Malnutrition in Children and Infants

Malnutrition as a global threat to children and babies health can result in both short and long term irreversible negative health effects. According to WHO it is responsible for around 54% child mortality in the world. The Global Nutrition Report 2018 finds that about 1/3rd children of the world suffer from some form of malnutrition. The time period between the conception of the baby and till the 2 years is very crucial for the overall development of the children. The children undergo huge brain development, growth and neuron pruning in these early two years. The loving relationship with caregivers usually parents in first 2 years are crucial for social, emotional and cognitive development. The brain develops from the beginning of life (in the womb) until the 2 years.

Read more on malnutrition and why it is a major cause of public health concern worldwide

Causes of Malnutrition in Children

The child malnutrition varies according to family wealth, mother’s education, mother’s age at first baby birth, birth history and other socio-economic and physical environment.

Good Parenting and family environment

Why parenting skills are important? According to the studies 90% brain develops in the first 3 years. Therefore not only good nutrition of mothers and infants matters but also good parenting is essential for emotional and social development. Children with good parenting are likely to be happier, independent and disease resilient in their later life. The experiences with caregivers or parents help in making new millions and millions of new connections in the brain.

On the other side, the negligence on the part of caregivers can make children more vulnerable to anxiety, depression and learning and memory impairments. Unfortunately, the breaking of the joint family system and busy schedule of parents has become hurdles for children to receive much-needed love, time and support of the parents and other family members. For centuries, the joint family system also provided the right kind of atmosphere to get parenthood skills from elder people and other siblings. The lack of parenting skills and practical experiences also impact the rate of breastfeeding and overall well being of the kids.

Healthy mothers and prenatal care

Why diet during pregnancy matter? During pregnancy, the body needs extra nutrients, vitamins, and minerals to meet the needs of the growing fetus. To meet the body requirements during pregnancy around 350 extra calories needed. A healthy and balanced diet can help in reducing birth complications like nausea and constipation. The poor diet and excessive weight gain may increase the risk of gestational diabetes.

Although everyone needs folic acid it is crucial for childbearing women. Lack of folic acid(Vitamin B9) can cause birth defects like the brain and spinal disorders and may cause death. The vitamin B9 helps in forming red and white blood cells. It is much helpful in the first 28 days after the conception when most of the neural tube defects take place. These birth defects occur in the first few weeks of pregnancy. But most of the time many women don’t know that they are pregnant before 28 days, therefore, folic acid should be taken before conception and during the pregnancy. It also helps in preventing miscarriage. The childbearing women need around 400 micrograms folic acid each day.

The balanced diet is good for both mother and child. It should be rich in vitamins, calcium, iron, fats, and carbohydrates. The nutritious diet is helpful for healthy birth weight, reducing the risk of anemia in mother and many serious birth fetus complications and boosting immunity of the child. The healthy diet may include protein, Vitamin C, Vitamin A, Calcium, grains, dairy products, eggs, legumes, fruits, and vegetables.

Food quality and quantity

Food security means quality food is available, accessible and affordable but due to poverty and many socio-economic causes, there is food insecurity in various nations. The imbalance in the nutrients required by the body and consumed from the food lead to malnutrition. Sub-Saharan African countries like Congo, Chad, and Niger are worst hit by poverty and hunger. Nearly 50% of people living in extreme poverty are 18 years old or younger. Due to extreme poverty, hunger kills 21000 people each day worldwide. 

Unsafe Drinking Water   

Unsafe water and sanitation have a direct impact on infectious diseases. Generally, when we talk about good nutrition, the food comes in our mind but clean water is also an essential part of a healthy nutritious diet. The contaminated water can lead to many water-borne diseases like diarrhea, cholera, typhoid, trachoma, etc. The unsafe or contaminated water along with poor sanitation and hygiene can cause stunting among children. The children miss the school due to the frequent episode of diarrhea and sickness which are caused by dirty drinking water. Many children due to lack of tapped water are forced to drink stagnant water of ponds, wells and from dirty streams. According to Thirsting for a future report around 36 countries are facing acute shortage of water.

Lack of sanitation

The poor hygienic conditions and poor sanitation invite the parasites and germs. The open defection also contributes to the pollution of drinking water. In a developing country like India where still people defect openly which is responsible for chronic infections via intestines. This reduces the ability of the intestine’s absorbing capacity. As a result, the nutrients in the food are not absorbed in the body. According to UNICEF around 1, 17,000 children died from Diarrhea every year. Sanitation is the main reason behind the high level of child malnutrition in India. The children who are exposed to open defection are suffered from chronic inflammation of gastrointestinal tracks which can cause stunting. 

Social inequality

In patriarchal society setup preferences are given to boy child hence the girl children are more likely to be malnourished than boys. Children belonging to low strata of the society may be more malnourished than high strata. In many countries, the economic decisions are made by men due to which both quality and quantity of food are not available for women and girl children.

Diseases and infections

According to WHO one of the dangerous consequence of malnutrition is the inability to resist diseases. In the absence of proper nutrients body and immune system become weak. Malnutrition in children is more dangerous in developing countries because of the prevalence of many communicable diseases like Cholera, Malaria, and Tuberculosis, etc.

The high frequency of diarrhea can cause acute malnutrition. Developing countries are also more prone to secondary malnutrition. For example, if a child is suffering from Diarrhea, the body cannot properly process minerals and nutrients available in the food. Since developing and underdeveloped nations suffer from lack of potable water, poor sanitation and hygienic conditions Diarrhea is common diseases among children.

Fast food culture and overeating

Malnutrition is not caused only due to lack of sufficient diet and energy but also due to excessive intake of the same. Children obesity is generally caused due to unhealthy lifestyle habits. Due to easy access and less time required to cook the consumption of fast food is increasing at an alarming rate across the world. The fast food lacks in Iron and has too much fat and added sugar. The fast and junk food is generally linked to obesity but it can also impact the learning abilities of the children according to new research. Therefore consumption of readymade food affects mental and physical development.

Overeating leads to weight gain and obesity. Obese children are at greater risk of developing serious health problems in their later life. Obesity can cause heart diseases, diabetes, sleep apnea, etc. But why children eat more? The possible causes of overeating can be emotional eating and binge eating disorder. You should encourage them for healthy eating habits. You should become a role model for them by establishing good eating habits for yourself.

Maternal Malnutrition

Immunity of children up to 5 years of age depends on the nutrition level of the mothers. Therefore compromise on healthy food and intake of nutrients during pregnancy can seriously affect the health of the newborn baby and mother. The maternal malnutrition can increase the risk of gestational anemia, hypertension and can be a cause of death of mother and baby. The newborn outcomes are strongly connected to maternal malnutrition. The bad lifestyles like eating junk foods, smoking, tobacco, and drinking (alcohol) can have an adverse impact on both mother and baby. There can be placental problems, heart and lung tissues complications. It is also important before getting pregnant the women should have a healthy weight. Underweight and overweight both can cause problems. Avoid eating raw meats and fish or undercooked food to keep yourself safe from harmful microorganisms. The pregnant women and their unborn children are at greater risk of developing Listeriosis (A foodborne disease).

Measurement

The WHO prepared growth chart and nations use this chart as a reference to measure the level of malnutrition. So, there are three commonly used methods to determine the malnutrition in the children.

Stunting

Stunting means the child has low height according to his or her age. Stunting is an indicator of chronic undernutrition, especially protein-energy deficiency which is caused due to prolonged deprivation of food and illnesses. It is generally irreversible after the age of 2 years.

It is estimated that stunting is 3 times more in poor children than the wealthy one. This is because wealthy families can better invest in nutritious food and can maintain hygienic conditions and can drink clean water and invest in better health care.

Wasting

A child is wasted if his weight is low for the height. It is an indicator of acute undernutrition and is the result of more recent food deprivation or illness. It can lead to diseases like Kwashiorkor and Marasmus.

Underweight

A child having low weight for age or less than 2.5 Kg at the birth is said to be underweight. Underweight is used as a common indicator to reflect both acute and chronic nutrition.

Mid-upper-arm-circumference (MUAC)

Each country has many ethnic communities. In some communities, people are of short stature but that doesn’t mean they are malnourished. There can be many discrepancies if the WHO growth chart is used to measure malnutrition. Therefore to avoid these errors another easy way (MUAC) of WHO is used. A child whose MUAC is less than 115mm is said to be severely malnourished. Children with 115-125mm MUAC are moderately acute malnourished and those having MUAC above 125 are considered normal.

Signs and Symptoms

Sometimes the physical measurements like height, weight, and MUAC are not enough to identify malnutrition in babies. It is not always that scarcity of nutrients or lack of food cause malnutrition but there may be some other reasons like a chronic illness. Due to Diarrhea child cannot absorb the nutrients available in the food. So if you find the below signs or behaviors of the child then consult with your pediatrician for further diagnosis and treatment.

Children lose interest in eating and get full too quickly. This inadequate eating may further complicate the situation.

Tiredness, fatigue, irritation, anxiety, lack of attention and too much crying are common with malnourished babies.

Children with malnutrition are inactive and don’t show interest in playing. Due to the weakness of muscles body strength is reduced to carry out daily activities.

They may not grow as expected in terms of weight, height or both.

They feel cold most of the time.

They can suffer from frequent vomiting. 

They lack immunity against infections and diseases. Slow recovery from diseases and injuries.

The skin becomes dry and scaly and hair may turn dry and fall.

A bloated stomach can be developed due to the lack of strength of muscles of the abdomen. Legs are swollen due to edema.

Malnourished children have poor cognitive and learning abilities.

Prevention of malnutrition

You can avoid malnutrition in your children by addressing the various physical, social, emotional and nutritious food needs. It should be a vital component of the comprehensive care of the child. Working closely with the pediatrician, health workers, and Anganwadi (school) workers, you can address the problem of malnutrition before it gets too dangerous for the health of your baby.

Make sure that your child eats nutritious food rich fibers, fruits, low-fat dairy products, vegetables, and whole grains. Help your child to develop a healthy eating diet at regular intervals (after 3-4 hours). It is important that children should pick up good eating habits at childhood so that they will benefit when they are adults. Teach them how to select healthy food choices and leave junk and fast food choices. Encourage your child to eat slowly and to chew food properly before swallowing.

 

Although safe drinking water and bad sanitation is not the problem of the developed world but developing and underdeveloped countries need to improve the basic facilities of safe water and toilets. They should promote proper hand washing by using soaps among children. The poor sanitation and hygienic conditions are roadblocks for a healthy population. These nations are going through demographic dividend and they must provide adequate basic facilities to reap the benefits of the demographic dividend and avoid disaster.

 

According to WHO Breast milk promotes sensory and cognitive development and protects the infant from chronic diseases. The WHO recommends that infants should be exclusively breastfed for the first 6 months followed by complementary foods while continuing breastfeeding up to 2 years or beyond. So, breastfeeding is essential for child growth. Pregnant women should be educated about the benefits of breastfeeding. Allow the mother and newborn baby to live together 24 hours a day. The health care providers who interact with pregnant women in a prenatal period play an important role in the encouragement of breastfeeding. And also improve feeding practices.

 

Water should be treated before drinking. Proper waste disposal mechanisms should be in place to stop contamination of environmental resources and to keep our self safe from communicable diseases and infections.

 

Women and communities should be educated for healthy foods and lifestyles. By increasing the birth spacing and reducing teenage pregnancy can reduce low birth weight problem. Delaying early marriages and pregnancy can help in curbing both maternal and infant mortality.

Consequences of malnutrition

Iron deficiency

Lack of Iron can develop iron deficiency anemia, a common nutritional deficiency in children. Iron helps red blood cells carry oxygen to the body. Children lacking in Iron may not develop adequate red blood cells. Iron deficiency can impact learning and behavioral aspects of the child. The teenage boys may develop an iron deficiency in their puberty. Iron deficiency is common in teenage girls because of the loss of Iron during menstruation. Around 27% of adolescent girls in developing countries are Iron deficient. According to WHO anemia is responsible for 20% of all maternal deaths.

The newborn baby gets Iron from mother by breastfeeding but once they start eating other foods, they should get enough Iron for better muscles and brain development. The symptoms of Iron deficiency may include tiredness, weakness, pale skin, rapid heartbeat, etc.

Iodine deficiency

Nearly 1/3rd children are at risk of iodine deficiency worldwide. It is a trace mineral required to produce thyroid hormone. It helps in regulating growth, metabolism, heart rate and other vital body functions. Its deficiency may result in goiter, hypothyroidism, miscarriage, stillbirth, congenital defects, infant mortality, and impaired growth. Lack of iodine may result in fatigue, weight gain, constipation, hair, and cold feeling. An adequate thyroid hormone is essential for normal growth and neurodevelopment in fetal life. The risk of developing complications is greater in the first 3 years of child life.

Vitamin A deficiency

According to WHO around 190 million preschool-age suffer from Vitamin A deficiency. It can cause visual impairment (night blindness) and may increase the risk of diseases and death. Vitamin A helps in the growth of tissues in nail, skin, and hair. It helps in bone growth and protects from infections.

Impaired growth and development

It can impair brain development, cognitive abilities, and physical development and can lead to reduced growth. Beyond the age of 2-3 years, the effects of chronic malnutrition are irreversible. Malnourished children since an early age can have a low ability to learn.

Economic loss

Malnutrition perpetuates the cycle of poverty. Poor families don’t have enough resources for a healthy diet and better health care of the children. Because of this most of the malnourished children belong to poor households and they earn less due to less productivity than better-nourished co-workers.

The long term human capital of the country is severely affected if the large population of children suffers from malnutrition. This will have a negative impact on the country’s GDP and overall economic development.

High risk of infections and Mortality

Around 19000 children die each day worldwide from the illnesses which could have been easily prevented. The newborn babies with low weight are at greater risk of morbidity. They are at risk due to both communicable and non-communicable diseases. They can easily suffer from malaria, respiratory illnesses, and diarrhea, diabetes and hypertension problems.

Low performance in Schools

The malnutrition in children can lead to an increase in absenteeism and poor performance in the schools. Millions of malnourished children who manage to reach to schools fail to learn basics and lack skills to earn their livelihood.

Malnutrition in India

In India malnutrition is rampant. According to the national family health survey –III which was conducted in 2005-06, the health of children is at dangerous status. India has 48% stunted (61 million), 20% wasted (25 million) and 43% under-weight (53 million) children below 5 years of age. Out of 25 million wasted children, 8 million suffer from severe acute malnutrition.

Despite the world third largest and fastest economy, India has the worst level of child malnutrition in the world. More than 100 districts of India are suffering child malnutrition. India is home to 33% malnourished children and 60% of them are from the states of Uttar Pradesh, Madhya Pradesh, Maharashtra, Rajasthan, and Tamilnadu.

Treatment

The treatment depends on the severity of malnutrition and complications. If you see any signs of malnutrition then you should consult with appropriate health workers to carry out tests like blood test, MUAC, etc. Many of the complications can be reversed if treatment is taken on time. The delay in the treatment can cause permanent damage to your child health and development. The pediatrician and dietitian will recommend an appropriate diet and supplements.

Children are the future of the world. Therefore, their health care and overall development cannot be ignored. The rights of children should be protected in letter and spirit. The food should have adequate macro and micronutrients for healthy development.   They should have access to safe drinking water, toilets, better health care system and family support. The governments across the world need to curb extreme poverty and hunger. They need to formulate plans and execute them in letter and spirit by working with other nations and NGOs. The prevention of malnutrition in children is the way forward.