Nutrition is very crucial to the life cycle of man as it is a key driver of growth and development. Infant life and early childhood years (0-2) are phases when growth and development are at its peak (Bhandari and Chowdhury, 2016). However, it is also a period of vulnerability to long term consequences if their feeding is not critically looked into. In Nigeria, about 70 infants and toddlers in a thousand die as a result of inappropriate feeding and nutrition (MICS, 2017).
There are other factors that affect child growth and development and also influence the nutritional status of the child as well, they include; water, sanitation, hygiene etc.
What Nutrition Entails
Nutrition in infants and toddlers is a description of the dietary needs of these children. It entails providing an adequate amount of nutrient rich food which makes up for good nutrition (Pomeranz et al., 2018). The food given to infants and toddlers should provide them with the energy and nutrients needed for them to grow adequately and maintain a healthy life.
Nutrition needs for infants and toddlers are quite different. For infants aged 0-6 months, breast milk is considered the best food as it contains all necessary vitamins and minerals that they require, however infants from 6 months of age will require additional sources of nutrients to enable them to grow effectively (Heyman et al., 2017).
Importance of Nutrition in Infants and Toddlers
Adequate nutrition is necessary for normal brain development in infants and growing toddlers. This is crucial because it is required for the formation of the brain, hence laying the foundation for the development of cognitive and socio-emotional skills throughout childhood and life (Prado and Dewey, 2014).
Poor nutrition increases the risk of illnesses. It is linked to long-term impairments in growth and health. It can also lead to childhood obesity which is currently an increasing public health problem in many countries (Black et al., 2008; WHO/ UNICEF/ USAID, 2008).
In toddlers, adequate nutrition sets the basis for healthy eating for the rest of their lives. It helps to give a good start and foundation for their healthy eating habits even as they grow. This also helps to ensure the development of children to their full potential (WHO/UNICEF/USAID, 2008).
Nutritional Needs of Infants and Toddlers
Infants and toddlers need energy from food for various activities, growth and also for their normal development. This energy is obtained from various food sources containing carbohydrates (breast milk, lactose free formulas, soy-based formulas), fat (breast milk, meat, egg yolk, cheese, any fats/oils added to home-made foods) or protein (breast milk, meat, fish, egg yolks, cheese, yoghurt, legumes, cereals and other grain products) (Olsen et al., 2003). Infants and toddlers’ energy/caloric requirement is dependent on various factors which includes the body size and composition, metabolic rate, physical activities, generic factors and the growth rate (Owen et al., 2002). These infants and toddlers are capable of regulating their intake of food to enable them to consume the exact amount of kilocalories they need.
It has been established that children from ages 0-6 months should be exclusively breastfed; children from 6-8 months require 200kcal/day in addition to breast milk; children 9 to 11 months require 300kcal/day; while those 12-24 months require 550-650kcal/day (WHO, 2009).
Carbohydrates are of importance in their diets because they:
1, Supply food energy for growth, body functions and activities;
2, Allow protein in the diet to be used efficiently for building new tissues;
3, Allow for the normal use of fats in the body; and
4, Provide the building blocks for some essential body compounds (Lifschitz, 2000).
Functions of Protein in Their Diet
1, They build, maintain and repair new tissues including those of the skin, eyes, muscles, brain and other organs;
2, Manufacture important enzymes, hormones, antibodies and other components;
3, Perform specialized functions in regulating body processes (Institute of Medicine, Food and Nutrition Board, 2005).
Functions of fats in their diet
1, They promote the accumulation of stored fat in the body which serves as insulation to reduce body heat loss and helps to protect body organs;
2, They also allow for the absorption of fat soluble vitamins A, D, E and K
3, They provide essential fatty acids required for normal brain development, healthy skin and hair, normal eye development and also aid in resistance to infection and diseases (Olsen et al., 2003).
Other nutrients required by these infants and toddlers include vitamins (A, B, C, D, E and K). Vitamin D is mainly manufactured in the skin by the action of ultraviolet light from the sun, hence it is dependent on the amount of exposure a child gets to sunlight. Other sources of this vitamin include fish, liver and egg yolk. Breast milk also contains a little amount of this vitamin (Institute of Medicine, Food and Nutrition Board, 2005).
Vitamin A is also obtained from breast milk, egg yolks, yellow and dark green leafy vegetables (spinach, sweet potatoes, greens etc). Vitamin E can be gotten when breast milk, whole-grain bread, cereals, butter, liver and egg yolks are consumed. Vitamin K is sourced from green leafy vegetables and liver. Vitamin C has several sources which includes vegetables (tomatoes, cabbage, potatoes) and fruits (orange, pawpaw, strawberries). Sources of vitamin B include; meat, dairy products, cereals, potatoes, legumes etc (Institute of Medicine, Food and Nutrition Board, 2005).
Functions of all vitamins
1, The proper formation of bones
2, To utilize calcium and phosphorus in the body
3, The formation and maintenance of healthy skin, hair and mucus membranes
4, Proper vision
5, To enhance healthy immune and reproductive systems
6, To prevent tissue breakdown
7, Proper blood clotting
8, The healing of wounds
9, The absorption of iron
10, To maintain capillaries, bones and teeth
11, To form collagen, a protein that gives structure to bones, cartilage, muscle, blood and other connective tissues
12, The body in fat metabolism (Welch et al., 2000)
Other nutritional needs of infants and toddlers include calcium, iron, zinc, fluoride, sodium and water. If these nutritional needs are not met they result in deficiencies and can impact on the growth of the child which may have long term consequences (Institute of Medicine, Food and Nutrition Board, 2005).
Types of infant and toddler feeding
There are two types of infant feeding practices which include:
1. Breastfeeding; and
2. Complementary feeding.
Breastfeeding is the nourishment designed by nature for newborns, infants and also toddlers (PAEDIATRICS, 2012). The most acceptable form is the exclusive breastfeeding (EBF) as recommended by the WHO (2009). However, statistics have shown that only 37% of children under 6 months of age are being exclusively breastfed in low and middle income countries (LMIC) of which Nigeria is part (Victora et al., 2016). Early initiation of breastfeeding in infants is observed to be associated with a 44% reduction in neonatal mortality (Debes et al., 2013).
Continued breastfeeding for toddlers is associated with a 26% reduction in childhood and adolescent obesity and a 35% reduction in the incidence of type-2 diabetes (Horta et al., 2015a). EBF has reduced 32% of diarrhoea and lower respiratory tract infection hospitalizations in the first 2 years of life (Horta and Victoria, 2013). It is also associated with a 19% reduction in the incidence of childhood leukemia (Amitay and Keinan-Boker, 2015).
A steady increase in the percentage of children who have been exclusively breastfed has been observed since 2008 as seen in fig 1.
Fig 1: Percentage of children under 6 months who were exclusively breastfed (WHO, 1990-2016) (Source: The MSDAT).
Advantages of breastfeeding
1, Breastfeeding is free;
2, Breast milk requires no preparation and contains all the nutrients needed for the baby to grow;
3, It promotes a healthy digestive system; and
4, It strengthens the baby’s immune system (Grote et al., 2017).
Disadvantages of breastfeeding
1, Mothers may feel discomfort especially in the first few days;
2, Not all forms of medication can be taken during the period;
3, Keeping up with the newborn feeding schedule may be difficult (Grote et al., 2017).
Complementary feeding, on the other hand, refers to the introduction of other foods and liquids starting from 6 months of age with continued breastfeeding up to 24 months and beyond (WHO, 2009; Agostoni et al., 2016). It should be timely and adequate, meaning that it should be given in required amounts and consistency, using a variety of foods to cover the nutritional needs of the growing child while also continuing breastfeeding (Bhandari and Chowdhury, 2016).
A study conducted by Ariyo et al., in 2021 shows that about 72% of mothers commence complementary feeding at 6 months of age. After 12 months of age, complementary feeding should provide about 60% energy, 40% protein, over 50% of iron and 20% of vitamin A of the total daily requirement. Dietary diversity is also important for children between 6 months to 2 years of age (Bentley et al., 2015).
Advantages of complementary feeding
1, It helps to fulfill the need of vital nutrients and supplements for the children in order to enhance their growth;
2, Others can help out with feeding the child and this helps bonding as well (Jimenez-Cruz et al., 2018).
Disadvantages of complementary feeding
1, The preparation consumes time;
2, There may be danger of being overweight due to the consumption of various foods;
3, There’s a risk of contamination during preparation and also may initiate infections in children (Kulwa et al., 2017).
Effects of poor nutrition in infants and toddlers (0-2)
Poor nutrition in infants and toddlers will impact on their growth and development hence resulting in stunting (height-for-age), wasting (weight-for-height) and being underweight (weight-for-age). This is very critical as it affects their cognitive and learning ability and will not make them develop to their full potential. Poor nutrition can result in;
1, Stunting: This is referred to as the impaired growth and development that children experience as a result of poor nutrition and repeated infection (WHO, 2015). Children are said to be stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standard median. About 48% of children aged 6-11 months and 44% of children aged 12-24 months are reported to be stunted according to the National Nutrition Health Survey (NNHS, 2018). In 2018, it was observed that the North-West region had the highest prevalence of stunting in children under 5 while the South-East recorded the least (fig 2).
Fig 2: Prevalence of stunting among under 5 children (NDHS, 2018) (Source: The MSDAT).
2, Wasting: This is used to refer to a child who is too thin for his/her height. It occurs as a result of rapid weight loss, weakening their immune system and making them vulnerable to developmental delays, diseases and death (WHO, 2012). A decline in the prevalence of wasting in children under 5, has been observed since 2018 as shown in fig 3.
Fig 3: Prevalence of wasting among under 5 children (World Bank, 1990-2020) (Source: The MSDAT).
3, Underweight: A child is said to be underweight if they are in the bottom 5th percentile for weight compared to their height. Children are said to be underweight if they are below two standard deviations on the WHO Child Growth Standard median (WHO, 2012). There has been a decline in the number of underweight children since 2018 as observed in fig 4.
Fig 4: Prevalence of underweight in children under 5 years of age (World Bank, 1990-2020) (Source: The MSDAT).
Nutrition in infants and toddlers is very crucial as it affects their development through life stages, it serves as the basis for their healthy eating habits. Breastfeeding is very important and contains virtually all nutrients needed for growth from infancy. Exclusive breastfeeding should be encouraged and practiced among mothers for children between ages 0-6 months so as to boost their immune system and help proper brain development. Complementary feeding should be diverse and in adequate quantity so as to provide all needed nutrients required for the child’s growth.
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