After more than a year of being confined at home, your child will finally be able to attend pre-school again.
However, you can’t help wondering what the experience will be like.
Will your child easily reconnect with his or her friends, as if no time had lapsed at all? How will they adjust to the classroom environment? How have they all grown?
You would be delighted if your child has outgrown his or her clothes. But what if the pants show little sign of shortening and still fit as nicely as some 18 months ago?
Do not despair. Instead, obtain a professional evaluation by asking your paediatrician for a growth check-up.
By plotting your child’s weight and height measurements onto the growth charts, the doctor will be able to tell how your little one is growing, and if poor growth is detected, can advise you accordingly.
Here are some reasons and actions to take.
Nutrition, Immunity And Growth
According to consultant paediatrician and neonatologist Dr Anna Padmavathy Soosai, poor growth typically shows up as underweight (low weight for age), wasting (low weight for height), and/or stunting (low height for age)(1).
She pointed out that stunting is particularly concerning because it is associated with reduced immunity, cognitive impairment, chronic diseases, and reduced socioeconomic opportunities in adulthood(2).
Despite its impact, prevalence of stunting has been rising in the last decade and currently affects one in five children under 5 years old in Malaysia(3, 4).
“Short stature is common and often deemed as normal in our society. As such, actual stunting may not be well-recognised in the early childhood. The only way to detect it is by tracking children’s height measurements against a standard growth chart, and the most commonly used are the Growth Standards and Reference charts from the World Health Organization(5)”, said the IMFeD for Growth expert panel member.
“If height falls to below -1 standard deviation from the mean (average), the child is said to be at risk of stunting. A child whose height falls to below -2 standard deviation mark is already stunted. Coming to below -3 standard indicates severe stunting(6).”
Dr Anna added that while genetics and hormones may play a role, malnutrition is the most common culprit responsible for growth problems. Its impact is increased when partners in crime are present, namely poor immunity and diseases(7, 8).
“Young children should receive appropriate nutrition to meet the increased demand for energy and nutrients needed for their growth and development. However, many children may suffer from malnutrition because they have inadequate food intake, lack of variety in their diet, experience poor appetite, and suffer from picky eating or other feeding difficulties(8),” she elaborated.
She pointed out that the children would be deficient, not only in the nutritional fuel to grow, but also to stay healthy.
“Nutrition and immunity are closely linked. A healthy diet helps maintain a good balance of microorganisms that live in the gut. This enables them to perform important roles, such as protecting against disease-causing germs, producing vitamins and fatty acids, keeping the gut and central nervous system functioning properly(7,9)”.
“On the other hand, poor nutrition upsets the balance of these microorganisms. This, in turn, increases one’s susceptibility to infection by compromising the gut’s barriers and immune function. Frequent illness will sap children’s already-limited energy and nutritional reserves, leaving little left for growth(9,10)”.
Early Intervention Is Key
According to the head of dietetic services at the University of Malaya Specialist Centre and IMFeD for Growth expert panel member Rozanna M Rosly, stunted growth in the first five years of life does not have to be permanent. However, nutritional intervention needs to be started as early as possible(11).
“Children need a complete and balanced nutrition to get their growth back on track. Protein plays an important role in building muscle while calcium, arginine, vitamins D and K help with bone growth(12,13). Nutrients such as iron, zinc and vitamin C help support the immune system. These nutrients work together to help children achieve their full growth potential(14,15),” she said.
She advised parents to improve their children’s diet quality to achieve nutritional adequacy.
“Provide a healthy and nutritious diet that includes all five food groups, i.e. vegetables, fruits, rice, noodles, grains, and other carbohydrate sources such as fish, poultry, eggs, meat and legumes, milk and dairy products(16)”, she said.
“It is important that children with growth faltering increase their caloric intake(17). Some tips include adding dairy products (eg cheese or cream cheese) in dishes such as steamed egg, soup and rice; adding additional fats, such as vegetable oil, butter or ghee into meals or dishes; and thickly spreading peanut butter, chocolate spread or kaya on bread or crackers.”
“Finally, consider oral nutritional supplementation (ONS). Research has shown that it effectively boosts growth in children who are unable to meet their nutritional needs, such as due to picky eating or other issues(18). ONS can be provided in addition to normal food to increase energy and nutrient intake when indicated. Experts recommend introducing ONS to help children who are stunted as well as prevent those at-risk of growth faltering from actually becoming stunted(19),” she added.
Rozanna concluded that parents would benefit from counselling on the appropriate methods and approaches to manage interactions with their children over food and feeding.
The counselling would also provide valuable guidance on lifestyle, habits and behaviours that contribute to better growth.
The IMFeD for Growth programme is organised by the Malaysian Paediatric Association (MPA) to help bring health care professionals and parents together to effectively optimise children’s growth.
Speak to your paediatrician about your child’s growth today. To find the nearest participating IMFeD for Growth clinics, click here.
1. World Health Organization. Stunting, wasting, overweight and underweight. Nutrition Landscape Information System. https://apps.who.int/nutrition/landscape/help.aspx?menu=0&helpid=391&lang=EN. Accessed October 5, 2021.
2. Victor O, Tahmeed A, Michael F, et al. Environmental Enteric Dysfunction and Growth Failure/Stunting in Global Child Health. Am Acad Pediatr. 2016;138(6):e20160641.
3. Institute for Public Health (IPH), National Institutes of Health, Ministry of Health Malaysia. National Health and Morbidity Survey (NHMS) 2019: Vol. I: NCDs – Non-Communicable Diseases: Risk Factors and Other Health Problems.; 2020.
4. Institute for Public Health (IPH), National Institutes of Health M of HM. National Health and Morbidity Survey 2011 (NHMS 2011). Vol. II: Non- Communicable Diseases.; 2011.
5. World Health Organization (WHO). Child growth standards.
6. World Health Organization (WHO). Training Course on Child Growth Assessment: Interpreting Growth Indicators.
7. Estrada JA, Contreras I. Nutritional Modulation of Immune and Central Nervous System Homeostasis: The Role of Diet in Development of Neuroinflammation and Neurological Disease. Nutrients. 2019;11(5):1076.
8. Nilesh MM, Corkins MR, Lyman B, et al. Defining Pediatric Malnutrition: A Paradigm Shift Toward Etiology-Related Definitions. J Parenter Enter Nutr. 2013;37(4):460-481.
9. Maggini S, Pierre A, Calder PC. Immune Function and Micronutrient Requirements Change over the Life Course. Nutrients. 2018;10(10):1531.
10. Velly H, Britton RA, Preidis GA. Mechanisms of cross-talk between the diet, the intestinal microbiome, and the undernourished host. Gut Microbes. 2017;8(2):98-112.
11. D. T. T. Huynh, Estorninos E, Capeding RZ, Oliver JS, Low YL, Rosales FJ. Longitudinal growth and health outcomes in nutritionally at‐risk children who received long‐term nutritional intervention. J Hum Nutr Dietitics. 2015;28(6):623-635.
12. Vught AJAH van, Dagnelie PC, Arts ICW, et al. Dietary arginine and linear growth: the Copenhagen School Child Intervention Study. Br J Nutr. 2013;109(6):1031-1039.
13. Popko J, Karpiński M, Chojnowska S, et al. Decreased Levels of Circulating Carboxylated Osteocalcin in Children with Low Energy Fractures: A Pilot Study. Nutrients. 2018;10(6):734.
14. Bailey RL, West Jr. KP, Black RE. The Epidemiology of Global Micronutrient Deficiencies. Ann Nutr Metab. 2015;66(suppl 2):22-23.
15. Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients. 2017;9(11):1211.
16. Paramashanti BA, Yhona P, Marsiswati M. Individual dietary diversity is strongly associated with stunting in infants and young children. J Gizi Klin Indones. 2017;14(1):19-26.
17. Millward DJ. Nutrition, infection and stunting: The roles of deficiencies of individual nutrients and foods, and of inflammation, as determinants of reduced linear growth of children. Nutr Res Rev. 2017;30(1):50-72. doi:10.1017/S0954422416000238
18. Ghosh AK, Kishore B, Shaikh I, et al. Effect of oral nutritional supplementation on growth and recurrent upper respiratory tract infections in picky eating children at nutritional risk: a randomized, controlled trial. J Int Med Res. 2018;46(6):2186–2201.
19. Yackobovitch-Gavan M, Lebenthal Y, Lazar L, et al. Effect of Nutritional Supplementation on Growth in Short and Lean Prepubertal Children after 1 Year of Intervention. J Pediatr. 2014;165(6):1190-1193.
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