Importance of Nutrition in the First Three Years of life

1. Adequate Nutrition

2. Session 3
Adequate Nutrition
IAP NURTURE (2021-23) District level Workshops

4. Learning Objectives
At the end of this section the participant should:
 Understand the role of optimal nutrition and IYCF in ECD
 The magnitude of problems related to IYCF
 The changes in IYCF according to the developmental stage
 Responsive feeding
 What should be done in the well child visits

5. Optimal Nutrition, IYCF & ECD
• Nutrition: process of providing or
obtaining food necessary for growth
and development
• Provides macro & micronutrients
• Optimal nutrition important for child
survival
• Comparison of interventions in
decreasing under 5 mortality:
maximally effective

6. Food & Energy Requirements
• Breast feeding is the only source of energy till 6 m of age
• If CF not of proper quantity & quality beyond 6 m growth falters

7. • Minerals and vitamins play a major role in growth and development
• Micronutrient deficiency (‘hidden hunger’): Does not cause hunger per se but
nonetheless leads to undernutrition, e.g. Zinc, Iodine, Iron, vitamin A
• Intake or absorption too low to sustain health and development in children
Micronutrients & ECD

8. IYCF Indicators
National Health Family Survey 4 (2015-16)/ NHFS 5 (2019-21)
 Children < 3 y breastfed within one hour of birth: 41.6%/ 41.8%
 Children < 6 m being exclusively breastfed: 54.9%/ 63.7%
 Children aged 6-8 m receiving solid/semi-solid food and breastmilk: 42.7%/ 45.9%
 Breastfed children aged 6-23 m receiving adequate diet: 8.7%/ 11.1%
 Non-breastfed children aged 6-23 m receiving adequate diet: 14.3% / 12.7%
 Total children aged 6-23 m receiving adequate diet: 9.6%/ 11.3%

9. Monthwise developmemt of Masticatory Apparatus & Textures

10. Development and Determinants
of Complementary Feeding
Parameter 7-8 months 9-11 months 12 – 24 months
No of
meals
2 – 3 3 – 4 3 – 4, 1 – 2 snacks
Size of
serving
30 -45 ml (2 – 3 tbsp)
to 125 ml (1/2 cup)
125 – 180 ml
(½ to ¾ cup)
180 – 250 ml
(¾ to 1 cup)
Consistency Pureed food (soft) Mashed/chopped finger
foods (semi-solid)
Solid food from the
family pot
Feeding
stage
Up and down
munching
Biting and chewing
movements
Rotatory chewing,
stable jaw

11. Food Groups
• Complete food: Proteins,
carbohydrates, fats, minerals, vitamins
and fibers, etc.
• Balanced Food: All components present
in appropriate proportions
• Diverse Food: ≥ 4 out of 7 food groups

12. Responsive feeding
• Offering food based on cues (hunger and satiety) with
understanding, love, patience and play
• Infant encouraged to eat a variety of textures, tastes,
and food groups
• Process should be enjoyable for both- parents
maintaining eye contact and talking with child
• No force feeding, indifferent feeding or using screens
as distractors
Allow the child to try to feed
himself/ herself even if
messy or spills occur

13. ECD Companion for Pediatrician
The way forward
Visit Ask Assess Office staff Counsel Parents
<7 d Any concerns,
Details of BF
If concerns check
attachment,
positioning, nipple /
breast issues
Identify gap between
recommended amount,
number, consistency, food
groups, responsive
feeding, extent of
supervision, food safety
and what is being
practised.
Counsel using ALPAC
strategy.
Support EBF during first 6
m & adequate responsive
CF >6 m with continued BF
into 2nd year of life.
Check maternal diet, child
and mother’s supplements
Tell about benefits of
BF/CF & drawbacks of not
BF/giving CF
Routine Supplements
Iron, Vit. D, USI, Vit. A,
deworming
6 w
10 w
14 w
6 m Any concerns,
details of BF
& CF,
responsive
feeding, food
safety
Assess quality of
responsive feeding if
concerns voiced
/fussy eater
Nutritional status &
deficiencies
9 m
12 m
18 m
24 m
30 m
36 m

14. Key Messages
 EBF till 6 m & timely introduction of CF is essential for optimal ECD
 Pediatricians should check attachment, positioning, suckling and breast/nipple
problems if there are concerns regarding breastfeeding.
 Parents should be instructed about EBF and timely, adequate, safe, and nutritious CF
(with presence of ≥ 4 food groups)
 Tell them about the Do’s (responsive feeding) and Don'ts of IYCF
 The advantages and consequences of good and poor nutrition on ECD
 Adequate Nutrition components in the ECD companion are easy to follow