can be distressing for parents of underweight children.
Seeing other bouncy children when theirs seem skinny
in comparison, despite special care, nutrition and medication,
makes them wonder where have they gone wrong.
As long as a child is active, responds
to stimuli and has sparkling eyes, parents need not
worry, says Consultant Paediatrician and Senior Lecturer
in Paediatrics Dr. Rohitha Seneviratne, as a number
of factors determine the weight of a child including
genetic make-up, diet and physical activity.
While little can be done with regard
to hereditary factors - such as a parent or grandparent
being of slight build, parents can play an important
role in ensuring that their child has a nutritious diet
and adequate physical activity.
Why is weight important? "Weight
and height of a child is one indicator of the child's
health and development," Dr. Seneviratne says,
"more so in the first two-three years as it ensures
wellbeing in future adult life." Tracked over a
period of time, the measurements indicate if a child
is growing properly.
One of the main reasons a child may
not gain weight is due to lack of proper nutritious
food. "Parents are influenced by cultural and social
beliefs and take suggestions from friends and relatives
rather than medical advice," he says. To ensure
that a child maintains healthy weight, he recommends
Type of food:
A balanced diet should include fish,
meat, eggs, fresh vegetables, green leaves, fruit, rice,
pasta, noodles and pulses. Some parents believe that
yoghurt, cheese, eggs and butter are too rich or can
bring about cold, chest infections or wheezing, but
these are calorie dense products, high in nutrition
and provide children with the energy they need. It needs
mention that adult diseases such as diabetes or hypertension
can result from the type of nutrition taken as a child.
|Children come in different sizes
and weights and grow at different rates. As long
as their weight gain is proportionate, irrespective
of their weight at birth (First five months = 700
gm/month and next seven months = 500 gm/month) following
the centile lines , it indicates a proper growth.
While exclusive breast feeding is imperative
during the first six months, children should be weaned
from the 7-12th month. From one year onwards a child
should be encouraged to eat with the family and not
separately, whatever everyone eats however messy the
experience may be. The doctor dissuades mothers and
grandmothers from force-feeding children, entertaining
them with songs or TV or walking around with them during
their lunch, lengthening the entire process for several
hours. Bribing with gifts or outings is strongly discouraged.
Meal times should be pleasurable.
Children only eat what they like and often convey their
preferences through their actions. When a child sees
a love for fruits and greens in the family, he too will
follow the family food pattern. Initially a toddler
may throw food around but will eventually learn by imitating
his parents and be appreciative of meal time discipline.
Such discipline also helps the child
understand that meals would be provided only at certain
times of the day. Should a toddler not eat adequately,
he should be ignored rather than punished. However he
can be rewarded when completing a meal.
Four meals a day:
Children and toddlers should be fed
what they like for breakfast, lunch, teatime snack and
dinner. Attempts should be made to prepare food in the
way they like, for instance fried fish instead of curry
fish. It is often the case that underweight children
are also picky eaters. Parents should ensure that the
small amounts they eat are nutritious. An egg a day
and dessert after every meal even ice cream which contains
milk is recommended. Sweets in between meals should
be disallowed as they can cause tooth decay.
The home environment should be happy
and stimulating, not stressful. An environment where
routine and discipline is maintained will foster a child
with healthy habits, as well as improve his/her growth
and development. Adequate sleep and exercise is a must.
Concerns for underweight children:
Despite adequate nutrition some children
show no weight gain. There are several possible reasons:
not consuming enough food, an underlying illness, like
a urinary tract infection or some disorder relating
to the heart or lungs. Such cases would need further
investigations. Dr. Seneviratne warns parents to watch
out for signs such as weakness that would prevent day-to-day
activities, excessive sleep, no sparkle in the eyes
and lack of response to stimuli in which case they would
need to seek immediate medical treatment. An under-nourished
child is more likely to fall sick. Rather than preventing
the child from eating adequate food when sick, a child
should be given more food - for metabolic activities
and fighting infection, failing which the child's stored
fat would be used, reducing his/her weight further.
However, if a child has no interest
in eating, it could be a sign of anxiety or even an
eating disorder which needs to be checked by a health
professional. Dr. Seneviratne cautions against food
supplements. "If a balanced diet is given there
is no need for appetite stimulants, vitamins or food
supplements," he stresses unless there is a nutritional
disorder such as a vitamin deficiency.
"Children need energy to build
their bodies, for growth and for their daily activities
which includes playing and metabolic functions,"
Dr. Seneviratne emphasizes. While some have energy for
activities they do not have any left for growth. It
is the parents' duty to set an example by eating nutritious
food and ensuring that their offspring do the same.
Under nutrition still a major
problem in Sri Lanka
A UNICEF publication based on
data from the Demographic and Health Survey 1987states
that despite improvements in many public health
indicators, problems of under nutrition persist
in Sri Lanka, particularly among women and young
* More than one in three children
of ages 0-3 are underweight for their age.
* Every fourth child has a low
height for age which may have resulted from under
nutrition and repeated illnesses.
The damaging effects of under
nutrition include reduced mental development,
lower resistance to infection, learning disabilities
and low productivity, effects that continue from
one generation to another.