Mother & Child Nutrition - Diarrhoea, Diarrhea, Dehydration, Oral Rehydration, Water, Sanitation, Hygiene

Diarrhoea is an important cause of undernutrition. This is because nutrient requirements are increased during diarrhoea, as during other infectious diseases, whereas nutrient intake and absorption are usually decreased. Each episode of diarrhoea can cause weight loss and growth faltering. Moreover, if diarrhoea occurs frequently, there may be too little time to "catch up" on growth between episodes, the result being a flattening of the normal growth curve. Children who experience frequent episodes of acute diarrhoea, or have persistent diarrhoea, are more likely to become undernourished than children who experience fewer or shorter episodes of diarrhoea. In general, the impact of diarrhoea on nutritional status is proportional to the number of days a child spends with diarrhoea each year.

In turn, undernutrition contributes to the problem of diarrhoea. In children who are undernourished as a result of inadequate feeding, previous diarrhoeal episodes, or both, acute diarrhoeal episodes are more severe, longer lasting, and probably more frequent; persistent diarrhoea is also more frequent and dysentery is more severe. The risk of dying from an episode of persistent diarrhoea or dysentery is considerably increased when a child is already undernourished. In general, these effects are proportional to the degree of undernutrition, being greatest when undernutrition is severe.

Thus, diarrhoea and undernutrition combine to form a vicious circle which, if it is not broken, can eventually result in death; the final event may be a particularly severe or prolonged episode of diarrhoea or, when severe undernutrition is present, another serious infection such as pneumonia. Deaths from diarrhoea are, in fact, usually associated with undernutrition. In hospitals where good management of dehydration is practised, virtually all mortality from diarrhoea is in undernourished children.

Diarrhoea is, in reality, as much a nutritional disease as one of fluid and electrolyte imbalance, and therapy is not adequate unless both aspects of the disease are treated. However, in contrast to fluid replacement, nutritional management of diarrhoea requires good feeding practices both during the illness and between episodes of diarrhoea, when the child is not sick. When this is done, and undernutrition is either prevented or corrected, the risk of death from a future episode of diarrhoea is greatly reduced.

Infant and Young Child Feeding and Nutrition

Feeding is a critical aspect of caring for infants and young children. Appropriate feeding practices stimulate bonding with the caregiver and psycho-social development. They lead to improved nutrition and physical growth, reduced susceptibility to common childhood infections and better resistance to cope with them. Improved health outcomes in young children have long-lasting health effects throughout the life-span, including increased performance and productivity, and reduced risk of certain non-communicable diseases.

Child Feeding and Nutrition ( 2-5 years age )

Malnutrition contributes to more than half of all childhood deaths, although it is rarely listed as the direct cause. For most children, lack of access to food is not the only cause of malnutrition. Poor feeding practices and infection, or a combination of the two, are both major factors of malnutrition. Infection – particularly frequent or persistent diarrhoea, pneumonia, measles and malaria – undermines nutritional status. Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, giving insufficient quantities, and not ensuring that the child gets enough food, contribute to malnutrition.

Malnourished children are, in turn, more vulnerable to disease and the vicious circle is established.

Improved feeding practices to prevent or treat malnutrition could save 800,000 lives per year.

Adolescent Nutrition

Adolescence represents a window of opportunity to prepare for a healthy adult life. During adolescence, nutritional problems originating earlier in life can potentially be corrected, in addition to addressing current ones. It is also a timely period to shape and consolidate healthy eating and lifestyle behaviours, thereby preventing or postponing the onset of nutrition-related chronic diseases in adulthood.

As adolescents have a low prevalence of infections such as pneumonia and gastroenteritis compared with younger children, and of chronic disease compared with ageing people, they have generally been given little health and nutrition attention, except for reproductive health concerns. However, there are nutritional issues, which are adolescent-specific, and which call for specific strategies and approaches.

The main issues in adolescent nutrition are:

Breast milk is the ideal food for infants and is all they need for optimal growth and health during the first six months of life. Breastfeeding is considered a pillar of child survival; it provides nourishment, helps develop the immune system, improves response to vaccines, and prevents many infections, including diarrheal diseases.¹ Because of the unique benefits of breast milk, it is recommended that infants continue breastfeeding for up to two years and beyond. Breastfeeding also provides health benefits for the mother.

It is estimated that 1.5 million children die each year because they were not breastfed, particularly not exclusively breastfed through six months of age. These deaths could be avoided by educating mothers and health workers about the vital role that breastfeeding plays in keeping infants healthy and by providing support to encourage appropriate feeding practices. In many developing countries, counseling and support have proven very effective for increasing rates of exclusive breastfeeding for up to six months, in turn reducing infant morbidity and mortality.

A midwife in Indonesia teaches a new mother about breastfeeding, which can protect against diarrheal infections.

A study in Brazil associated formula feeding with a 14-fold increase in diarrhea motality for all infants and a 25-fold increased risk in infants less than two months old.

Malnutrition, caused by inadequate nutrient intake and disease, is a direct cause of 30 percent of all child deaths in developing countries and can result in a five-to-ten-fold increase in a child’s risk of death from diarrhea.³ Characterized by low weight and height for age, and low weight for height, malnutrition can be prevented through optimal infant and young child feeding—exclusive breastfeeding in the first six months, along with continued breastfeeding and nutritious, hygienically prepared complementary foods during the six to 24 month period. Feeding should continue during an episode of diarrhea, as well as increased feeding after the episode to counteract weight loss and prevent malnutrition.

PATH’s Infant and Young Child Nutrition project works in developing countries to promote optimal infant and young child feeding practices—proven methods for reducing malnutrition and enhancing child growth and survival.

UNICEF works to protect, promote and support optimal infant and young child feeding practices as a means to improve nutrition status, growth, development, and health.

Key resources

Below are some key documents on breastfeeding and infant nutrition. Please also browse our list of other helpful websites for more resources.

Other helpful websites

References

¹ Davis MK. Breastfeeding and chronic disease in childhood and adolescence. Pediatric Clinics of North America. 2001;48(1):125–141, ix.

² Victora CG, Smith PG, Vaughan JP, et al. Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. The Lancet. 1987;2(8554):319–322.

³The Lancet's Series on Maternal and Child Undernutrition. Available at: www.globalnutritionseries.org/. Accessed 23 February 2009.

Photo: PATH/Carib Nelson.

Reproduced from the PATH Resources for Diarrheal Disease Control website at www.eddcontrol.org, [6 November, 2009].

Mother and Child Nutrition

Infant and young child feeding

Nutrition Resources