Guidelines for Young Child Feeding in the Caribbean - Part III

This section is the final of three parts on the revised guidelines for young child feeding by the Caribbean Food and Nutrition Institute (CFNI). In the previous section, we covered the areas of nutrition of the newborn, feeding of low birthweight infants and those with special requirements, and replacement and complementary feedings. This section deals with the guidelines on vitamin and mineral supplementation, and the management of feeding-related problems in early childhood. The section also discusses nutrition policy issues and nutrition in relation to the promotion of adequate nutrition in early childhood.(Au)

The relationship between nutritional supplementation, physical growth and mental development in stunted children

Nutritional supplementation benefits the mental development of stunted children. To determine whether this relationship is mediated through growth, we investigated the growth and change in development of 127 stunted children. They participated in a 2 year randomized control clinical trial of supplementation. The associations between changes in height and changes in development (measured with the Griffiths Mental Development Scales) were evaluated using multiple regression analyses. Height gain over both years combined, was significantly associated with concurrent change in mental age and the locomotor and hearing speech (HS) scores. Height gain in the first year predicted change in mental age and HS in second year. 2/3 of the effect of supplementation on change in development was independent of growth in height whereas 1/3 was shared. This proportion varied among subscales. The mechanism linking supplementation to developmental improvement is not straight-forward and differs from that linking supplement to growth. (AU)

Nutritional supplementation, psychosocial stimulation and development of stunted children: the Jamaican study - abstract

In developing countries, low height for age (stunting) is extremely common in children, and is associated with poor development. It is uncertain whether their poor development is due to poor nutrition or deprived social backgrounds, and whether nutritional supplementation improves their development. We assessed the effects of giving supplementation for two years, with or without psychosocial stimulation, to 129 stunted children aged 9 to 24 months. The children were identified from a survey of poor neighbourhoods in Kingston. They were randomly assigned to 4 groups: control, supplemented, stimulated, and both treatments. A group of matched non-stunted children (n=32) was also studied. All children were visited every week. The supplement comprised 1 kg of full cream milk. The stimulation comprised teaching mothers to play with their children for an hour each week. All children had their developmental levels (DQs) assessed regularly on the Griffith's Test. Initially, the stunted groups' DQs were significantly lower than those of the non-stunted groups, and the control group declined further during the study. Stimulation benefited the children's scores in the locomotor and performance subscales, and the developmental quotients. The effect on hearing and speech approached significant levels (p= <0.08). The treatment effects were additive, not interactive, and both groups made substantial gains. The results indicate that supplementation improves stunted children's development, and suggest that their poor development is at least partly attributed to undernutrition (AU)

The effects of nutritional supplementation and psychosocial stimulation on the growth and development of stunted children - abstract

Supplementation programmes are used in many countries to reduce the prevalence of undernutrition. However, their effectiveness is uncertain. We have conducted a longitudinal study to determine the effects of nutritional supplementation with or without psychosocial stimulation on the growth of stunted children. Stunted (n = 128) and non-stunted (n = 32) children, aged 9-24 months, were recruited by house-to-house survey of poor areas of Kingston. Stunted children were randomly assigned to four groups: control, nutritional supplementation (1 kg whole milk powder/week providing 750 kcals and 20 gm protein daily), stimulation (structured play sessions) and both interventions. All groups were visited weekly. Length, weight, head (HC) and arm (AC) circumferences, and triceps (TSF) and subscapular (SSF) skinfolds were measured on enrollment and 6 and 12 months later. Multiple regression analysis was used to determine the increases in the measurements attributable to supplementation (Table). The partial regression coefficient B, represents the difference between supplemented and non-supplemented groups controlling for age, sex, initial status and several socioeconomic variables. Supplemented children had significantly increased length, weight, HC and TSF in the first six months. There were no significant effects in the second six months. Weight-for-age and height-for age were increased but not weight-for-height. There was no effect of stimulation and no interaction between the interventions. The timing of the response to supplementation may have implications for the design of future interventions (AU)

Selective review on the behavioural effects of childhood malnutrition

Nutrient deficits can cause transient behavioural changes. In contrast severe malnutrition in early childhood is usually associated with long term poor mental development when the children return to poor environments. The duration of undernutrition may be critical. Nutritional supplementation in early childhood may prevent some of the poor development found in mild to moderately undernourished children, for the duration of supplementation (AU)

Selenium status during recovery from malnutrition: effects of selenium supplementation - abstract

It was previously shown that malnourished Jamaican children often had evidence of selenium deficiency, viz. low erythrocyte glutathione peroxidase (RBC GSH Px) activity that correlated inversely with cardiothoracic ratio, and was particularly low in children who died. In this study, RBC GSH Px activity, plasma GSH Px activity and plasma selenium concentration were measured in 41 malnourished children on admission to hospital, and after recovery in weight-for-height. Plasma GSH Px activity and selenium concentrations were also measured longitudinally throughout recovery in a group of 24 initially selenium-deficient children, 17 of whom were given oral selenium supplements for the first 3 weeks. RBC GSH Px activity was low in all malnourished children, whether oedematous or not (Table). It did not change with recovery. Plasma GSH Px activity and plasma selenium concentration were low only in oedematous malnourished children. PEM GROUPS: control, marasmus, oedematous; ERYTHROCYTE GSH Px (U/gHb)- *36ñ2, 24ñ4, 21ñ3 respectively; PLASMA GSH Px act. (U/L) - 140ñ9, 142ñ15, 98ñ8 respectively, PLASMA SE CONCN. (æg/e) - 86ñ4, 76ñ12, 53ñ5. *meanñSEM. Selenium was associated with a rapid rise in both plasma GSH Px activity and plasma selenium concentration. The increase in plasma selenium was more dramatic (44 up to 144 æg/e in 6 days): the variability in plasma GSH Px activity was much greater, and they remained within the control range. The changes were sustained after supplementation ceased. We conclude that (1) selenium deficiency in malnourished Jamaican children is not reversed during 'recovery' on the conventional 'high energy' diet, (2) plasma selenium concentration responds rapidly to changes in selenium intake, and is a useful measure of selenium status, and (3) oral selenium supplements improve selenium status in children recovering from malnutrition (AU)

Community rehabilitation of malnourished children: effects of nutritional supplementation on morbidity - abstract

Fifty-one moderately and severely malnourished children were studied in the community. They were randomly allocated to receive either medical care and an energy dense dietary supplement for three mons and then medical care alone for a further three months (supplemented) or to receive medical care alone for the six months (unsupplemented). All children were seen at two-weekly intervals, alternately in their homes by community Health Aides and in the clinic by a paediatrician. At each visit, a morvidity questionnaire was administered to obtain the mother's history of the child's illness during the previous two weeks. Weight was measured every two weeks and height monthly. Clinical assessment was done montly. During the first 3 months, growth velocity was higher in the supplemented than the unsupplemented children (2.4 and 1.2 times normal growth rate). During the second 3 months, growth rate was equal in the two groups (1.1 times normal growth rate). The mean ñ SD number of days of respiratory illness and diarrhoea (3 or more loose stools daily) were as follows: FOLLOW-UP PERIOD: Respiratory infection: (1-3 MONTHS - Unsuppl. 22ñ17, Suppl. 23ñ12), (4-6 MONTHS - Unsuppl. 15ñ13, Suppl. 20ñ15); Diarrhoea: (1-3 MONTHS - Unsuppl. 6ñ9), (4-6 MONTHS: Unsuppl. 2ñ3, Suppl. 8ñ12): No. Of Children With > 7 Days: (1-3 MONTHS: Unsuppl. 8/25, Suppl. 18/26), (4-6 MONTHS: Unsuppl. 1/24, Suppl. 7/25). In the first three months, the supplement was not associated with any significant decrease or increase in morbidity from respiratory illness or diarrhoea. Although more of the children had diarrhoea lasting for over seven days, these latter children did not show a diminution in rate of weight gain. In the second three-month period, there were fewer days of both respiratory illness and of diarrhoea in the unsupplemented children than in the children who had been supplemented during the previous three months. There were fewer children who had diarrhoea for more than seven days in the three-month period amongst the unsupplemented than the previously supplemented. Their preliminary analysis shows that dietary supplementation with an energy dense formula does not lead to a reduction in morbidity in malnourished children. It is possible that the supplement is associated with an increased in incidence of diarrhoea following its cessation (AU)

Failure of a supplementary feeding programme to improve the health of young children - abstract

Each year the world devotes over $300 million to supplementary feeding projects. Yet there are few truly empirical studies on the impact of particular schemes. In St. Lucia an evaluation was made of a three-year World Food Programme clinic-based handout project. The objectives were to prevent and to treat childhood malnutrition and to increase the average birth weight by improving the diet of pregnant women. The evaluation showed that (1) faulty classification of children had led to inadequate coverage of the target groups (2) mean birth weights of babies of supplemented and unsupplemented mothers were 93.3 percent and 93.9 percent of Harvard Standard respectively (3) The proportion of infants offered breast-milk before and after the intervention was similar, but bottle-feeding was more prevalent after. The introduction of the "family pot" mixed diet was correspondingly delayed (4) intakes of energy and of protein were higher in the supplemented group, but differences were negligible after one year of age (5) despite, or because of, their supplements, children in this group had an average 2.4 percent diarrhoea rate (6) since well-nourished children were receiving supplementary food while many who were undernourished were not, we were presented fortuitously with an ideal design for comparison. Between 6 months and 2 years of age, the increase in the number of malnourished children was greater in the supplemented than in the unsupplemented group. Analysis of the reasons for the above findings should lead to changes in the World Food Programme's policies for distribution of dried milk and other foods in the Caribbean (AU)

Influence of the availability of commercial infant foods on feeding practices in Jamaica

The decision to cease breast feeding did not have a clearly defined physiological basis in over half of a sample of 150 Jamaican mothers questioned on the feeding regimes of their infants. Neither income nor place of residence, appeared to be related to the decision to cease breast feeding although the source of information on infant feeding did show some association. A variety of commercial infant food products was available; about 40 percent of the mothers used more than one product. Health workers, including midwives, have a potentially important role in bringing about satisfactory weaning (AU)

Assessment of the nutritional status of elementary school children of British Guiana by periodic sampling surveys, and evaluation of the beneficial effects of supplementary feeding

Beneficiaries of the mid-morning snack of skimmed milk, yeast-enriched biscuits and fish liver oil capsules have at the end of a year period shown remarkable improvement in their nutritional health especially in regard to the removal or the modification of the usual classical clinical signs attributed to B. complex and vitamin A deficiencies, of which the dietary of the people is lacking. The East Indian boys in reciept of the snack meals showed a statistically significant increase in their weight gains. Beneficiaries of two other groups showed increased weight gains over those of the controls but the increases were not statistically significant. Many of the beneficiaries have manifested an observable increase in their diffuse energy drive, alertness, keenness and interest in their work. School attendance has considerably improved. (Summary)