[Psychosomatics and psychoanalysis; apropos of infant and child nutrition disorders].
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Child Nutritional Physiological Phenomena↗
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[Influence of high-risk factors in child nutrition disorders].
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Birth Weight↗
Health of homeless children and housed, poor children.
Homeless children in families are increasing in numbers across the country and have been noted to have frequent health problems. The health status of homeless children was assessed on multiple dimensions through parental report in a survey conducted with 196 homeless families in 10 shelters in Los Angeles and 194 housed poor families after March 1987 through January 1988. During the month before the survey, the homeless and housed poor children experienced high rates of illness symptoms, disability, and bed days. Homeless and housed poor children were frequently rated by their parents to be in fair or poor health (17% vs 13%, P = .14). Homeless children, however, were reported to have more behavior problems and school failure [30% vs 18%, P = .06] than housed poor children. Homeless children also had high rates of other health problems such as developmental delay (9%) and overweight (13%). The diets of homeless children were frequently imbalanced, dependent on food from "fast-food" restaurants, and characterized by repeated periods of deprivation. Family problems were more common among homeless families, especially among single-parent homeless families compared with single-parent housed families (spousal abuse, 68% vs 41%, P less than .01; parental drug and alcohol abuse, 60% vs 39%, P less than .01). It is concluded that homeless children have significant child behavior and developmental problems and disorders of nutrition and growth, which are associated with multiple risk factors in their environment.
Child↗
You are what you eat: healthy food choices, nutrition, and the child with juvenile rheumatoid arthritis.
Children with juvenile rheumatoid arthritis (JRA) often experience nutrition related concerns. Growth abnormalities are common. Protein-calorie malnutrition and inadequate intake of other nutrients result from aspects of the disease process, treatment (including drug treatment), and dietary choices. Mechanical feeding difficulties can also compromise adequate intake. Because nursing assessments usually explore eating habits and family issues, the registered nurse is in a good position to identify nutrition concerns, to provide intervention recommendations, or to act as a referral source.
Arthritis, Juvenile↗
[Nutritional status of 0-to-59-month-old children in urban and rural areas of Cameroon].
The nutritional status of preschool-age children (0-59 months) in the Littoral Province of Cameroon was studied in a representative sample of the population of this age group in rural and urban areas, with a total of 2011 children. The nutritional indicators weight-for-height, weight-for-age, and height-for-age were compared with reference data from the United States National Center for Health Statistics. A high prevalence of stunting (15.2% in urban and 21.8% in rural areas, P < 0.0008) was found among the children. The prevalence of wasting was 4.0% in urban and 6.5% in rural areas (P < 0.03). In all age groups, rural children were shorter than urban children with no significant difference between the sexes. The increase in the prevalence of acute malnutrition (8.4%) since the last nutritional survey in 1978 (0.7%), which is probably due to a deterioration in the economic situation in recent years, indicates that urgent measures should be taken to improve the nutritional situation of these children, especially in the villages. The findings of the study could serve as baseline data for the evaluation of the effectiveness of future nutrition programmes.
Anthropometry↗
Feeding method and health outcomes of children with cerebral palsy.
Disorders of feeding and swallowing are common in children with cerebral palsy. Feeding and swallowing disorders have significant implications for development, growth and nutrition, respiratory health, gastrointestinal function, parent-child interaction, and overall family life. Assessments need to be comprehensive in scope and centered around the medical home. Oral feeding interventions for children with cerebral palsy may be effective in promoting oral motor function, but have not been shown to be effective in promoting feeding efficiency or weight gain. Feeding gastrostomy tubes are a reasonable alternative for children with severe feeding and swallowing problems who have had poor weight gain.
Cerebral Palsy↗
The impact of a nutrition education programme on the anthropometric nutritional status of low-income children in South Africa.
OBJECTIVE: The study determined the impact of a community-based nutrition education programme, using trained community nutrition advisors, on the anthropometric nutritional status of mixed-race children aged between 2 and 5 years. DESIGN AND SETTING: The programme was implemented over two years in four study areas in the Free State and Northern Cape Provinces. Two control areas were included to differentiate between the effect of the education programme and a food aid programme that were implemented simultaneously. Weight-for-age, height-for-age and weight-for-height were summarised using standard deviations from the NCHS reference median. For each of the indicators, the difference in the percentage of children below minus two standard deviations from the reference NCHS median in the initial and follow-up surveys was determined. SUBJECTS: Initially 536 children were measured and, after two years of intervention, 815. RESULTS: Weight-for-age improved in all areas, but only significantly in boys and girls in the urban study area, and in boys in one rural study area. No significant improvement in height-for-age occurred in any area. Weight-for-height improved significantly in the urban study area. CONCLUSION: The education programme in combination with food aid succeeded in improving the weight status of children, but was unable to facilitate catch-up growth in stunted children after two years of intervention.
Anthropometry↗
Implications of women's work for child nutritional status in sub-Saharan Africa: a case study of Nigeria.
The study examines the relationships between women's work and child nutritional status (stunting and wasting) of 5331 Nigerian children aged 0-59 months, using data from the 1990 Nigerian Demographic and Health Survey. In defining women's work, the study considers whether women earned cash from their work and carried their children to work in order to assess the importance of childcare and income, which are the principal pathways through which women's work affects child nutritional status. The study also examines infants and children differently in order to assess the influence of child's age on nutritional status. The results reveal that wasting among infants increased when mothers did not take them to work. Furthermore, mothers' work reduced stunting in their children, but the expected positive effect of earning cash from work on childhood nutrition was less visible from the results. Other results from the study revealed that during infancy, having recent episodes of diarrhea or shorter breast-feeding duration increased wasting. Additionally, wasting was lower during infancy for children in households with pit toilets and children with Christian mothers. For infants, immunization reduced stunting, but longer duration of breast-feeding, being a higher parity child, being in households with pit toilets increased stunting. During childhood, higher birth weight, immunization, and having a Christian mother reduced stunting and wasting. Children in wealthy households are less likely to be stunted, while mother's education and being a higher parity child increased stunting. Also during childhood, having a Christian mother reduced wasting while recent episodes of fever increased wasting.
Breast Feeding↗
Chronic disease from early malnutrition.
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Child↗
Prevalence and predictors of underweight, stunting, and wasting among children aged 5 and under in western Kenya.
The health and nutritional status of children aged 5 and under was assessed in three villages in Siaya District of western Kenya. A cross-sectional survey was conducted among 121 adults and 175 children during July 2002. Primary caretakers were interviewed during home visits to assess agricultural and sanitation resources, child feeding practices, and the nutritional status of their children aged 5 years and under. Through anthropometry, the prevalence of underweight, stunting and wasting were determined: 30 per cent were underweight, 47 per cent were stunted, and 7 per cent were wasted. Predictors of undernutrition were analysed using logistic regression controlling for age, sex, and SES, and four major findings emerged. First, children in their second year of life were more likely to be underweight and stunted. Second, children who were introduced to foods early had an increased risk of being underweight. Third, up-to-date vaccinations were protective against stunting, while reports of having upper respiratory infections or other illness in the past month predicted underweight. Finally, living with non-biological parents significantly increased risk of stunting. Emphasis should be placed on current immunization, prolonging exclusive breastfeeding, and improving access to nutrient-rich foods among adopted children and their families via community-based nutrition interventions.
Adult↗
Nutritional status as a predictor of child survival: summarizing the association and quantifying its global impact.
By pooling the results from five previously published prospective studies, we have obtained estimates of the relative risks of mortality among young children 6-24 months after they had been identified as having mild-to-moderate or severe malnutrition. These risk estimates, along with global malnutrition prevalence data, were then used to calculate the total number of young-childhood deaths "attributable" to malnutrition in developing countries. Young children (6-60 months of age) with mild-to-moderate malnutrition (60-80% of the median weight-for-age of the reference population) had 2.2 times the risk of dying during the follow-up period than their better nourished counterparts (> 80% of the median reference weight-for-age). Severely malnourished young children (< 60% of the reference median weight-for-age) had 6.8 times the risk of dying during the follow-up period than better nourished children. Each year approximately 2.3 million deaths of young children in developing countries (41% of the total for this age group) are associated with malnutrition. The comparability of studies, methods used to derive pooled values, potentially confounding factors that may influence risk estimates, and the validity of the results are discussed. Child survival programmes should assign greater priority to the control of childhood malnutrition.
Body Weight↗
Selective gender differences in childhood nutrition and immunization in rural India: the role of siblings.
This article examines the role of the sex composition of surviving older siblings on gender differences in childhood nutrition and immunization, using data from the National Family Health Survey, India (1992-1993). Logit and ordered logit models were used for severe stunting and immunization, respectively. The results show selective neglect of children with certain sex and birth-order combinations that operate differentially for girls and boys. Both girls and boys who were born after multiple same-sex siblings experience poor outcomes, suggesting that parents want some balance in sex composition. However, the preference for sons persists, and boys who were born after multiple daughters have the best possible outcomes.
Birth Order↗
Impact of maternal depression on infant nutritional status and illness: a cohort study.
BACKGROUND: The risk for emotional and behavioral problems is known to be high among children of depressed mothers, but little is known about the impact of prenatal and postnatal depression on the physical health of infants. OBJECTIVE: To determine whether maternal depression is a risk factor for malnutrition and illness in infants living in a low-income country. DESIGN: Prospective cohort study. SETTING: Rural community in Rawalpindi, Pakistan. PARTICIPANTS: Six hundred thirty-two physically healthy women were assessed in their third trimester of pregnancy to obtain at birth a cohort of 160 infants of depressed mothers and 160 infants of psychologically well mothers. MAIN OUTCOME MEASURES: All infants were weighed and measured at birth and at 2, 6, and 12 months of age, and they were monitored for episodes of diarrhea and acute respiratory infections. The mothers' mental states were reassessed at 2, 6, and 12 months. Data were collected on potential confounders of infant outcomes, such as birth weight and socioeconomic status. RESULTS: Infants of prenatally depressed mothers showed significantly more growth retardation than controls at all time points. The relative risks for being underweight (weight-for-age z score of less than -2) were 4.0 (95% confidence interval [CI], 2.1 to 7.7) at 6 months of age and 2.6 (95% CI, 1.7 to 4.1) at 12 months of age, and the relative risks for stunting (length-for-age z score of less than -2) were 4.4 (95% CI, 1.7 to 11.4) at 6 months of age and 2.5 (95% CI, 1.6 to 4.0) at 12 months of age. The relative risk for 5 or more diarrheal episodes per year was 2.4 (95% CI, 1.7 to 3.3). Chronic depression carried a greater risk for poor outcome than episodic depression. The associations remained significant after adjustment for confounders by multivariate analyses. CONCLUSIONS: Maternal depression in the prenatal and postnatal periods predicts poorer growth and higher risk of diarrhea in a community sample of infants. As depression can be identified relatively easily, it could be an important marker for a high-risk infant group. Early treatment of prenatal and postnatal depression could benefit not only the mother's mental health but also the infant's physical health and development.
Birth Weight↗
Nutritional status and gastrointestinal structure and function in children with ichthyosis and growth failure.
UNLABELLED: Growth failure occurs in several of the ichthyoses, a heterogeneous group of inherited disorders characterized by thickened or scaly skin. This suggests that there may be common pathogenic mechanisms causing failure to thrive. Previous studies have proposed that a hypermetabolic state induced by epidermal inflammation and hyperproliferation or enteropathy leading to malabsorption and nutritional deficiencies might account for the growth failure in icthyosis. OBJECTIVE: The purpose of this study was to examine the extent of enteropathy and nutritional deficiency in children with severe ichthyosis and growth failure. METHODS: Ten children with different types of ichthyoses and growth failure were studied. RESULTS: Evaluation of gastrointestinal structure and function revealed few abnormalities other than mild fat malabsorption in two patients. Total caloric intake exceeded established requirements for age, height, and weight in all patients. Deficiencies of fat-soluble vitamins were identified in a few subjects. Mild elevations in total calcium and magnesium blood level, elevated hematocrit levels, and constipation were observed in many patients. CONCLUSIONS: Nutritional deficiencies and gastrointestinal abnormalities are uncommon in children with ichthyosis and failure to thrive. Chronic hypovolemia caused by impaired epidermal permeability barrier may be common in this population.
Calcium↗
Birthweights and growth of infants in five Aboriginal communities.
OBJECTIVES: To improve, by culturally appropriate means, birthweights and growth of children up to three years of age over 14 months in five Aboriginal communities in north-western Australia. METHODS: Frequent individual nutritional assessment of infants and children with counselling of mothers and carers and of pregnant women and the introduction of the Aboriginal-controlled Strong Women, Strong Babies, Strong Culture maternal support program. Outcomes compared with those in the same communities for the five years preceding intervention. RESULTS: By international standards, pre-intervention birthweights of full-term infants (37-42 weeks) were only moderately depressed and recovered to exceed standard weight-for-age within two weeks of birth. Growth of full-term infants slowed abruptly after six months. Prevalence and duration of breastfeeding were very high. Prevailing low average birthweight was chiefly attributable to a prevalence of pre-term birth approaching 20%. Intervention was not accompanied by any change in full-term birth weight but was associated with increased weight gain after six months. From 12 to 36 months growth rose by 30 g per month (p = 0.001). Average birthweights of pre-term infants were < 2,500 g and average weight-for-age did not improve during intervention. CONCLUSIONS: Both low birthweight and a disproportionate part of intransigent failure to grow by Aboriginal infants were associated with pre-term birth. Depressed average growth of full-term infants appeared to respond to nutritional counselling accompanied by a community support program. IMPLICATIONS: Investigation of the causes of the exceptionally high rate of Aboriginal pre-term birth in the region is urgently required.
Birth Weight↗
Home-based treatment of malnourished Malawian children with locally produced or imported ready-to-use food.
OBJECTIVES: To determine the efficacy of home-based therapy with ready-to-use food (RTUF) in producing catch-up growth in malnourished children and to compare locally produced RTUF with imported RTUF for this purpose. METHODS: After a brief inpatient stabilization, 260 children with severe malnutrition were enrolled and systematically allocated to receive home therapy with either imported, commercially produced RTUF or locally produced RTUF. Each child received 730 kJ/kg/day and was followed up fortnightly. Children completed the study when they reached a weight-for-height Z score > -0.5 (WHZ), relapsed, died, or failed to achieve WHZ > -0.5 after 16 weeks. Analyses were stratified by human immunodeficiency virus (HIV) status. RESULTS: 78% of all children reached WHZ > -0.5, 95% of those with HIV-negative status and 59% of those with HIV-positive status. Eighty percent of those receiving locally produced RTUF and 75% of those receiving imported RTUF reached WHZ > -0.5. The difference between recovery rates was 5% (95% confidence interval [CI], -5-15%). The rate of weight gain was 0.4 g/kg/day (95% CI, -0.6, 1.4) greater among children receiving locally produced RTUF. The prevalence of diarrhea reported by mothers was 3.7% for locally produced RTUF and 4.3% for imported RTUF. After completion of home therapy and resumption of habitual diet for 6 months, 91% of all children maintained a normal WHZ. CONCLUSIONS: Home-based therapy with RTUF was successful in affecting complete catch-up growth. In this study, locally produced and imported RTUF were similar in efficacy in treating of severe childhood malnutrition.
Body Height↗
Supplementary feeding of underweight, stunted Malawian children with a ready-to-use food.
OBJECTIVE: Maize and soy flour mixes are often used in the treatment of moderate malnutrition in Malawi. Their efficacy has not been formally evaluated. A recently developed ready-to-use food (RTUF) effectively promotes growth among severely malnourished children. The authors compared the effect of maize and soy flour with that of RTUF in the home treatment of moderately malnourished children. METHODS: Sixty-one underweight, stunted children 42 to 60 months of age were recruited in rural Malawi, in southeastern Africa. They received either RTUF or maize and soy flour for 12 weeks. Both supplements provided 2 MJ (500Kcal) of energy daily but had different energy and nutrient densities. Outcome variables were weight and height gain and dietary intake. RESULTS: Before intervention, the mean dietary intake and weight and height gain were similar in the two groups. During the supplementation phase, the consumption of staple food fell among children receiving maize and soy flour but not among those receiving RTUF. There was thus higher intake of energy, fat, iron, and zinc in the RTUF group. Both supplements resulted in modest weight gain, but the effect lasted longer after RTUF supplementation. Height gain was not affected in either group. Periodic 24-hour dietary recalls suggested that the children received only 30% and 43%, respectively, of the supplementary RTUF and maize and soy flour provided. CONCLUSIONS: RTUF is an acceptable alternative to maize and soy flour for dietary supplementation of moderately malnourished children. Approaches aimed at increasing the consumption of supplementary food by the selected recipients are needed.
Body Height↗
A longitudinal study of prolonged breastfeeding in relation to child undernutrition.
BACKGROUND: In a number of studies prolonged breastfeeding was associated with a higher risk of undernutrition, although most of these studies are limited by their cross-sectional design which does not allow examination of temporal relationships between full weaning and undernutrition. METHODS: The relationship between prolonged breastfeeding and child growth was examined prospectively among children under 36 months old who participated in a large cohort study. At baseline and at each of three 6-monthly follow-up visits breastfeeding status was assessed and all subjects were weighed and measured. RESULTS: Undernourished children were more likely to be breastfed for a longer period of time compared with normal children. We found a small difference between breastfed and fully weaned children in the gain in height over the following 6-month period; however, breastfed children were likely to gain significantly less weight, particularly among children who were aged 6-12 months. Similar findings were noted when these associations were examined among children who were normally nourished at the time of breastfeeding assessment. The inverse association between breastfeeding status and weight gain was significantly larger among children of poor or illiterate mothers compared with children of relatively more affluent or literate mothers, respectively. CONCLUSIONS: Our findings suggest that the inverse association is not causal, and may be explained by poorer complementary feeding among breastfed compared with weaned children. Children from poorer households and whose parents are illiterate are more likely to have less than adequate complementary feeding. The importance of adequate complementary feeding in the second half of infancy needs to be stressed in nutrition education programmes.
Body Height↗