Nutrition, Health and Well-being

Written and reviewed by Anjali Sharma, Biology & Home Science faculty at UniDrill (M.Sc. Botany, Banaras Hindu University · 8 years teaching). Based on NCERT Home Science Class XI (Human Ecology and Family Sciences Part II), Chapter 8.

Why does a six month old eat only milk, and a ten year old need more iron than her brother?

Because a child's body is a construction site, and the materials needed change at every stage. A baby doubles her weight in six months, a preschooler is all movement, and a girl nearing menarche needs far more iron than the boy beside her. This chapter follows that site through four stages: infancy, the preschool years, the school years, and the habits, influences and health problems that go with them. Nutrition here means "food at work": the way the body obtains nutrients and uses them for growth, repair and well being.

Why childhood matters so much. Physical and mental development is very fast, so a nutritional deficiency at this stage can leave lifelong impairments, while good nutrition lets a child reach full potential. Good nutrition is not just height and weight. It supports organ functions, thinking, the ability to fight disease and heal, energy, and a pleasant, positive attitude.

Infancy (birth to 12 months)

Growth is fastest in the first six months. Weight doubles in six months and triples by one year, and length rises from 50 to 55 cm at birth to about 75 cm at one year. Per kilogram of body weight, an infant needs about twice as many calories as an adult doing heavy work. Besides energy, protein is needed for muscles, calcium for bones, and iron for growth and for expanding blood volume.

Why the mother's diet matters. A well nourished mother producing about 850 ml of breast milk a day can supply all nutrients for the first 4 to 6 months, and recommended allowances for infants are worked out from the composition of mother's milk. She needs a diet rich in protein, calcium and iron, with plenty of fluids such as milk, soups, juices and water.

Breast feeding

WHO recommends exclusive breast feeding for six months, with not even water needed. Put the baby to the breast soon after birth. In the first 2 to 3 days the mother makes a thick yellow fluid, colostrum, very rich in antibodies, which protects the baby from infection.

The best clock is the baby's hunger, though feeding intervals can be gently regularised after one month.

Low birth weight babies. A baby weighing less than 2.5 kg at birth has poor sucking and swallowing reflexes and a small stomach and intestine, yet a relatively high calorie need. Mother's milk has all essential amino acids, calories, fat and sodium, and its anti microbial property protects against infection, so it remains the best food. Supplements are considered only if the baby does not gain weight satisfactorily.

Pause and predict: a mother in a village is told to give her newborn honey water and boiled water for the first three days, and to throw away the thick yellow first milk. What should the health worker advise, and why?

Check your answer: feed the colostrum and give nothing else. The yellow fluid made in the first 2 to 3 days is very rich in antibodies and protects the baby from infection, and exclusive breast feeding means not even water is needed in the first six months.

Complementary feeding

Complementary feeding means gradually adding other foods to breast milk, which can begin by 6 months. Complementary foods should be calorie dense and give at least 10 per cent of energy as protein. Bottles and utensils must be kept hygienic to prevent infection.

Low cost home made mixes. These use local cereals roasted, mixed in set proportions, seasoned and fortified with vitamins and calcium.

Guidelines for starting new foods. Introduce one food at a time, in small quantities that rise gradually; do not force a disliked food but try again later; avoid spicy and fried foods; do not show personal dislikes; and offer variety so new foods become acceptable.

Worked example: two calculations a health worker can do

Problem 1. An 8 month old baby weighs 7.5 kg. Using the allowance for 6 to 12 months, how much energy and protein does she need in a day?

Common wrong step: using the birth to 6 months value of 108 kcal per kg. That band stops at six months, so the answer would be $108 \times 7.5 = 810$ kcal, about 75 kcal too high.

Problem 2. An Anganwadi prepares Balahar (wheat, groundnut and bengal gram flours in the ratio 7:2:2) in a batch of 1.1 kg. How much of each flour is needed?

Check: $700 + 200 + 200 = 1100\ \text{g}$. Common wrong step: dividing 1100 g by 3 because there are three ingredients. A ratio divides by the sum of the parts, not by the number of items.

Immunisation: training the body in advance

A vaccine contains an inactive form of a bacterium or virus, or a toxin made by the germ. It cannot cause the disease, but it makes white blood cells produce antibodies, which later kill the real germ. Immunisation in the first year gives long lasting protection against the six dreaded communicable diseases: polio, diphtheria, tuberculosis, pertussis, measles and tetanus.

Problems of infancy and early childhood

Malnutrition is a national problem with several causes: illiteracy, poverty, ignorance of children's needs and poor access to health care, especially in rural and tribal areas. Children start to become malnourished when breast milk is no longer enough and they cannot yet use the family diet fully. Diarrhoea is very common in this period. It drains water and electrolytes from the body, which causes dehydration and is a major cause of infant death.

Why infection and malnutrition together are so dangerous. Infections strike at a low age, and when malnutrition and infection occur together in the same infant they feed each other. Poor access to health centres, climate, certain local customs and untested traditional treatments raise a child's chances of infection, so people need to learn about the hazards of contaminated food, poor sanitation and inadequate personal hygiene.

Beyond the textbook. For the exam: diarrhoea is dangerous because it causes dehydration and loss of electrolytes. In reality: this is why oral rehydration solution (ORS), a measured mix of salts and sugar in clean water, is the standard first aid at home for a child with loose motions, and why health workers tell mothers to keep feeding and keep breast feeding during diarrhoea.

Preschool children (1 to 6 years)

Growth slows compared with infancy, but the child is very active. Needs are similar to the rest of the family, but the amounts differ with age, height, weight, health and activity. These are also years of forming eating habits, so they are a golden time to teach healthy eating.

Guidelines that build healthy food habits. Eat as a family, since children copy what they see. Offer a variety in child size portions. Keep regular meal and snack times so the child is properly hungry. Add new foods beside favourites, with a mix of hard, soft and colourful items. Include finger foods such as small sandwiches, chapati rolls, mini idlis or samosas, whole fruit and boiled eggs. Seat the child at one place, not walking around. Let the child rest before meals, and never bribe or punish a child to eat.

Planning meals. An active preschooler's energy need rivals that of some grown up women, so there is no need to track calories, but a lack of balanced food can mean the child never reaches the full genetic potential for height. PEM, xerophthalmia and anaemia result when protein, vitamin A and iron respectively are lacking, and universal use of iodised salt is a simple, cheap way to prevent iodine deficiency disorders. A preschooler's diet should stress three things.

Three meals and two snacks work better than three meals alone, because preschoolers find it hard to eat enough in three sittings, and snack time is a good time to introduce new foods.

Balanced diet by food group (grams per day).

Pause and predict: a 5 year old refuses dal at lunch, and her father says she cannot leave the table until she finishes it. Which guideline is being broken, and what is the better approach?

Check your answer: the rule against bribing or punishing a child to eat. Forcing builds resistance to the food. The better approach is to keep dal on the menu with variety in how it is served, to eat together and to stay calm about a skipped meal.

Children with special needs. Three things matter: observe the child at mealtimes (abilities, preferences, allergies), build eating skills (more time, comfortable seating, praise, adaptive equipment, increasingly challenging textures), and use special diets where needed, such as thickening thin liquids or softening lumpy food for spastic children and a feeding tube when required. Any food the child is allergic to is removed immediately.

School age children (7 to 12 years)

The growth rate is slow, a latent period, yet days are packed with activity so energy is important. Needs are the same for boys and girls up to 9 years. After that, girls need more protein, iron and calcium for bone growth and preparation for menarche, while boys of 10 to 12 need more energy for the adolescent spurt.

Balanced diet by food group (grams per day).

Five rules for planning the school child's diet.

Worked example: reading the school diet table. A 10 year old girl needs 27 mg of iron, a boy of the same age 21 mg. The extra iron for the girl is $27 - 21 = 6\ \text{mg}$ per day. Her cereals allowance is lower than the boy's, 240 g against 300 g, so the extra iron must come from food quality, such as green leafy vegetables and pulses, not from a bigger cereal portion. Common wrong step: assuming girls need more of everything. Her energy need, 2010 kcal, is actually lower than the boy's 2190 kcal.

What shapes what children eat

Healthy habits and problems of school age

Four healthy habits. Establish sensible eating (an interesting salad with fancy names can replace mindless munching in front of the TV). Encourage 45 to 60 minutes of moderate physical activity and limit TV, with parents modelling an active life. Ensure food safety, including washing hands, fruits and vegetables. Let children judge quantity themselves from 9 to 12 years and never force food or use it to show love.

Obesity is rising. It comes from fatty, salty, low fibre foods, sugary drinks and inactivity, and is more common in higher income groups. Type II diabetes and hypertension, once rare in children, are becoming more common because of it. Undernutrition still persists among poorer groups, where children go to school on an empty stomach and perform poorly. India faces both problems together.

Mid day meal scheme. It gives a free lunch to children in Classes I to VIII. Reported results are better classroom performance and attention, higher enrolment, lower drop out and a smaller gender gap in attendance. School health programmes with free check ups and treatment add to well being.

Two views. For the exam: the mid day meal scheme improves nutrition, attention, enrolment and attendance, and reduces drop out. Another reading: education and nutrition researchers add that the benefits depend on the quality, safety and regularity of the meal and on the kitchen, so supervision and hygiene are as important as the scheme itself.

Beyond the textbook. For the exam: girls aged 10 to 12 need 27 mg of iron, the highest in the school age table. In reality: adolescent girls are one of the groups for whom iron and folic acid supplements are given through schools in India, because periods add to iron loss at the same time as growth raises the need.

Exam traps

60-second revision

Where this chapter connects

• Previous: Concerns and Needs in Diverse Contexts introduced malnutrition, the nutrition and infection cycle and the double burden.
• Next: Our Apparel moves from feeding children to clothing them.
• Related: Food, Nutrition, Health and Fitness gives the five food groups used here.
• Class XII link: Early Childhood Care and Education and Public Nutrition and Health extend these ideas to programmes and policy.