Vitamin A supplementation Universal access to iodised salt

26. Promote breastfeeding, improve complementary feeding Dietary diversification Double fortified salt Screen all children where ever possible – school health, hospitals OPDs Detect and treat anaemia vigorously Combating anaemia

27. Food guide Eat a variety of foods Balance the food eaten with physical activity. Choose a diet with plenty of grain products, vegetables and fruits Choose a diet low in fat, saturated fat, and cholesterol Choose a diet moderate in sugars and salt Choose a diet that provides enough calcium and iron to meet their growing body's requirements.

28. Food Guide-contd Grain group servings include 1 slice of bread, 1/2 cup of cooked rice or pasta, 1/2 cup of cooked cereal, and 1 ounce of ready to eat cereal. Your child should eat 6 servings from this group.

29. Food Guide-contd Vegetable group servings include 1/2 cup of chopped or raw vegetables, or 1 cup of raw leafy vegetables. Your child should eat 3 servings from this group.

30. Food Guide-contd Fruit group servings include 1 piece of fruit or melon wedge, 3/4 cup of 100% fruit juice, 1/2 cup of canned fruit, or 1/4 cup of dried fruit. Your child should eat 2 servings from this group. Milk group servings include 1 cup of milk or yogurt or 2 ounces of cheese. Your child should eat 2 servings from this group.

31. Food Guide Meat group servings include 2 to 3 ounces of cooked lean meat, poultry or fish, 1/2 cup of cooked dry beans. You can substitute 2 tablespoons of peanut butter or 1 egg for 1 ounce of meat. Your child should eat 2 servings from this group.

32. Food Guide-contd Fats & Oils: No more than 30% of your diet should come from fats. For a 1600 calorie diet, that would equal 53g of fat each day, with most preschool children requiring even less. The type of fat that you eat is also