Pal Dalal NutritionSecurity

Nutrition Security in Young
Children
Dr. Rupal M Dalal, MD FAAP IBCLC
Adjunct Associate Professor, CTARA IIT B
Director of Health, Shrimati Malati Dahanukar Trust, Maharashtra
Important Questions…
• What is Nutrition and other terminology?
• What does security encompass?
• Why young children?
• How?
Nutrients, Nutritious, Nutrition
• Nutrient is the constituent
• Nutritious is descriptor
• Nutrition is a state or a condition

40 Essential Nutrients
Nutritious Foods
Nutrition Status of Infants
2 months baby
Nutrition Status of Toddlers
18 months old twins 15 months old
Food Security to Nutrition Security…
Earlier Definition from 1996 World Food Summit defined food security
as a state or condition
“When all people, at all times, have physical, economic and

social access to sufficient, safe and nutritious food to meet
their dietary needs and food preferences for an active and
healthy life”
FAO Report of the World Food Summit (FAO, 1996).

FAO, WFP & IFAD. The state of food insecurity in the world
In their 2012 report6 , the Committee for
World Food Security set the benchmark as
“When all people, at all times, have physical, social and

economic access to food which is safe and consumed in
sufficient quantity and quality to meet their dietary needs and
food preferences, and is supported by an environment of
adequate sanitation, health services and care, allowing for a
healthy and active life”
CFS. Global strategic framework for food security and nutrition

41–42 (FAO, 2012).
Why Young Children?
5.5 months old baby
Breastfeeding
Breastfeeding & Complementary Foods

❏ Data for 699,421 children aged 0–59 months, drawn from 125 DHS implemented between 1992
and 2014 in 57 countries
❏ The outcome variables were height-for-age Z scores (HAZ) and stunting (HAZ<-2), and
weight-for-height z scores (WHZ) and wasting (WHZ<-2)
❏ Independent variables included household wealth, parental education, maternal height,
demographic factors, and exposure to WASH and health services
❏ Most linear growth faltering and wasting takes place prior to 23 months of age
❏ Estimates of the magnitude of association with wealth, education and improved toilet use from
HAZ regressions(Stunting)are systematically larger in the sample of children 24–59 months than
in the 0–23 month or 0–59 month samples
❏ The reverse is true for WHZ regressions (Wasting)
❏ Linear growth rate before, but not after 12 months of age, and infant weight before four months
of age signiﬁcantly predicts child intelligence quotient (IQ) at age 9 years. Neither child linear
growth nor weight after 12 months is associated with child IQ nine years later
❏ Systematic review of 38 studies found that children with IUGR born at 35 weeks of gestation or
later scored 0.5 standard deviation units lower across all neurodevelopmental assessments.
This difference was 0.7 standard deviation units in children with IUGR born before 35 weeks
gestation
❏ The relationship between brain growth in different periods of pre- and postnatal life and
cognitive function was investigated in 221 9-year-old children whose head circumference had
been measured at 18 weeks gestation, birth and 9 months of age.
❏ Full-scale IQ at age 9 years rose by 1.98 points for each SD increase in head circumference at 9
months and by 2.87 points for each SD increase in head circumference at 9 years of age.
❏ There was no relation between IQ and measurements of head size at 18 weeks gestation or at
birth.
❏ Brain growth during infancy and early childhood is more important than growth during foetal
life in determining cognitive function
Age-wise Nutrition Status of Children of India – NFHS 4
Effects of Nutrition Insecurity in Children & Adolescents
• Undernutrition & anthropometric failures
• Poor overall health and more hospitalizations
• Children with food insecurity are more likely to be iron deficient & other micronutrient deficient,
as are adolescents with food insecurity
• Food insecurity is associated with lower bone density in preadolescent boys
• Poverty is associated closely with the development of obesity
• Lower cognitive indicators, dysregulated behavior, and emotional distress
• Higher risk of developmental & behavior problems, which presage impaired school function,
compared with children of the same age living in low-income, food-secure households
• Longitudinal studies have shown that food insecurity in kindergarten students predicts reduced
academic achievement in math and reading over a 4-year period.
• Adolescents in food-insecure families are more likely to experience dysthymia and suicidal
ideation
Promoting Food Security for All Children

COUNCIL ON COMMUNITY PEDIATRICS, COMMITTEE ON
NUTRITION
Pediatrics Nov 2015, 136 (5) e1431-e1438; DOI:
10.1542/peds.2015-3301
Under 6 Months of Age Babies
Elephant in the Room…
Widespread BF Failure – Nutrition Insecurity to our Babies
Why Every Mother Needs Help
Sample of 532 First Time Mothers at UC Davis Hospitals, CA
92% of the new moms reported at least one breastfeeding concern
Concerns at any postpartum interview were significantly associated with increased risk of stopping breastfeeding and formula use, with
peak ARR at day 3 (eg, stopping breastfeeding ARR [95% confidence interval] = 9.2 [3.0–infinity]). The concerns yielding the largest
adjusted PAR for stopping breastfeeding were day 7 “infant feeding difficulty” (adjusted PAR = 32%) and day 14 “milk quantity” (adjusted
PAR = 23%)
Wagner EA, Chantry CJ, Dewey KG, Nommsen-Rivers LA. Breastfeeding concerns at 3 and 7 days postpartum and
feeding status at 2 months. Pediatrics. 2013 Oct;132(4):e865-75.
Reasons for stopping significantly associated with mother’s breastfeeding intention. (N =
1177).
Pediatrics
. 2013 Mar;131(3):e726-32. doi: 10.1542/peds.2012-1295.
Epub 2013 Feb 18
Breastfeeding – What it Should be & What it is Now….
The ideal ….
Indicators for assessing infant and young child feeding practices Definitions and measurement methods. WHO and UNICEF 2021
If there is breastfeeding failure …..this is it
The ideal ….and the current ..
That,
Was essentially the story of IYCF in India.

Moral of the Story
The More..
We do the Same …
The More…
We Remain Static
What we need to do?
A thorough revisit into our approaches
A…Creative disruption
Is Disruption Possible under 6 Months of Age for
Nutrition Security?
Yes!!
How?
Effective Breastfeeding Skills
Cross cradle hold with 45 points of counselling
6 months old boy
Gain in Length with CC Hold & 45 Points
Complementary Feeding
It is important to have a strong foundation of a good
st
weight gain on breastmilk in the 1 6 months to have a
smooth introduction to CFs
Total children age 6-23 months receiving an adequate diet
( NFHS 4 vs NFHS 5 )
17 of 22 states improved total child dietary diversity

Concept of Type 1 & Type 2
Nutrients
40 Essential Nutrients
Functional Nutrients
• Important to fight infection
• Make eyes, bone, gum, teeth
strong
• Make our blood red so that we
don’t get tired
• Important for many organs
Growth Nutrients
• To help us grow tall in the
growing phase
• To build muscles
• For hair, nails, skin
• To give us energy
• For our vital organs like brain,
eyes, heart
Clinical Difference between 2 Types
Functional Nutrients Growth Nutrients

Among macronutrients, children require good amount of first class
protein to grow muscles, bones & other organs while they require good
fats for their brain and energy.. Complex carbohydrates rich in fiber are
important for gut microbiome..
5 meals + Breastfeeding
Steps to Initiate Part of family meals (1 cup per
meal)—5 meals i.e 3 main meals, 2
Complementary Feeding 4 meals + Breastfeeding
snacks like fruit, curd
Stop giving paste instead >12m Add nuts/seeds/leaf powders to

3 meals + chunky food 1/2 cup snacks
Breastfeeding
9-11m
Quantity of food per
meal =1/2 cup (250ml)
Consistency is At 8m
2 meals + Breastfeeding mashed/lumpy 5 meals + Breastfeeding
(Day 1) Give soft and finger foods
One meal would consist of At 7m
1/2cup (Eg: boiled egg and
1tbsp (15gm) of first food cooked veg pieces)
(Choose only 1 food from
options ) >6m
>6m
>Day 3-13: Same no of meals+BF Safe preparation and storage of baby

Choose 1 new nutrient dense food from food food Safe servinf of baby food
groups every 4th day; Same preparation style
Include combinations with cereals and
Increase 1 tbsp of new food paste and reduce pulses, soon as possible after 6 months
1 tbsp of old paste of age
(Eg: By Day 7, one meal =1 tbsp of third food Absorption of nutriets—roasting,
paste + 3 tbsp of first & second food paste) germinating, fermenting and cooking.
At 6m completion, choose from options like

chickpeas, sprouted green gram beans, pureed
egg, chicken or fish
Whole beans can be cooked, pureed or
sprouted
How to make thick paste;
Consistency of paste is such that it stays on spoon
when titled
First 3 days plan: Every day increase first food
paste by 1 tbsp
Complementary Feeding: Key Considerations
6m
completion
At 7m
At 8m
9-11m >12m
Preparation of first food paste:

A thick paste made with expressed breastmilk else
use boiled cold water if breastmilk not available
Consistency must be age appropriate! (>6m, 7m,

8m, 9-11m and 12m completion)
• 11 months
Thank You…. • 5 months old
• 4 months old

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Nutrition Security in Young

• What does security encompass?

• Why young children?

• Nutrition is a state or a condition

“When all people, at all times, have physical, economic and

FAO Report of the World Food Summit (FAO, 1996).

“When all people, at all times, have physical, social and

CFS. Global strategic framework for food security and nutrition

Breastfeeding & Complementary Foods

Promoting Food Security for All Children

The ideal ….and the current ..

Was essentially the story of IYCF in India.

A thorough revisit into our approaches

17 of 22 states improved total child dietary diversity

Functional Nutrients Growth Nutrients

Stop giving paste instead >12m Add nuts/seeds/leaf powders to

>Day 3-13: Same no of meals+BF Safe preparation and storage of baby

At 6m completion, choose from options like

Preparation of first food paste:

Consistency must be age appropriate! (>6m, 7m,

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