Complementary Feeding Period 624 Months

Undernutrition, especially wasting and micronutri-ent deficiencies, is most prevalent during the complementary feeding period. Linear growth retardation is usually well established during this stage of the life cycle. This age group is particularly vulnerable because of its high nutrient requirements that cannot be supplied through breast milk alone. A variety of nutrition interventions have been proposed to prevent undernutrition, and the use of multiple approaches is likely to be most successful.

Breast feeding promotion Beyond 6 months of age, breast milk alone is not sufficient to sustain optimal growth and its contribution to energy and nutrient intake progressively declines. After the age of 12 months, breast fed children are not better nourished than non-breast fed children. However, prolonged breast feeding is very important and needs to be promoted because it improves child survival. The poor nutritional status of breast fed children older than 6 months of age is due to late introduction of an appropriately balanced diet. Family planning is an important intervention for promoting prolonged breast feeding because a new pregnancy can be a frequent cause of breast feeding cessation.

Nutrition education Undernutrition among children is often ascribed to ignorance, and nutrition education programs are often proposed to resolve this. However, choosing and recommending foods that are appropriate for promoting child growth at low cost is not easy. Moreover, micronutrient requirements in this age group are high, and it is usually not possible to provide a balanced diet without large quantities of animal source foods or fortified foods that are generally not readily available to the poor.

In theory, advising mothers to use nutrient-dense foods when they are available might improve child nutrition. Some nutrition education programs have be shown to be efficacious in pilot studies, but their effectiveness when scaled up has been disappointing.

Infection control Acute infections have a transient effect on the growth of young children. However, controlling chronic infections, including parasitic and other subclinical infections, can have a positive effect on growth. A general improvement in environmental hygiene and sanitation may be more effective in removing this cause of undernutrition than medical interventions per se, with the possible exception of regular deworming.

Food supplements Food supplements are designed to provide nutrients missing from the diet. They are usually made from a cereal flour mixed with a lysine-rich flour, generally soy flour, or milk powder to improve the amino acid balance (e.g., corn-soy blend). The fat content is usually low because fat mixed with flour is rapidly oxidized and cannot be added to food without costly packaging. Nowadays, such food supplements are usually fortified with micronutrients that are likely to be missing in chil-drens' diet, especially iron, zinc, retinol, and riboflavin.

The efficacy of food supplements has been tested in pilot programs, and most randomized trials that compared the growth of children receiving food supplements with that of children receiving the usual family diet failed to show a major effect on growth, especially height. The reasons for this are not clear. Biological factors may be involved. For example, most trials tested a low-cost supplement that had a high phytate content, which would limit the bioavailability of minerals such as zinc (known to be important for growth) and iron. Moreover, the food supplements were low in fat, which may be a limiting nutrient for children who usually have a very low fat intake. Finally, even in carefully controlled trials the food supplement may be shared within the family, especially if it requires special preparation, which would dilute its effect.

Besides the pilot trials, the use of donated food supplements has been usually limited to food crises, such as wars and environmental catastrophes. Food supplements are also available in the commercial market, but their price often precludes their use by those most in need of them.

Micronutrient supplements Vitamin A is routinely distributed through immunization programs and is a standard health package delivered in under-5 clinics to improve child survival. In very few countries, prophylactic liquid iron is given to older infants. Routine iron supplementation to children is not without controversy in malarial areas. Most micronutrient supplementation trials have been carried out using syrups, which are expensive to use on a large scale, or tablets/capsules, which are difficult to administer to young children. New formulations, such as multiple micronutrient sprinkles or water-dispersible tablets, are being tested. Highly fortified spreads that can provide fat along with micronutrients are also being tested.

New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.

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