3. Rationale
The 1,000 days between a woman’s pregnancy and her child’s 2nd
birthday offer a unique window of opportunity to shape healthier and
more prosperous futures.
Children who do not get adequate nutrition during the 1,000 days
between their mother’s pregnancy and their second birthday can suffer
from stunted physical and cognitive development.
Impaired cognitive function means a child can have a diminished
capacity to learn, leading to lower educational performance and
ultimately, lower economic productivity.
This in turn can hinder a nation’s economic development.
Evidence shows that in countries where childhood undernutrition is
pervasive, the loss to GDP can be as high as 2 to 3%, not including
the indirect costs of malnutrition such as health care and lost wages
due to illness.
In the adult life they are greater risk of the NCDs such as
diabetes, heart disease, hypertension, Osteoporosis, Neuro
-Psychiatric Disorder, Cancer etc, resulting life long medical
expenses
6. Back Ground
• On an average, more than 22,000 children < 5 yrs
of age still die every day from preventable causes.
• Hunger starts in the womb. Malnutrition in the first
1,000 days can lead to irreversible damage to minds and
bodies.
• According to UNICEF’s State of the World’s Children
2010, undernutrition contributes to more than one-
third of these deaths.
• Undernutrition, particularly in children < 2 Yrs of age,
prevents them from reaching their
full development potential.
6
7. Back Ground
•World over 136 million babies are born annually, around
250babies every minute.
•WHO’s recommendation of optimal infant feeding
includes: beginning breastfeeding within an hour of birth
and exclusive breastfeeding for the first 6 mos, followed
by timely and appropriate complementary feeding after
6 mos along with continued breastfeeding for 2 years or
beyond.
• Every minute more than 250 women need support to
practice the first standard of health care for their babies.
•According to the UNICEF’s State of World Children
Report only 32.6 % (about 44.5 million) of the babies
born worldwide are able to practice exclusive
breastfeeding for the first six months, i.e. about
7
8. Breastfeeding in the First Hour:
Why it Matters
All newborn mammals stay close to their mothers and start to suckle
shortly after delivery.
Breastfeeding immediately after birth is a natural behaviour.
Human babies are no
different.
Step 4 of the ‘UNICEF/WHO Ten Steps to Successful Breastfeeding’
is “Help mothers initiate breastfeeding within a half-hour of birth.”
The uninterrupted journey of a newborn baby to the mother’s breast is
guided by the sensory stimulation of touch and smell.
Finding the mother’s nipple for the first time outside the sheltered
environment of the womb, baby and mother’s first encounter is not
only full of wonder but also full of nourishment & benefit for both. 8
9. Colostrum – First Food
■ Colostrum is the first rich, yellow milk -.contains large amounts of
leukocytes – living cells that engulf and defend against viruses and
infectious micro-organisms.
■ It has large quantities of the antibody, secretory immunoglobulin
IgA which protects the vulnerable mucous membranes of the
throat, lungs and the intestinal tract.
■ It has a laxative effect that helps the newborn baby pass early stools
and excrete excess bilirubin and prevent jaundice.
■ A newborn baby’s stomach holds about 5 to 7 mL, the amount of
one teaspoon. Newborn babies need frequent feeds to gain the
maximum benefit from colostrum and to stimulate milk production.
■ By day 3 the baby’s stomach capacity
has grown to nearly 30 mL
■ Stomach capacity of newborn to 1 yr increases 10 times
9
•Stomach Volume of adult is: 20.4ml/KG of BW& 30gm/KG of BW
10. Intelligence quotient by type of feeding
BF 12.9 points
BF 2 points higher than FF
higher than FF Study in 9.5
year-olds
Study in 3-7
1996
year-olds
1982
BF 8.3 points
higher than FF
Study in 7.5-8
BF 2.1 points year-olds
higher than FF 1992
Study in 6 months
to 2 year- olds References:
1988 BM 7.5 points
•Fergusson DM et al. Soc
higher than no BM SciMed 1982
Study in 7.5-8 •Morrow- Tlucak M et al.
BF = breastfed year-olds SocSci Med 1988
FF = formula fed •Lucas A et al. Lancet 1992
BM = breast milk 1992 •Riva Eet al. Acta Paediatr 1996
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11. Nutrition during pregnancy
Conception to 2nd week The total cost of supplying
•Umbilical cord not formed & maintainaning the Foetus
•Mother’s food intake does not •Calorie: 40,000KCal
have an effect on the embryo up to •Protein: 910 gm
2 wks •Calcium: 30 gm
From 2 wks mother need extra •Iron: 540 mg
Energy, extra Protein, extra EFA, •Vitamin A: Retinol
extra Iron, Calcium & other 5400-7200 micro gram
Micronutrients.
•Lactating mother need more than Fetal growth & development
increases the BMR by 5%
in Antenatal Period. during 1st trimester and 12%
during 2nd & 3rd trimester.
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15. Let's make malnutrition visible
Malnutrition is an "invisible crisis" - ignored by governments and
development agencies. Most malnourished children may appear healthy
- there is no obvious “distress”
Most people think malnutrition is all about not having enough food or
enough of the right kind of food to eat. But there are many other links
in the chain Dealing with malnutrition means fixing all the links in the
chain - food, health, sanitation, water and care... If children are
drinking dirty water or are playing in areas where people are defecating
in the open, diarrhea will ensure that the nutrients are not absorbed
and that appetite will be depressed.
If children do
not receive enough attention from parents and care givers, they will fail
to receive the stimulation and interaction that helps convert food
15
intake into growth.
16. Six key nutrition solutions
• Iron, vitamin A and zinc – are typically packaged as
capsules costing pennies per dose, or about $1 to $2 per
person, per year.
• The other three solutions – breastfeeding,
complementary feeding and good hygiene – are
behaviour-change solutions, which are implemented
through outreach, education and community support.
These can be delivered through community nutrition
programs at a cost of $15 / household or
$7.50/child.
• All combined, the entire lifesaving package costs less 16
17. WHO child growth standards
• WHO standards for MUAC-for-age,
115 mm is recommended as
it will identify more infants and
children as having severe acute
malnutrition and have a high
specificity of more than 99% over the
age range 6–60 mos.
mos
5 Types of Undernutrition
Stunting Under weight
Wasting Micro nutrient deficiency
Over Weight/ Obesity
17
18. Need of Nutrition
Not only proper food ,but
proper feeding technique is
required for proper growth
& development.
Babies feed themselves,
caregivers’ role is to provide &
help them in age appropriate
manner 18
19. Human Brain Development
Synapse Formation Dependent on Early Experiences
Required
3 Components
1. Nutrition
2. Prevention of infection
3. Psycho Social Stimulation
Synaptic Connections
19
19
20. Emerging Brain Structures
•At 3 week after conception, the neural plate forms .
•At 6 week Spinal Synapse occurs.
•50,000 neurons/ sec are developed.
•There can be 15,000 synaptic connections for each cell.
•In the 4th month , axons begin to form myelin, which helps to speed transmission
&baby can show liking / disliking.
Nerve cell generation complete.
Cortex beginning to wrinkle.
•By 28 weeks after conception, the brain has 100 billion neurons &
1 trillion synaptic beads.
By 2 yrs age baby’s brain has double & by 3 yrs triple synaptic connections than adult
brain, but in later life the brain mapping decreases due to inappropriate handling.
Nurture is equally important as Nature.
•Myelinization completes by 30 yrs
6 Week Fetus 7 Weeks 14 Weeks 6 Months
20
20
21. Eight Phases in Embryonic and Fetal
Development at a Cellular Level
1. Mitosi s 2. Migration 3. Aggregation 4.
Differentiation
5. Synaptogenesis 6. Death 8. Myelination
7.Rearrangement
Between
40
and 75 %
of all
neurons born in
embryonic and
fetal development
21
do not survive.
22. Brain Cell Connections in the Early Months
newborn 1 month 3 months 6
months
14
6 Years Years
22
22
23. Parenting as Primary Prevention of Ill Health
Promoting Parenting Skills in the first 1000 days
– Parenting is personal – makes pediatricians NERVOUS!
– “Positive/Nurturing/Supportive” Parenting
– Are parenting skills “teachable?” YES !
teachable
•Early maternal support
exerts a positive influence on
hippocampal development
•The positive effect of
maternal support on
hippocampal volumes was
greater in
nondepressed children
Lusby et al., 2012. Available at: www.pnas.org/cgi/doi/10.1073/pnas.1118003109
23
24. Altered Immunity Human rights
in PEM & IDA The International Convention on
Children Human Rights, to which nearly all
countries of the world adhere,
includes the right to access to food.
Hunger and malnutrition are a
violation of human rights.
Nutrition is now so much a part of the
consciousness of today’s political leaders,
that the current political and economic
crisis will not in the long run jeopardize the
remarkable progress that has been achieved
in overcoming or reducing the burden of
IDA children
PEM children
malnutrition on the population of the
Normal children country. 24
25. Proper Food Handling
•Wash caregivers’ and children’s •Encourage families to continue
hands before food preparation breastfeeding for ill baby.
and eating •Avoid medications or birth
•Use clean utensils, cups, and control methods that can
bowls to prepare, serve, and affect breastfeeding
store food. •Encourage the use of spoons
•Avoid the use of feeding bottles and cups for feeding in
•Serve foods immediately after responsive method with
preparation. complementary foods,
•Store foods safely expressed breast milk,
• Use safe water. or breast milk substitutes
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27. Broad Objective
Every birth should be safe, supervised & with scientific facilities, target
• reducing child mortality by two-thirds (MDG 4),
• maternal mortality by three-quarters (MDG 5),
• improving child nutrition (MDG 1).
Success Stories
Vietnam, the success in reducing malnutrition was fuelled by
economic growth by reducing inequality and this led to
important investments for the poorest.
Mexico, a successful cash transfer programme made the receipt
of money conditional on visits to health centers. .
Brazil's Zero Hunger programme was driven by the values of
that country's labour movement, by electoral politics, and by the
personal conviction of then President Lula.
India is undertaking ‘Janani Suraksha Yojona’ , JSK & NSSK with these
28. We can eradicate malnutrition in 20 years
It is a movement of individuals and organisations who are
determined to make nutrition more visible, to raise
resources for it, to support governments which do
something about it.
There are about 170 million young children who are
malnourished, and there are many more adults who are
suffering from the terrible legacy of malnutrition early in
their own lives.
Good nutrition and education may be not just the best way, but
the ONLY way to reach ALL of the MDGs.
28
29. Thanks
Nation’s
prospect
depends on
the
Nutritional
Status of
Mother &
Children of
that Country.
29
