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What are the nutritional needs of a growing child?
A World Health Organization (WHO) multicountry study leading to the development of the WHO Child Growth Standards (2006) has shown that all young children across all regions can attain a similar standard of height and weight and development with optimal nutrition, good healthcare and a healthy environment.4 Therefore the nutritional needs of rapidly-growing children everywhere in the world are essentially the same.
Breast milk is the only food that a child younger than six months of age needs. After six months, children require more energy and essential nutrients than breast milk alone can provide. This includes proteins and essential fats, as well as vitamins and minerals such as calcium, potassium, zinc and iron.
How are these needs met in a developed country?
In developed countries, young children eat a variety of nutrient-dense foods such as meat, poultry, fish and eggs, as well as fruits and vegetables to meet their nutritional requirements, as they continue to breastfeed. Even if infants don't eat meat, infant foods and cereals are fortified with vitamins and minerals, especially iron and zinc, in order to meet their nutritional
needs. Milk is a good source of most of these nutrients (except iron) and is an important part of most children's diets after one year of age.
In resource-limited settings, diets consist primarily of plant-source foods, with little added fat. These lack iron, zinc and calcium in particular and nutrients are not as easily absorbed from plant foods as they are from meats, fish, poultry, eggs or dairy. However, these animal-source foods are usually prohibitively expensive or simply not available.
What are the limitations of fortified blended food ?
Corn soy blend (CSB) and other fortified blended foods have long been used in food assistance programmes to prevent nutrient deficiencies. The composition has remained largely unchanged despite better knowledge about how to meet the nutritional needs of young children.
Animal (dairy) protein is best suited to maximizing growth of young children. The composition of CSB, being an exclusively plant-based food without any dairy component, is not ideal to facilitate growth of children in the first two years of life.
CSB also contains a number of elements that limit the body's ability to absorb the nutrients that are present. Additionally, preparing CSB requires clean water, which is often not available in resource-limited settings. CSB also needs time for cooking and bears the risk of being over-diluted.
Why does ready-to-use food work ?
Experience by different organizations including MSF has shown that a very successful way to deliver essential nutrients to malnourished children is with ready-to-use foods (RUFs). This is an effective treatment because each packet delivers 500 calories in the form of a dense nutrient spread that contains milk powder and the 40 essential nutrients that a malnourished child needs to reverse nutrient deficiencies and gain weight.
Further, RUFs are simple to use in resource limited settings as an efficient and safe way to provide milk to children under the age of three: it contains no water, making it resistant to bacterial contamination, it comes in individually wrapped airtight foil packets, no preparation is required, the product has a long shelf life, and it is easy to transport and use in hot climates.
Most critically, the vast majority of malnourished children can take this treatment at home, under the supervision of their mother or caregiver, instead of in hospital. This allows programmes to reach many more children, while at the same time minimising the risk for children of contracting an infection in hospital.
Malnutrition must be addressed before it reaches a life-threatening stage. The quality of complementary foods provided to children after six months of age in resource-limited settings requires reexamining. If any of the 40 essential nutrients are deficient in a young child's diet, the body's defences are weakened and the likelihood of falling seriously ill from a minor infection increases.
