Journal of Clinical Nutrition & Dietetics

Keywords

COVID-19; Good nutrition; Immunization; Diet

Description

ECD is a maturational process starting from conception to 6 years (now extended upto 8years), resulting in orderly progression and acquisition of motor, cognitive, language, socioemotional and other skills in a child. It deals with a life cycle approach wherein the child not only survives but also thrives. Thus it is the practice of nurturing care [1-2]. This is to be practiced by health professionals, parents and caregivers for optimum child development.

ECD includes five domains viz. Health, 2. Nutrition, 3. Security and safety, 4. Responsive care giving, and 5.Early learning. For critical development of a child all components are important. It has been seen by two decadal experience in Jamaica and many meta analyses have shown that only good nutrition without stimulation and nurturing may not result in good cognition, higher IQ in the child. Better earning potential (25% increase), psychosocial adjustment was seen wherein children were given good nutrition and parental stimulation.

All of us know that 1000 days from conception to two years of life are critical in the development of a child [3]. This is the most important window of opportunity when good nutrition and stimulation by care givers has the best impact on a child’s development. Brain growth starts in the 7th intrauterine week. It is very rapid and neurons multiply at a great speed with 100 billion neurons at birth. Neuronal migration. Pruning is the next step. All these are dependent on diet and stimulation. Brain is like a sponge. The more it is stimulated the better is the learning in the child. A child who has received optimum diet, is breast fed exclusively for first six months with correct complementary feeding (minimal meal frequency and dietary diversity), has received complete primary immunization, protection from diarrhea, malaria, tuberculosis etc., will have good survival and growth. This further needs continuous stimulation by parents, other family members and care givers. Good nurturing care involves responsive parenting. It is like ‘serve and return’. The child responds to parental action. The environment becomes congenial to learning. Role of safe and secure environment, free from domestic violence is equally important. The result is better cognition, better IQ, better psycho-emotional development, all leading to better education and increased productivity in adulthood.

COVID-19 has resulted in enormous hardships besides the disease itself. The lockdowns, job losses, supply chain disruptions, unavailability of foods, inability to buy due to skyrocketing prices ,closure of Anganwadi centers, private clinics, immunization services have had detrimental effects on child health and nutrition. parents have not been able to give proper attention to a growing child. COVID disease has had direct impact on nutrition of children. Some hospital studies have shown that 14 to 20% of babies with COVID-19 have developed malnutrition. Women have delivered more preterm, low birthwt. babies. Domestic violence has increased. This has had a negative impact on ECD. If we do not pay attention now, one may have a generation of impacted children. They would miss the opportunity.

It is a call to wake up. All have to join hands and practice ECD at all levels, from a village anganwadi, private pediatric clinic to large tertiary hospital. Capacity building of healthcare professionals is equally important.

Role of various bodies in developing ECD framework

University-Maharashtra University of health sciences along with the Directorate of Medical Education and Research Mumbai, India and UNICEF has held many workshops on ECD and introduction of ECD in undergraduate and postgraduate medical curriculum in Pediatrics, ObsGynec, and Community Medicine subjects is being initiated.

Role of I.A.P: Task force of Indian Academy of Pediatrics (I.A.P) held a meeting in Sept .2019 on ECD and decided on the plan of action. The committee observed that the medical curricula lack training in nurturing care (ECD). Hence the task Force of Indian Academy of Pediatrics suggested inclusion of these topics as integrated teaching in existing medical education to promote and practice NC-ECD in community. Indian Academy of Pediatrics (IAP task force) [4]. Workshop was held on 17^th November 2022 at Nashik.

Private pediatric clinics and hospitals are point of care opportunities for ECD implementation. High risk assessment, anthropometric monitoring, treatment of illnesses, immunization, diet counseling and therapeutic ties with families are routine for them [5]. However, busy practices frequently miss developmental surveillance and screening. IAP has issued guidance for ECD.

Conclusion

An integrated concept that cuts across multiple sectors including health and nutrition, education, and social protection and refers to the physical, cognitive, linguistic, and socioemotional development of young children is required. Thus, public health, nutrition (DWCD),education, water and sanitation, social welfare are some of the depts. under the Govt and non governmental organizations that have to work together for achieving optimum results in ECD. Multisectoral involvement will be richly rewarding.

One may conclude and state that today is the time to look at ECD, by one and all. Let us join hands to prevent a generation from missed opportunity.

Conflict of Interest

We declare no conflict of interest.

References

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