Prevent malnutrition in children

04/05/2023

Long-term malnutrition in children leaves many unfortunate consequences for children’s health and constraints both physical and intellectual growth by age. Therefore, caregivers need to keep an eye on children’s linear growth and provide a rational, balanced diet to effectively prevent malnutrition.

Overview of malnutrition

According to the World Health Organization (WHO), malnutrition is a serious medical condition caused by a severe lack of energy, protein and micronutrients which need to be supplied to the body1. The results of the 2019-2020 Nutrition Census announced by the Ministry of Health, although the rate of malnutrition in children under 5 years old nationwide is only 19.6% (at average level according to the classification of the WHO) and on the way to achieve the Global Nutrition Goals, the rate of stunting in mountainous areas is still very high comparing to the WHO classification of 38%. Nationwide, there are still 7 provinces with a stunting malnutrition rate of over 30%, which is highly significant in terms of public health2.

Chronic or recurrent malnutrition will cause children to develop poorly with the most obvious manifestations being stunting, underweight and wasting, thereby leading to short stature in adulthood and a series of other medical problems. Among all of malnutrition causes, inappropriate care in the early stages of life is considerable.

To prevent malnutrition in children, there are two things that caregivers need to keep in mind: measuring height and weight development monthly and ensuring a nutritional diet for children.

Measure height and weight monthly to prevent malnutrition in young children

Based on a study of the nutritional status of children in many countries around the world, UNICEF concluded that children born anywhere in the world have the ability to develop in the same range of height and weight when raised in an environment that promotes healthy development3. Therefore, height/length and weight of children by age are important indicators to monitor the nutritional status of children under 5 years old, a method recognized by WHO worldwide and applicable to Vietnamese children4.

The table below is the height and weight reference for children aged 0 – 5 years old according to WHO standards, compiled by the US Nutricare Institute:

Standard height – weight by age WHO chart for girls.

(Compiled by the US Nutricare Institute)

Age Weight (kg)

Height (cm)

-2 SD Median 2 SD -2 SD Median +2 SD
0 month 2.4 3.2 4.2 45.4 49.1 52.9
1 month 3.2 4.2 5.5 49.8 53.7 57.6
2 months 3.9 5.1 6.6 53.0 57.1 61.1
3 months 4.5 5.8 7.5 55.6 59.8 64.0
4 months 5.0 6.4 8.2 57.8 62.1 66.4
5 months 5.4 6.9 8.8 59.6 64.0 68.5
6 months 5.7 7.3 9.3 61.2 65.7 70.3
7 months 6.0 7.6 9.8 62.7 67.3 71.9
8 months 6.3 7.9 10.2 64.0 68.7 73.5
9 months 6.5 8.2 10.5 65.3 70.1 75.0
10 months 6.7 8.5 10.9 66.5 71.5 76.4
11 months 6.9 8.7 11.2 67.7 72.8 77.8
12 months 7.0 8.9 11.5 68.9 74.0 79.2
14 months 7.4 9.4 12.1 71.0 76.4 81.7
16 months 7.7 9.8 12.6 73.0 78.6 84.2
18 months 8.1 10.2 13.2 74.9 80.7 86.5
20 months 8.4 10.6 13.7 76.7 82.7 88.7
22 months 8.7 11.1 14.3 78.4 84.6 90.8
2 years 9.0 11.5 14.8 80.0 86.4 92.9
2.5 years 10 12.7 16.5 83.6 90.7 97.7
3 years 10.8 13.9 18.1 87.4 95.1 102.7
3.5 years 11.6 15.0 19.8 90.9 99.0 107.2
4 years 12.3 16.1 21.5 94.1 102.7 111.3
4.5 years 13.0 17.2 23.2 97.1 106.2 115.2
5 years 13.7 18.2 24.9 99.9 109.4 118.9

 

Standard height – weight by age WHO chart for girls.

(Compiled by the US Nutricare Institute)

Age Weight (kg) Height (cm)
-2 SD Median 2 SD -2 SD Median +2 SD
0 month 2.5 3.3 4.4 46.1 49.9 53.7
1 month 3.4 4.5 5.8 50.8 54.7 58.6
2 months 4.3 5.6 7.1 54.4 58.4 62.4
3 months 5.0 6.4 8.0 57.3 61.4 65.5
4 months 5.6 7.0 8.7 59.7 63.9 68.0
5 months 6.0 7.5 9.3 61.7 65.9 70.1
6 months 6.4 7.9 9.8 63.3 67.6 71.9
7 months 6.7 8.3 10.3 64.8 69.2 73.5
8 months 6.9 8.6 10.7 66.2 70.6 75.0
9 months 7.1 8.9 11.0 67.5 72.0 76.5
10 months 7.4 9.2 11.4 68.7 73.3 77.9
11 months 7.6 9.4 11.7 69.9 74.5 79.2
12 months 7.7 9.6 12.0 71.0 75.7 80.5
14 months 8.1 10.1 12.6 73.1 78.0 83.0
16 months 8.4 10.5 13.1 75.0 80.2 85.4
18 months 8.8 10.9 13.7 76.9 82.3 87.7
20 months 9.1 11.3 14.2 78.6 84.2 89.8
22 months 9.4 11.8 14.7 80.2 86.0 91.9
2 years 9.7 12.2 15.3 81.7 87.8 93.9
2.5 years 10.5 13.3 16.9 85.1 91.9 98.7
3 years 11.3 14.3 18.3 88.7 96.1 103.5
3.5 years 12.0 15.3 19.7 91.9 99.9 107.8
4 years 12.7 16.3 21.2 94.9 103.3 111.7
4.5 years 13.4 17.3 22.7 97.8 106.7 115.5
5 years 14.1 18.3 24.2 100.7 110.0 119.2

In particular, +2 SD (standard deviation) means that the baby may be obese (if considered by weight) or very tall (if considered by height); -2 SD means the baby is malnourished, underweight and stunted.

Malnutrition in children is divided into 3 types: underweight malnutrition, stunting malnutrition and wasting malnutrition. To comprehensively evaluate as if a child is malnourished or not, it is necessary to monitor weight-for-age, weight-for-height, and height-for-age indicators. By monthly measuring of children’s height and weight indicators according to WHO standards, caregivers will soon detect the following nutritional conditions in children4:

Stunting: height for age < -2 SD of WHO child growth standards – This means that the child’s height is lower than the standard of children of the same age and sex. The child’s height-for-age value is also below -2SD. This is a form of chronic malnutrition, clinical manifestations of stunting are the consequence of long-term malnutrition in the first years of life, sometimes earlier while the fetus is still in the mother’s womb. Therefore, this condition can be understood as a sign of poor developmental environmental conditions, which limits the child’s developmental potential.

Wasting: weight-for-height < -2 SD of WHO child growth standards This happens when the child’s weight-for-height is lower than the standard for children of the same age and sex, which is also below -2SD level. At this time, muscle and fat are greatly atrophied. This is an acute form of malnutrition, occurring over a short period of time, often as a result of inadequate diet or infectious diseases, especially diarrhea. Wasting weakens the immune system, making children susceptible to infections such as pneumonia, and diarrhea… and increasing the risk of death.

Underweight: weight for age <-2 SD of WHO Child Growth Standard Median – This occurs when a child’s weight is lower than the standard of children of the same age and same sex, as well as the child’s weight-for-age value is below -2SD. The method of comparing weight by age is an easy method to implement, however, this is also the most difficult method to accurately determine a child’s nutritional status among the three methods. Underweight children may be stunted, wasted, or have both conditions at the same time. However, this is also a noteworthy indicator because the risk of death increases in severely underweight children.

Monthly tracking of children's height and weight indicators and comparing to WHO standards to promptly detect nutritional problems in children (Photo: istockphoto.com)

Monthly tracking of children’s height and weight indicators and comparing to WHO standards to promptly detect nutritional problems in children (Photo: istockphoto.com)

After determining the child’s nutritional status, caregivers need to take measures to improve the care regimen if the child is in poor nutritional status, or maintain the current care regimen if the child is in good nutritional status.

Maintaining a rational diet helps children have a standard development

As the core of the problem of malnutrition in children lies in a serious deficiency of energy and nutrients, ensuring a rational and balanced meal is considered an important prevention measure. A rational nutritional diet is a diet that meets the energy and nutritional requirements at each stage of a child’s development, with all nutrient groups (Protein, Carbohydrate, Lipid, Vitamins, and Minerals).

A rational nutritional diet meets the energy and nutritional needs for each stage of child development (Photo: Freepik.com)

A rational nutritional diet meets the energy and nutritional needs for each stage of child development (Photo: Freepik.com)

So the question is how to achieve a rational nutrition regimen? Implementing the National Nutrition Strategy (period 2011 – 2020 with a vision to 2030), the Ministry of Health has issued 10 tips on rational nutrition for Vietnamese people5.

1. Breastfeed your baby immediately after birth, exclusively breastfeed for the first 6 months, feed your baby appropriate complementary foods, and continue breastfeeding for up to 24 months

In the first 6 months of life, breast milk is the best food for infant’s development. Breast milk provides all the necessary nutrients such as protein, carbohydrates, lipids, vitamins, and minerals. Besides, breast milk also contains a variety of antibodies to help infants prevent diarrhea, allergies, respiratory infections etc.

From the 7th month, breast milk cannot fully meet the growing nutritional needs of the baby. Therefore, the baby needs to eat other foods to make up for this deficiency. Supplemental foods also need to ensure nutritional balance with all food groups providing energy, protein, lipids, vitamins, minerals and fiber.

2. Eat a variety of foods and ensure all 4 groups are sufficient: carbohydrates, proteins, lipids, vitamins, and minerals

A single food naturally cannot provide all the nutrients needed for the body. Therefore, children need a diverse diet with at least 5 out of the following 8 food groups to ensure the supply of 4 groups of nutritional components (Protein, Carbohydrate, Lipid, Vitamins, and Minerals):

Foods that provide high levels of energy for the body:

Group 1: Rice, corn, potatoes, cassava

Foods that provide protein:

Group 2: Nuts (beans, beans, peanuts, sesame, etc.)

Group 3: Milk and dairy products

Group 4: Meat of all kinds (pig, chicken, beef…) and seafood (fish, shrimp, crab, eel…)

Group 5: Eggs and products made from eggs

Foods that provide vitamins, minerals, and fiber:

Group 6: Yellow, orange, and red fruits or fresh dark green vegetables

Group 7: Other vegetables and fruits such as kohlrabi and radish

Foods that provide lipids:

Group 8: cooking oils and fats of all kinds.

Children need a diversified diet to provide the body with all the necessary nutrients (Photo: Thewell.northwell.edu)

Children need a diversified diet to provide the body with all the necessary nutrients (Photo: Thewell.northwell.edu)

3. Utilize both animal and plant protein sources, consume more shrimp, crab, fish, and beans

Although protein sources from animals such as chicken, beef, and pig contain many essential amino acids with high biological value, their drawback is a high cholesterol profile, which if consumed in excess will not be good for the body. Protein sources from plants usually have little or no cholesterol, but the essential amino acid content is often not high and the ratio is unbalanced. Therefore, to compensate for the advantages and disadvantages of these two protein sources, caregivers need to feed children a combination of two protein sources in the meal with a ratio of 1/3 – ½ of the total protein being animal protein.

4. Utilize both vegetable oils and animal fats in a proper proportion, eat sesame and peanuts

The human body needs to supplement both saturated and unsaturated fatty acids, LDL and HDL cholesterol, in a certain ratio. Animal fats and butter have a lot of saturated fatty acids, and a lot of LDL cholesterol, but also contain vitamins A and D. Sesame oil, peanut oil, soybean oil, and fish oil have a lot of unsaturated fatty acids like omega 3,6,9, DHA, EPA. Therefore, a diet with 10% of meal energy an amount of saturated fatty acids which contributes to 10% of meal sum energy, and an amount of unsaturated fatty acids which supplies 10 – 15% of meal sum energy will help take advantage of both fat sources.

5. Eat fruits and vegetables every day

Vegetables provide many vitamins, minerals, and fiber. Although vitamins and minerals are in small quantities, they play an important role in physiological processes in the body, helping children prevent malnutrition due to micronutrient deficiencies. Meanwhile, fiber plays an important role in children’s digestive system. Therefore, children need to eat at least 100 – 200g of vegetables and fruits per day.

6. Children after 6 months old and adults should use milk and products containing milk in an appropriate amount for each age group.

Animal milk has high nutritional content with all 4 basic groups of substances to help the body develop and stay healthy. For children who are underweight or have lost weight and need quick nutritional recovery, high-energy milk especially one with formula F100 (100kcal/100ml), rich in protein and micronutrients, can be used to help children restore nutrition quickly, catch up with growth momentum, and end long-term malnutrition.

In addition, there are some other tips that caregivers should also pay attention to:

7. Use iodized salt, eat less salty foods: The amount of consuming salt should be <2.8 g/day for children under 5 years old.

8. Drink enough clean water every day. Note: Children under 6 months old should not be given water to drink.

9. Ensure hygiene and safety in selecting, processing, and preserving food

10. Increase physical activity, maintain a proper weight, limit the use of carbonated drinks, sweet food and drinks.

Children's diets need a full range of nutrients including Protein, Carbohydrate, Lipid, Vitamins, and Minerals (Photo: womensfitness.co.uk)

Children’s diets need a full range of nutrients including Protein, Carbohydrate, Lipid, Vitamins, and Minerals (Photo: womensfitness.co.uk)

Thus, to prevent malnutrition in young children, measuring height and weight and applying a balanced and rational nutritional diet is extremely important for children to achieve standard development and have a healthy body and big stature.

REFERENCES:

  1. WHO. “Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers,” 1999
  2. Judith E. Brown. “Nutrition through the life cycle” 2018
  3. UNICEF. “Multiple indicator cluster survey manual” 2012
  4. https://www.who.int/data/nutrition/nlis/info/malnutrition-in-children
  5. Bộ Y Tế. Quyết định số 189/QĐ-BYT “BAN HÀNH “10 LỜI KHUYÊN DINH DƯỠNG HỢP LÝ ĐẾN NĂM 2020” THỰC HIỆN CHIẾN LƯỢC QUỐC GIA VỀ DINH DƯỠNG GIAI ĐOẠN 2011 – 2020 TẦM NHÌN ĐẾN NĂM 2030”. 2013
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