Infants And Young Children Research Articles

Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children.

Poor quality infant and young child (IYC) diets contribute to chronic under‐nutrition. To design effective IYC nutrition interventions, an understanding of the extent to which realistic food‐based strategies can improve dietary adequacy is required. We collected 24‐h dietary recalls from children 6–23 months of age (n = 401) in two rural agro‐ecological zones of Kenya to assess the nutrient adequacy of their diets. Linear programming analysis (LPA) was used to identify realistic food‐based recommendations (FBRs) and to determine the extent to which they could ensure intake adequacy for 12 nutrients. Mean nutrient densities of the IYC diets were below the desired level for four to nine of the 10 nutrients analysed, depending on the age group. Mean dietary diversity scores ranged from 2.1 ± 1.0 among children 6–8 months old in Kitui County to 3.7 ± 1.1 food groups among children 12–23 months old in Vihiga County. LPA confirmed that dietary adequacy for iron, zinc and calcium will be difficult to ensure using only local foods as consumed. FBRs for breastfed children that promote the daily consumption of cows'/goats' milk (added to porridges), fortified cereals, green leafy vegetables, legumes, and meat, fish or eggs, 3–5 times per week can ensure dietary adequacy for nine and seven of 12 nutrients for children 6–11 and 12–23 months old, respectively. For these rural Kenyan children, even though dietary adequacy could be improved via realistic changes in habitual food consumption practices, alternative interventions are needed to ensure dietary adequacy at the population level.

Effect of Home-Based Complementary Food Fortification on Prevalence of Anemia Among Infants and Young Children Aged 6 to 23 Months in Poor Rural Regions of China.

Following the 2008 Wenchuan earthquake, the Chinese government instituted an infant and young and child nutrition program that included promotion of in-home fortification of complementary food with ying yang bao (YYB), a soy-based powder containing iron, 2.5 mg as iron-EDTA and 5 mg as ferrous fumarate, and other micronutrients. Ying yang bao was provided to participating families in 8 poor rural counties in Sichuan, Shaanxi, and Gansu provinces by the Ministry of Health. We assessed hemoglobin levels among infants and young children (IYC) aged 6 to 23 months at baseline in May 2010 (n = 1290) and during follow-up in November 2010 (n = 1142), May 2011 (n = 1118), and November 2011 (n = 1040), using the Hemocue method. Interviewers collected basic demographic information and child feeding practices from the children's caretakers. Altitude-adjusted hemoglobin level averaged 10.8 g/dL, and total anemia prevalence was 49.5% at baseline. Average hemoglobin was 11.3 g/dL at 6 months, 11.6 g/dL at 12 months, and 11.7 g/dL at 18 months after introduction of YYB. Moderate anemia (hemoglobin: 70-99 g/dL) decreased from 20.3% at baseline to 7.5%, 5.8%, and 7.3% after 6, 12, and 18 months of home fortification, respectively (P < .001), whereas mild anemia (hemoglobin: 100-110 g/dL) decreased from 29.0% to 16.7%, 18.1%, and 15.4%, respectively (P < .001). Among infants aged 6 to 23 months, 95% had regularly been fed YYB during the observation period. Regression analysis showed that the duration of YYB consumption and number of sachets consumed per week correlated positively with hemoglobin levels and negatively with anemia rates. Home food fortification with YYB is feasible and effective for nutrition promotion among IYC in high-risk regions of China.

Infant and Young Child Feces Management and Enabling Products for Their Hygienic Collection, Transport, and Disposal in Cambodia.

In Cambodia, children's feces are rarely disposed of in an improved sanitation facility. This study examines current practices and the role that enabling products may play in increasing hygienic management of infant and young child (IYC) feces in households with access to improved sanitation. A survey was conducted with the primary caregiver of a child under 5 years of age in 130 homes with an improved latrine in 21 villages across two provinces in Cambodia. Two focus group discussions per province were conducted after the survey to obtain caregiver feedback on new enabling products for hygienic management. Among caregivers, 63% reported child feces disposal in an improved latrine but only 36% reported doing so consistently. Besides child age, years of latrine ownership, caregiver age, consistency of adult latrine use, and presence of child feces management tools in the latrine were associated with hygienic disposal. The youngest caretakers with the newest latrines and youngest children were least likely to dispose of IYC feces hygienically, representing a key target group for interventions to improve hygienic disposal in Cambodia. Reusable diapers, child-friendly potties, and possibly latrine seats, that offer child safety, time and cost savings, and easy disposal and cleaning could potentially facilitate hygienic disposal for these ages.

Infants and young children feeding practices and nutritional status in two districts of Zambia.

BackgroundAppropriate feeding is important in improving nutrition and child survival. Documentation of knowledge of caregiver on infant feeding is scanty in Zambia. The aim of this study was to describe feeding practices and nutritional status among infants and young children (IYC) in two districts in Zambia: Kafue and Mazabuka.MethodsA cross-sectional study was conducted between January and March 2006 using both quantitative and qualitative methods. A questionnaire was administered to caregiver of children aged under24 months. Lengths and weights of all children were measured. Focused group discussions were conducted in selected communities to assess parents or guardian knowledge, attitude and practice related to infant feeding.ResultsA total of 634 caregivers (361 from Kafue and 273 from Mazabuka) participated in the study. About 311/618 (54.0%) of the caregiver knew the definition and recommended duration of exclusive breastfeeding (EBF) and when to introduce complementary feeds. Two hundred and fifty-one (81.2%) out of 310 respondents had acquired this knowledge from the health workers. Only 145/481 (30.1%) of the respondents practiced exclusive breastfeeding up to six months with 56/626 (8.9%) of the mothers giving prelacteal feeds. Although 596/629 (94.8%) of the respondents reported that the child does not need anything other than breast milk in the first three days of life, only 318/630 (50.5%) of them considered colostrum to be good. Complementary feeds were introduced early before six months of age and were usually not of adequate quality and quantity. Three hundred and ninety-one (64%) out of 603 caregivers knew that there would be no harm to the child if exclusively breastfed up to six months. Most of the children’s nutritional status was normal with 25/594 (4.2%) severely stunted, 10/596 (1.7%) severely underweight and 3/594 (0.5%) severely wasted.ConclusionsThe caregiver in the communities knew about the recommended feeding practices, but this knowledge did not translate into good practice. Knowing that most of the mothers will breastfeed and have heard about appropriate breastfeeding, is important in the development of sustainable strategies required to improve feeding practices and, thus, nutritional status of children.

The focused ethnographic study ‘assessing the behavioral and local market environment for improving the diets of infants and young children 6 to 23 months old’ and its use in three countries

The concept of a focused ethnographic study (FES) emerged as a new methodology to answer specific sets of questions that are required by agencies, policymakers, programme planners or by project implementation teams in order to make decisions about future actions with respect to social, public health or nutrition interventions, and for public-private partnership activities. This paper describes the FES on complementary feeding that was commissioned by the Global Alliance for Improved Nutrition and highlights findings from studies conducted in three very different country contexts (Ghana, South Africa and Afghanistan) burdened by high levels of malnutrition in older infants and young children (IYC). The findings are analysed from the perspective of decision-making for future interventions. In Ghana, a primary finding was that in urban areas the fortified, but not instant cereal, which was being proposed, would not be an appropriate intervention, given the complex balancing of time, costs and health concerns of caregivers. In both urban and rural South Africa, home fortification products such as micronutrient powders and small quantity, lipid-based nutrient supplements (LNS) are potentially feasible interventions, and would require thoughtful behaviour change communication programmes to support their adoption. Among the important results for future decision-making for interventions in Afghanistan are the findings that there is little cultural recognition of the concept of special foods for infants, and that within households food procurement for IYC are in the hands of men, whereas food preparation and feeding are women's responsibilities.

Tackling poverty through private sector microcredit programs in Ghana: Does infant and young child nutrition improve?

Low income is a barrier to optimal feeding practices of infants and young children (IYC). Microcredit programs for rural Ghanaian women aim to improve incomes and may have the additional benefit of improving IYC nutrition. A cross‐sectional study was conducted in the Upper Manya Krobo District in Ghana to determine the association between a mother's participation in a rural bank microcredit program and IYC dietary quality and nutritional status. Participants included 102 active microcredit member mothers and 102 non‐microcredit member mothers and their youngest child (6–23 mo). Non‐members were matched to the microcredit group by community and child age. Information was collected on IYC feeding practices, length and weight and household socio‐demographic characteristics. IYC in the microcredit group (MC) consumed more dairy products (p &lt; 0.01) and iron‐fortified foods (p &lt; 0.05) while IYC in the non‐microcredit group (NMC) consumed more legumes and nuts (p &lt; 0.05). Overall, more MC than NMC children (57 % vs. 43 %; p &lt; 0.05) met minimum dietary diversity recommendations (≥ 4 food groups). Weight‐for‐age z‐scores tended to be higher among MC vs. NMC children (−0.43 ± 1.13 vs. −0.69 ± 1.03; p = 0.09). Microcredit programs may contribute to improving IYC nutrition in Ghana; longitudinal studies are needed to understand the role that this component of the private sector plays.Funding: IDRC #1045519‐017 &amp; McGill U.

Impact of flooding on feeding practices of infants and young children in Dhaka, Bangladesh Slums: what are the coping strategies?

Previous research has shown that urban slums are hostile environments for the growth of infants and young children (IYC). Flooding is a hazard commonly found in Dhaka slums (Bangladesh) which negatively impacts IYC's nutritional and health status. This paper aims 1) to identify the impact of flooding on IYC's feeding practices, and 2) to explore the coping strategies developed by caregivers. Qualitative data (participant observation and semi-structured interviews) and quantitative data (household questionnaire and anthropometric measurements) collected in slums in Dhaka (n=18 mothers, n=5 community health workers, and n=55 children) were analysed. The subjects of the interviews were mothers and Bangladesh Rural Advancement Committee (BRAC) community health workers living and working in the slums. Research findings showed that breastfeeding and complementary feeding practices for IYC were poor and inappropriate due to lack of knowledge, time, and resources in normal times and worse during flooding. One coping strategy developed by mothers purposely to protect their IYC's nutritional status was to decrease their personal food intake. Our research findings suggest that mothers perceived the negative impact of flooding on their IYC's nutritional health but did not have the means to prevent it. They could only maintain their health through coping strategies which had other negative consequences. The results suggests a holistic approach combining 1) provision of relief for nutritionally vulnerable groups during flooding, 2) support to mothers in their working role, 3) breastfeeding counseling and support to lactating mothers with difficulties, and 4) preventing malnutrition in under 2 year old children.

Responsive Feeding and Child Undernutrition in Low- and Middle-Income Countries1,2

Growth faltering and nutritional deficiencies continue to be highly prevalent in infants and young children (IYC) living in low- and middle-income (LAMI) countries. There is increasing recognition that feeding behaviors and styles, particularly responsive feeding (RF), could influence acceptance of food and dietary intake and thus the growth of IYC. This paper presents the evolution of RF research and the strength of the evidence for RF on child undernutrition in LAMI countries. Multiple approaches were used to identify studies, including keyword searches in many databases, hand searches of retrieved articles, and consultation with experts in the field. Articles were included if they contained a RF exposure and child undernutrition outcome. In total, we identified 21 studies: 15 on child growth, 4 on dietary intake, 3 on disease, and 8 on eating behaviors. Most studies were conducted among children <36 mo of age and were published in the last 10 y. Cross-study comparisons were difficult due to multiple definitions of RF. One-half of the studies were observational with cross-sectional designs and few interventions were designed to isolate the effect of RF on child undernutrition. Overall, few studies have demonstrated a positive association between RF and child undernutrition, although there is promising evidence that positive caregiver verbalizations during feeding increase child acceptance of food. Recommendations for future research include consensus on the definition and measurement of RF, longitudinal studies that begin early in infancy, and randomized controlled trials that isolate the effect of RF on child undernutrition.

Intussusception in children: evidence-based diagnosis and treatment

Keywords Intussusception.Infantsandchildren.Enema.BowelobstructionIntroduction and goals of imagingIntussusception is an invagination of the bowel into itself,usually involving both small and large bowel. The moreproximal bowel that herniates into more distal bowel iscalled the intussusceptum and bowel that contains it is calledthe intussuscipiens. It is an emergent condition where delayin diagnosis is common, which may lead to bowelperforation, obstruction, and necrosis. Most cases in infantsand young children are ‘idiopathic’ in that the etiology of theintussusception is due to hypertrophied lymphoid tissue inthe terminal ileum which results in ileocolic intussusception.The goal of initial bowel imaging is early detection (orexclusion)ofintussusceptiontoenableenemareductionoftheintussusception.Additionalimagingstudiesmaybeperformedto further characterize indeterminate results, possible leadpoints,incompletereduction,andrecurrenceofintussusception.EpidemiologyIntussusception is second only to pyloric stenosis as a causeof obstruction in children; it is the most common cause ofsmall bowel obstruction in children and occurs in at least 56children/100,000/year in the USA [1]. Viruses are associ-ated with intussusception, particularly adenovirus [1].Intussusception occurs most commonly in infants aged 5–9 months (67% occur by age 1 year) [2]. The classic triad ofcolicky abdominal pain, vomiting, and bloody stools ispresent in less than 25% children [3–5]. Delay in diagnosisand treatment is not uncommon, making enema reductionless successful, bowel resection more likely, and death dueto bowel ischemia possible [2, 6–8]. There were 323intussusception-associated deaths in American infantsreported to the Centers for Disease Control (CDC) between1979 and 1997.Abdominal radiographsThe presence of a curvilinear mass within the course of thecolon (the crescent sign), particularly in the transversecolon just beyond the hepatic flexure, is a nearly patho-gnomonic sign of intussusception. The absence of bowelgas in the ascending colon is one of the most specific signsof intussusception on radiographs [9]. However, abdominalradiographs have low sensitivity (45%) and therefore arenot recommended to diagnose intussuception.The increasing role of ultrasoundIntussusception can be reliably diagnosed when a ‘donut’,‘target’ or ‘pseudokidney’ sign is seen with sonography[10–13].The optimal US technique in this population iswell described and includes the use of a linear transducer[11–15]. US also plays a role in the evaluation ofreducibility of the intussusception, the presence of apathologic lead point (PLP) mass, intussusception limitedto small bowel, the diagnosis or exclusion of residual

The Carrageenan Connection III: Recent Regulatory Revisions and Recommendations

In the recent 1993 round of regulatory meetings, the joint FAO/WHO JECFA awarded a temporary restricted ADI to Processed Eucheuma Seaweed (PES); the Codex Committee on Food Additives and Contaminants ruled that PES is different from carrageenan; and the UK Food Advisory Committee has now confirmed that studies on carrageenan requested in 1992 are still required; that carrageenan should not be used in food for infants and young children, and that the specification for carrageenan should be tightened. Indicates the changes resulting from these separate regulatory considerations.

A study of quinidine dosage in infants and children

Summary 1. The foregoing study was carried out to obtain information about quinidine dosage in children, utilizing serum levels of the drug. 2. A method for determining serumquinidine concentration which is simple, can be run on capillary blood samples, and is sufficiently accurate for clinical use has been presented. 3. On the basis of body weight, infantsand young children appear to require relatively larger doses of quinidine than adults. 4. From information obtained instudies using single and multiple doses of quinidine, a tentative dosage schedule requiring a minimum of blood levels has been worked out. 5. A case has been presented inwhich the suggested dosage plan was successfully utilized to treat a 4-year-old child with congenital heart disease who had developed cardiac arrhythmia (impure auricular flutter). 6. Results which tended to vary from the normal were noted in patients with fever, with congestive heart failure, and with hydrocephalus; further work in these areas would be of particular interest.

Physiology of the hematopoietic system in infantsand young children, including the blood picture at birth and in young infants

Summary The newborn infant begins life with a type of blood picture peculiar to its age group. It is characterized by an increased number of most of the blood elements with a few immature cells. Rapid changes, caused mostly by physiologic factors, take place during the first few weeks reducing the hemoglobin and red blood cell count markedly. After three months a slow recovery begins.