With COVID-19 cases reducing in the country, several establishments, including schools, are opening again. While the reopening of all schools is on the anvil, the festive season ahead and the fact that children are not yet in the ambit of the vaccination drive are causing apprehension. We, as a society, must focus on the nutrition of children to ensure they are armed with good immunity as they get ready to take on new challenges especially after emerging from the confines of their homes. However, It is important to remember that even before the onset of the COVID-19 pandemic, India was facing significant nutritional challenges. Hence, there is a need to pivot on children’s nutrition, using the novel coronavirus pandemic to better understand current nutrition and nutritional requirements for a healthy body and mind.
Tackling India’s triple burden
India faces multiple problems of under-nutrition and overweight/obesity coexisting with deficiencies of micronutrients such as iron, zinc, calcium and several vitamins. This triple burden of malnutrition has to be identified, understood and addressed. It is much more important especially in the case of children and adolescents as it is during these phases of life that we see rapid growth of the body and development of food habits. Childhood and adolescence are two conjoined periods of continuous growth and development — a seamless duration. For instance, between two and 10 years of age, children tend to grow at an average of 6-7 cm in height and 1.5 to 3 kg in weight every year. But specifically, when the growth spurt happens at about 10-12 years in girls and two years later in boys during adolescence, their nutritional needs are vastly increased. In the case of girls, their nutritional status impacts not only their health but that of generations to come. Malnutrition in any form can put children and adolescents at risk of compromised immune function, thus making them vulnerable to infections.
Social factors
To understand and foster their immunity, one also needs to understand disruptive social environment factors that affect diet quality. In urban as well as among middle class and affluent communities, restricted movement, constrained socialisation and even dwindling physical contact have become the new normal. COVID-19 isolation and fatigue have led to generalised stress, adding to the immunity challenge for children. These challenges coupled with a lack of diet diversity leading to imbalanced micronutrient intake or consumption of high carbohydrate and high sugar foods, endanger the child’s health by compromising their immunity and making them vulnerable to infections. Hence, the way we approach nutrition needs to change.
Need for a balanced diet
It is essential to look beyond minimum calorie requirements and ensure children consume a balanced diet with adequate diversity in order to ensure the required balance of all necessary nutrients. Providing children with a balanced diet packed with all the necessary nutrients provides them with a solid foundation for an active and healthy life. Often overlooked, micronutrients are essential for production of enzymes, hormones and other substances for good immune function, healthy growth and development. Each stage of the body’s immune response relies on the presence of many micronutrients. To combat hidden hunger, affordable, accessible and diverse food sources must be made available across India. Micronutrients that are primarily available in fruits, vegetables, greens, nuts, legumes and whole grains play a crucial role in enhancing the native and adaptive immune function and also aid ‘immune memory’ formation. A substantial serving of fresh fruits and vegetables, as much as about 300-500 gm per day per child is recommended depending on the age group. These, along with curd and nuts, can increase beneficial probiotic bacteria in the intestine. But it is better to help them choose fresh fruits rather than fruit juices. Thoroughly cooked meat/poultry and sea fish are very good for protein; sea fish also provide essential fats. About 300ml-400 ml of milk or curd can provide the required calcium, good quality protein and other nutrients.
Among urban and affluent groups, indulgence in frequent munching of high-calorie snacks and sweetened beverages that are devoid of beneficial nutrients should be discouraged. However, fats need not be seen as a villain — children and adolescents need about 25g-50g a day, which should ideally be derived from more than two varieties of oils. Maintaining ideal body weight, regular physical activity, adequate water intake along with adequate sleep and low screen time can go a long way in building and regulating their immunity.
Editorial | Failing on food: on child malnutrition and mid-day meals
Noon meal scheme
The Pradhan Mantri Poshan Shakti Nirman Yojana (PM POSHAN) — the mid-day meal programme in its new avatar — is all set to broad base itself even to students of pre-primary levels or Bal Vatikas of government and government-aided primary schools along with primary and upper primary schoolchildren who are already within the ambit of the mid-day meal programme. The PM POSHAN envisages providing 450 Kcal energy and 12g of protein for primary; 700 Kcal and 20g protein for upper primary children through diet diversity. In addition, monitoring haemoglobin levels of schoolchildren, appointment of nutritional experts to ensure the haemoglobin and growth status are continuously monitored; focus on nutrigardens are all welcome steps as we prepare to reopen schools. Moreover, special provisions for nutritional items for children in districts with high prevalence of anaemia and the involvement of farmer producer organisations and self-help group women will strengthen linkages and convergence for promoting children’s nutrition.
COVID-19 or no COVID-19, good immunity will lay the foundation for long-term well-being. After all, good nutrition, safe food, and positive lifestyles are the cornerstones of great immune function. To ensure this, schools, when they reopen, should be avenues for teaching nutrition as a life skill than rhetorical pedagogy. It is our collective responsibility to ensure that our children are nurtured and nourished.
Dr. SubbaRao M. Gavaravarapu is Scientist E and heads the Nutrition Information, Communication and Health Education (NICHE) division at the Indian Council of Medical Research (ICMR)-National Institute of Nutrition (ICMR-NIN), Hyderabad. Dr. Hemalatha R. is Director, ICMR-NIN, Hyderabad
