Words by Dr Pawana Kayastha
She is an Associate Professor of Pediatrics and Vice Principal at Kathmandu Medical College. She is an executive member of the Nepal Pediatric Society (NEPAS) and Co-Chair of its Pediatric Nutrition Committee. A celebrated academic, she has received several prestigious accolades, including the IPALA Scholarship (2024), PENSA Best Oral Presentation Award (2023), and ESPEN Educational Grant (2022). Known for her expertise in pediatric nutrition, Dr. Pawana has contributed extensively to research and has presented at numerous international conferences. Her commitment to advancing pediatric care and nutrition underscores her role as a leader in her field.
Poor nutrition and food insecurity have remained challenges to the development in Nepal. The challenges to food security in Nepal are multifaceted and complex including poverty, geographical diversity, risk of natural disasters, poor road access, climate, agriculture and livelihoods, access to social services, migration . In the year 2022, 25% of children under age 5 were stunted, 8% were wasted, and 19% were underweight in Nepal. The devastating 2015 earthquake and the COVID pandemic proved a significant setback to malnutrition in Nepal. Our country now suffers a double burden of malnutrition, which consists of both undernutrition and obesity, as well as diet-related non-communicable diseases. Moreover, the diets of Nepali children aged 6–23 months are largely suboptimal: just 31 percent receive a minimum acceptable diet. Only one-fourth of children (24 percent) are fed with the recommended Infant and young child feeding (IYCF) practices.
Complementary feeds made from staples only are highly used, so risk of nutrient gap and micronutrient deficiencies including iron deficiency anemia, vitamin A deficiency and iodine deficiency disorder is a prevailing problem at present. In Nepali society, breast feeding in one way or another has wider social & religious explanations, attitudes, norms and values by which the continuity of breastfeeding is stressed and exhibited. But our demography data speaks differently; there seems to be a fall in the exclusive breastfeeding rate in 2022 as well.
In developing countries, childhood malnutrition rate rises significantly at 6 months of age when complementary foods start being introduced and inappropriate dietary diversity is strongly associated with morbidity and mortality. Malnutrition also impairs cognitive function of those children who survive. Malnourished hospitalized patients are associated with poorer outcomes and higher economic burden. Adequate understanding in appropriate feeding practice, development of feeding skills, and establishment of responsive feeding are essential for proper growth of children. Nutrition education, therefore, is a critical strategy of intervention to improve child complementary feeding practices which will subsequently decrease mortality and morbidity of under-5 children.
To get the most out of a healthy diet, complete and balanced nutrition sourcing from a minimum of 5 food groups–dietary diversity is strongly recommended. Foods are grouped conventionally as:
(i) cereals, millets and pulses;
(ii) vegetables and fruits;
(iii) milk and milk products;
(iv) egg, meat, fish; and
(v) oils and fats.
Low dietary diversity can have negative consequences at any age, but is particularly critical for infants and young children, mainly by reducing physical capacities as well as resistance to infectious diseases. So create a healthy plate with dietary diversity.
Make every bite count:
“Eat the rainbow” is the mantra for a healthy and balanced diet for children , and all you need to do is add more colorful plant based foods to your meals.
Nowadays the prevalence of picky eating behavior is increasing . This feeding problem comes under an umbrella term known as Feeding difficulty which encompasses all feeding problems, regardless of etiology, severity, or consequences. Feeding Problems are illustrated As:
– Food Selectivity ‘Pickiness’
– Partial/ Total Food Refusal
– Difficulty Swallowing/ Slow Chewing/ Prolonged Mealtimes
– Vomiting
– Colic
– Inability To Graduate To Textured Foods
– Delay In Self-feeding
– Tantrums And Other Problem In Mealtime Behaviours
– Pica
– Disruptive And Stressful Mealtimes,
– Nocturnal Eating In Infants And Toddlers,
– Introduction Of Distractions To Increase Intake,
– Prolonged Breast- Or Bottle Feeding In Toddlers And Older Children,
Problems with feeding may lead to significant negative nutritional, cognitive, developmental and psychological sequelae. Because the severity of these sequelae is related to the age at onset, degree and duration of the feeding problem, early recognition and management are important. If a wait-and-watch approach is made, treating feeding problems becomes more difficult for reasons like children becoming more resistant to change, delayed introduction of developmentally appropriate foods, nutritional deficiencies and aspiration pneumonia.
Must know Feeding Guidelines to parents:
– Avoid distractions during mealtimes (television, cell phones, etc.)
– Maintain a pleasant neutral attitude throughout meal
– Feed to encourage appetite
• limit meal duration (20–30 min)
• 4–6 meals/snacks a day with only water in between
– Serve age-appropriate foods and a structured mealtime schedule.
– Systematically introduce new foods (up to 8–15 times)
– Encourage self-feeding
– Tolerate age appropriate mess
– Maintain comfortable position of child while feeding.
– Allow only a limited number of feeders (ideally one person) .
– Food should not be given as a present or reward.
– Mealtime is not playtime.
– Food should be removed after 10 to 15 mins if the child seems to play with food without eating or throws food in anger.
Children having feeding problems should be regularly reviewed by a pediatrician to monitor growth and changes in dietary intake, tolerance, compliance, knowledge, views, and opinions of child and/or caregivers, estimate nutritional requirements, and changes in clinical status. Children who face feeding disorders aren’t the only ones affected but it’s challenging to parents too.
In Kathmandu Medical College I have observed children with feeding difficulties quite often and have facilitated and treated them in paediatric nutrition clinics. Growth assessment and monitoring, feeding counselling with diet plan, lactation management, inpatient and outpatient malnutrition therapies and disease oriented diet management is being done and such feeding strategies help improve growth outcomes.
When it comes to knowledge about complementary feeding, reviews indicate that 78% of mothers rely on information passed down from family, while only 22% receive proper guidance from their physician. Providing nutrition education to healthcare personnel, parents, teachers, and adolescents, along with implementing nutrition awareness and advocacy programs, are crucial strategies for improving complementary feeding practices for children.
As Co-chairperson of the Nepal Pediatric Society-nutrition Subspeciality chapter, we are committed to advancing pediatric nutrition in Nepal through strategic initiatives and collaborations. Our vision is a nation where every child receives optimal nutrition for healthy growth and development. Improvements in the nutrition of current cohorts of children and adolescents, confirms healthier future adults, as well as the health of the next generation of children.
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