Undernutrition in early childhood does damage that later feeding does not undo: to growth, to the immune system, and to brain development and schooling. The window in which it can be prevented is narrow and well defined.
Why the first thousand days
Counting from conception to a child's second birthday gives roughly a thousand days. This is when the body and brain are developing fastest and are most sensitive to what is available. A child who is well nourished through this period has a substantially different trajectory from one who is not, and the difference persists into adult life.
During pregnancy
- Attend antenatal care early and repeatedly, not once late in pregnancy.
- Take the iron and folic acid supplements provided.
- Eat more than usual, and more varied: greens, beans, groundnuts, eggs, fish or meat where available, and orange vegetables.
- Sleep under a treated bed net. Malaria in pregnancy causes low birth weight.
- Deworming and any other measures the health worker advises.
A woman who is undernourished during pregnancy is likely to have a small baby, and small babies start behind.
The first six months
Exclusive breastfeeding: breast milk only, no water, no porridge, no other liquids, unless a health worker directs otherwise.
This is the most commonly departed-from advice, usually with good intentions, because a hot day makes water seem necessary. Breast milk is mostly water and provides everything needed. Giving water displaces milk and introduces contamination.
- Start breastfeeding within the first hour of birth.
- The first thick yellow milk is not dirty and should not be discarded; it carries important protection.
- Feed on demand, day and night.
- Frequent feeding is what maintains supply, so a mother who thinks she has too little milk usually needs to feed more, and to eat and drink more herself.
From six months
Breast milk alone is no longer sufficient. Begin complementary foods while continuing to breastfeed to two years and beyond.
- Start with soft, mashed food two to three times a day, increasing as the child grows.
- Thick porridge, not thin. Thin porridge fills the stomach without providing enough energy.
- Add variety as early as possible: mashed beans, groundnut paste, egg, fish, pounded greens, mashed pumpkin or orange-fleshed sweet potato, and fruit.
- Enrich the staple. A spoon of groundnut paste or oil in porridge substantially increases its energy.
- Feed the child from their own bowl, so an adult can see how much has actually been eaten.
- Be patient with new foods. Children often refuse something several times before accepting it.
Hygiene during feeding
Diarrhoea in this period undoes nutrition faster than feeding builds it. Wash hands before preparing food and before feeding, use clean utensils, prepare food fresh where possible, and use safe water for anything mixed with food.
Recognising undernutrition
Watch for a child who is not gaining weight, is visibly thinner than others of the same age, is unusually lethargic, has swelling of the feet, or whose hair colour or texture has changed. Bring the child to the health facility for assessment. Severe acute malnutrition is a medical emergency and is treatable, but it needs a facility rather than home feeding.
Attend growth monitoring, and take the child's card. Growth faltering shows up on the chart before it is obvious to the eye.
What a community organisation can do
- Support kitchen gardens, which directly increase dietary variety.
- Use groups that already meet to carry the six-month and thick-porridge messages.
- Support mothers to attend antenatal care and growth monitoring, including transport.
- Encourage exclusive breastfeeding, which costs nothing and is frequently undermined by well-meaning advice.
- Refer suspected severe malnutrition to a facility promptly.
This is general guidance. Any concern about a specific child should go to a health worker.