Growth Monitoring in Under-Three Children Using the Mother Child Protection Card

Abstract

Right from its inception, ICDS programme envisaged monthly weighing and monitoring of growth in under-three children for early detection of under-nutrition. Currently accurate portable digital balances are available in anganwadi and Mother Child Production Card (MCPC) with child growth charts has been provided to children. A community based mixed longitudinal study was taken up in under-three children from urban low middle income families to assess feasibility and impact of growth monitoring and appropriate nutrition education using MCPC. Monthly weighing of children and plotting the weight-for-age in the MCPC was carried out by the research staff. A total of 5708 children were enrolled and followed up over 32879 visits between 2015 and 2019. Plotting the weight-for-age of the child in growth chart enabled identification of underweight children at the time of the visit so that appropriate nutrition and health education and care can be provided. Monthly weighing and plotting weight-for-age in growth chart enabled identification of small children growing along their own trajectory and prevented them from being mislabelled as under-nourished. Children showing deterioration in Weight for age Z score (WAZ) as compared to earlier visit(s) were readily identified and given needed advice. Personalised nutrition and health education provided at each visit taking into account current nutritional status, morbidity and Infant and Young Child Feeding Practices (IYCF) helped in preventing rise in underweight rates in the first 18 months and brought about some improvement in nutritional status of moderate and severely underweight children. It is feasible to operationalize growth monitoring as envisaged in Poshan Abhiyaan and accelerate the pace of reduction in under-nutrition in under three children.

Intrafamily differences in nutritional status of preschool children

“…13 Regular weighing of children, and plotting of growth in WHO child growth chart is not widely followed. 16 There are inadequacies in content, quality and continued coverage of children under the food supplementation component of the ICDS programme. Prevalence of infections continue to be high due to poor environmental hygiene and overcrowding but deterioration in nutritional status due to infection is prevented to a large extent due to access to heath care.…”

Nutritional status of Indian pre-school children and WHO nutrition targets for 2025

“…28,29 The further rise in underweight and stunting rates between 6-11 months might be due to late introduction, inadequate quantity, frequency and low-calorie density of complementary feeds as well as increase in morbidity due to infections. [28][29][30][31][32][33] Increase in the underweight and stunting rates between 12-23 months could be the result of inadequate energy intake when children shift to household diet. In India, the habitual family diets have relatively low-calorie density; infants have small stomach capacity and need to be fed 5-6 times a day to meet their food requirements.…”

“…In India, the habitual family diets have relatively low-calorie density; infants have small stomach capacity and need to be fed 5-6 times a day to meet their food requirements. [28][29][30][31][32][33] Nutrition education has a major role to play in improving infant and young child feeding practices thereby preventing rise in stunting and under-weight rates. Low birthweight children grow along a lower growth trajectory as compared to normal birthweight children; when their weight or length are compared to WHO standards they are misclassified as stunted and under-weight.…”