Adequate baby and child nutrition is imperative in order to achieve appropriate growth & development, build defence against infections and to decrease the overall incidence of life-threatening disease in childhood.

Approximate energy, protein, iron, and folate requirements during childhood

Age	Energy kJ/day	Protein g/day	Iron mg/day	Folate mcg/day
0-6 months	2700	13	6	65
7-12 months	3500	14	10	80
1-3 years	5500	23	10	150
4-8 years	7000	30	10	200
9-13 years	10000	45	18	300

(Adapted from the National Academy of Sciences- USA)

Baby nutrition (0-6 months) 

During the first 6 months of life most nutrient requirements are met by exclusive breastfeeding. Babies should thereafter be weaned onto solid foods such as vegetable feeds and cereals. It is important to view weaning as both a nutritional and developmental experience as babies explore various tastes and textures.

Breastmilk is advantageous because it contains several active enzymes, hormones, and growth factors. Breastmilk also has antibacterial and antiviral properties. Research has also shown that breastfeeding can delay the onset of allergy. The Baby Friendly Hospital Initiative (BFHI) was launched in 1991 by the World Health Organization to support breastfeeding mothers.

Infant and toddler nutrition (1-3 years)

This age group requires a good balance between breastfeeding and complementary feeds. It is recommended to start with a few teaspoons of nutrient dense food prepared hygienically. It is important to track the weight of the child during this crucial period of weaning. Food fortification is another implementation that helps prevent iron deficiency and nutritional anaemia.

Child and teenager nutrition (5-12 years)

Eating habits developed during this stage of development sets the scene for the approach to food well into adulthood. Encouraging three healthy meals a day is recommended but appetite may decrease during this phase which may worry parents. However, the incidence of childhood obesity is on the rise in South Africa which can put children and teenagers at significant risk for chronic conditions such as type 2 diabetes and hypertension. 

Malnutrition

Malnutrition may present as an abnormally high or low body mass, poor growth, failure to thrive, swelling of soft tissue (oedema) and recurrent infections due to a compromised immune system. Inappropriate intake of energy and protein may lead to malnutrition. Furthermore, certain micronutrient deficiencies may lead to unique signs & symptoms, such as Vitamin A deficiency or iron deficiency. 

Protein energy malnutrition (PEM)

This type of malnutrition depends on how long protein and energy has been insufficient for the child. Other factors that impact the severity of PEM include age of the child and other associated vitamin, mineral and trace element deficiencies. It is vital to keep track of a child’s weight for height which can be a useful indicator of protein and energy intake. 

Vitamin A deficiency 

Vitamin A is found in milk, egg yolk, fish oils, some vegetables and fruits. The diets of children with Vitamin A deficiency are often deficient in other nutrients. A deficiency in Vitamin A can cause dry eyes, night blindness and an increase in the severity of serious infections. Research has shown that Vitamin A supplementation during complicated measles decreases the duration of complications. If Vitamin A deficiency is suspected, a dose of Vitamin A should be given immediately. Vitamin A should be made easily available for children at local clinics and hospitals. Diets rich in Vitamin A containing foods should be encouraged such as green leafy vegetables, pumpkin, squash and carrots.

Vitamin B complex deficiency

Vitamin B complex can protect against disease and is essential for metabolic processes. Some signs of Vitamin B complex deficiency include dermatitis, diarrhoea, dementia, mood instability and anaemia. Good food sources of B vitamins include, meat (especially liver), seafood, poultry, eggs, dairy products, legumes, leafy greens and seeds.

Vitamin C deficiency

Vitamin C facilitates the absorption of iron. Interestingly, cow’s milk is low in Vitamin C and breastmilk is rich in Vitamin C. Other sources of Vitamin C are citrus fruits, broccoli, berries, melons, potatoes, papaya, guava and tomatoes. Vitamin C deficiency results in poor collagen, poor wound healing, bleeding and haemorrhage.

Iron deficiency 

This can occur commonly in especially the first year of life because milk is low in iron. Iron deficiency can lead to a poor immune system causing an increase in infections, gastrointestinal symptoms, impaired effective absorption of food and vitamins, impaired thermoregulation, fatigue, and impaired cognitive function. 

Zinc deficiency

Zinc is a trace element which aids in metabolic processes and immunity. It also helps maintain epithelial integrity and growth. Zinc deficiency is associated with growth faltering, low birth weight babies and skin lesions. Zinc supplementation is widely available for those children who may require it.

Prevention of nutritional disorders

Good health education as early as during and after pregnancy, at clinics and schools is critical. The use of Road to health booklets, growth and weight charts should be easily accessible in order to prevent malnutrition.

 “My plate” is one tool accessible on www.myplate.gov. This resource will allow children to explore food ideas and serves as a visual reminder to make healthy food choices.

Conclusion

My hope is for all children to grow up healthily while cultivating a positive attitude towards food. Food is vital fuel providing energy that can allow our children to thrive if chosen appropriately and in the correct portion sizes. The caregiver is the most important individual in a child’s life. You can make it easier for your kids to choose healthy options by keeping fruits and vegetables on hand and nutrient-dense foods easily available in the home. Sit down as a family and indulge in nutritious, wholesome meals together. A balanced diet is a balanced body. 😊

Dr Candice Shah

Specialist Paediatrician

Netcare- N1 City Hospital, Cape Town