Four pediatricians highlight why it is vital to pay attention to children’s nutrition from the beginning.

Fueling Children’s Potential With Multimicronutrient Supplementation

Dr M Narayanan, Consultant Pediatrician; MD; DCH; FIAP; Senior Consultant Pediatrician SAN Children’s Clinic & Ernakulam Medical Centre, Kochi, Kerala.

The interplay between nutrition and early childhood development is a complex yet profoundly influential relationship. While a balanced diet remains fundamental, supplementation can serve as a valuable complement to ensure children receive adequate amounts of vital nutrients crucial for their growth and cognitive abilities. In the realm of child development, the significance of nutrition during the first 1,000 days of life cannot be overstated. It lays the foundation for a child’s growth, health, and cognitive abilities. 

Multimicronutrient supplementation emerges as a promising strategy to address nutritional gaps and optimise children’s development. Studies have indicated that adequate intake of omega-3s during early childhood plays a pivotal role in brain development and positively correlates with improved cognitive performance, attention, and behavioural outcomes. Certain vitamins, such as vitamin D, B vitamins, and antioxidants like vitamin E, have also been implicated in supporting cognitive function and neurological development in children.

Essential nutrients such as iron, crucial for red blood cell formation and oxygen transport, calcium for bone development, and zinc aiding immune function and growth, are fundamental ingredients in this pursuit. Vitamins like A, C, and D play pivotal roles in the absorption of calcium for robust skeletal development. By fortifying children’s diets with these vital micronutrients, we lay the groundwork for holistic development, ensuring they thrive in both body and mind, poised for a healthier and more prosperous future.

The Malnutrition Dilemma

Dr G V Basavaraja, Consultant Pediatrician; MBBS (BMC & RI); MD (SMS, Jaipur); DNB, FIAP; Professor of Pediatrics, Indira Gandhi Institute of Child Health, Bengaluru; National President Elect-2023, IAP.

Nearly half of all deaths in children under five are attributable to undernutrition, which puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays in recovery. Poor nutrition in the first 1,000 days of a child’s life can also lead to stunted growth, which is associated with impaired cognitive ability and reduced school and work performance.

A critical period from the second trimester of pregnancy to two years of age, or the growth spurt period, is thought to represent the most vulnerable period of brain development. Malnutrition during this phase results in irreversible changes in cognition and behaviour. Malnutrition has far-reaching consequences of both a medical and psychological nature, especially in children. 

Malnourished children are less physically fit and have a weak immune system. Over the past few decades, nutrition has begun to meet the challenge of improving health in the pediatric population. Nutritional changes affect every aspect of the endocrine system. Currently, most childhood nutritional interventions begin after about six months of age. There is a need to provide nutritional and health support to women before conception, and to continue to help mothers through and beyond their pregnancies to prevent the repeating of that cycle of malnutrition in the next generation. 

Early nutrition optimisation ensures the greatest possible start in life, with long-term advantages.

Pediatric Obesity & Adolescent Weight Challenges

Dr Upendra Kinjawadekar, Consultant Pediatrician; MBBS; DCH; MD – Pediatrics; Kamalesh Mother and Child Hospital and Apollo Hospitals, Navi Mumbai; Indian Academy of Pediatrics (IAP) National President 2023.

India is at the precipice of a nutrition paradox. While on one hand the incidence of wasting, stunting, and being underweight is still very high, the prevalence of obesity amongst children under five has increased almost two-fold in urban parts of the country. 

While a small percentage of childhood obesity is inherited, socioeconomic and environmental factors have a larger role to play. Children’s idea of leisure time with friends by and large involves calorie-dense meals. Increasing academic pressures also result in less time allocated to physical activity, especially in adolescence. Overweight children become susceptible to a plethora of lifestyle and non-communicable diseases, including pediatric metabolic syndrome, diabetes, dyslipidemia, hypertension, cardiovascular disease, non-alcoholic fatty liver disease as well as other endocrine, orthopedic and psychosocial disorders. 

Recognising the continuum from childhood to adolescence is crucial in developing an effective treatment regimen. Early intervention promoting healthy eating habits, physical activity, and psychological well-being can significantly mitigate the risks of persistent weight issues. There is no single approach to the successful treatment of obesity, and lifestyle modification should be maintained throughout the pharmacologic treatment. Screening for mental health status in overweight youth and those with obesity at the onset of care and during treatment is important, particularly given the prevalence of depression, anxiety, weight stigma or bias.  Incorporating these lifestyle changes will significantly reduce the prevalence of childhood obesity, fostering healthier adolescence.

The Calcium Project

Dr Sachidananda Kamath, Consultant Pediatrician; MBBS; DCH MD; FIAP DHHM (Hospital Management); PGDAP (Adolescent Pediatrics); Director Of Medical Affairs, Senior Consultant Pediatrician, Indira Gandhi Co-operative Hospital, Kochi – Kerala; National President 2015 Indian Academy of Pediatrics.

The primary role of calcium is to provide structural strength to support the body’s weight and anchor the muscles to facilitate movement. 20–30 g of calcium is present in an infant at birth and this amount increases to 1200 g of calcium in an adult. During this period, calcium accumulates in the bones and the bone mineral content reaches a plateau, and this peak bone mass is maintained for up to the next 20 years. Hence it is imperative to ensure adequate intake of calcium to achieve optimal peak bone mass. 

Deficiency of calcium has long-term consequences. Growth disturbances are often compounded by the impact of low calcium and vitamin D. Dietary calcium deficiency also plays a role in the manifestation of rickets and classic skeletal deformities. Hypocalcemia drives hyperparathyroidism, which in turn results in reduced mineralisation compromising bone strength. 

Calcium does not work alone. As children grow, their bodies also need other minerals, such as phosphorus and magnesium, and other nutrients such as vitamin D and vitamin K. An inadequate provision of calcium may go unnoticed for long periods. Nutrition interventions to improve children’s calcium intake should focus on parents’ guidance on improving the consumption of calcium-rich foods. Calcium is the cause of bone strength. There should be enough calcium provided to children before adulthood so that they do not develop osteoporosis in the future.