The Impact of Malnutrition on Childrens Physical and Mental Development

what is the problem

Despite the fact that we live in an affluent country with a statutory child protection service, children in the UK are still suffering extreme neglect and malnutrition. Its unacceptable, but children are still dying from severe malnutrition, as was highlighted by the tragic case of 7 yr old Khyra Ishaq. Latest figures reveal that 4 million children in the UK live in low income households with over half of children in some London boroughs living in poverty. (endchildpoverty.org, 2012) Children living in poverty often battle with the added stress of material deprivation and unstable emotional lives, circumstances that leave them particularly at risk of malnutrition. Amongst hospitalised children in the U.K its been found that 16% were severely stunted, 14% wasted and 20% at risk of severe malnutrition. (Textbook of Paediatrics, 2003) Kids Companys support reaches thousands of children who have or are experiencing malnutrition, hunger or food insecurity.

what is food insecurity

Food insecurity is term used to describe the limited or uncertain availability of nutritionally adequate and safe food or limited or uncertain ability to acquire food in socially acceptable ways. Children who experience food insecurity may get good quality food some of the time and none or poor quality food at other times. Research has demonstrated that children who are hungry are more socially dysfunctional than children who are not hungry. In addition children experiencing food insecurity are more likely to engage in fighting and stealing behaviours than other children. (Kleinman et al, 1998) Other studies have associated food insecurity with problem behaviours in school aged children as well as being a source of family stress that negatively affects parenting behaviours and child reactions. Further evidence from research has found that hungry children are more likely to be receiving special education services, score higher on aggression and irritability scales and more likely to struggle with academic achievement. (Dunifon & Kowaleski, 2003)

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what is malnutrition?
Malnutrition is not the same as hunger, although they often go together. Malnutrition is insufficient, excessive or imbalanced consumption of protein, energy or micronutrients (vitamins and minerals). There are two types of malnutrition;  Protein-energy malnutrition (PEM) arises due inadequate intake of calories from proteins, such as fish and meat, and vitamins and minerals, such as zinc, iron and vitamin A. Micro-malnutrition refers to mineral and vitamin deficiency. Both these conditions can have serious negative consequences for physical and mental health.

What are the effects of malnutrition?

At worst severe malnutrition leads to death. The WHO currently attribute more than one third of child mortality to malnutrition making it the leading cause of child death worldwide. For survivors, chronic malnourishment, both short and long term, leaves the body lacking the nutrients for proper health and development and vulnerable to infection and disease. The physical effects of malnutrition include;  Fatigue, low energy and dizziness.  Swollen, bleeding gums and decaying teeth.  Underweight, muscle weakness and poor growth.  Poor immune function leaving the body vulnerable to infection.  Problems with organ function, that may lead to disease states such as Coronary Heart Disease or Osteoporosis  Insulin-resistance resulting from a diet with low nutritional value, eg high fats and sugar content, can result in Diabetes.  Diseases such as Marasmus and Obesity result from under, or over, eating respectively.  Poor cognitive functions such as learning memory and attention.  Cancer risk is increased by eating certain foods and additives that are high in carcinogens.

Pregnant women and infants.

If a pregnant woman is malnourished, her child may weigh less at birth and have a lower chance of survival. Low birth weight babies are predisposed to many health and development problems. failure to thrive is a common term used in child medicine to describe an infant, or childs, inadequate growth rate. This can be due to premature birth and co-existing chronic illness however, neglect and poverty are often the causal factors. If not addressed, failure to thrive is a risk factor for long term physical and mental deficits.

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Impact on brain development

Malnutrition not only harms the body but leaves an imprint on the minds of those who survive it. Research has revealed that poor diet during early development (0-3yrs) leads to learning and memory deficits, lower IQ and school achievement, and behavioral problems in childhood and adolescence (Mcgregor, (1995), Lui et al, 2005). There has also been links between food deficiencies and mental health problems in young people. Conditions such as ADHD, Bipolar Disorder and Schizophrenia, seem to involve functional deficiencies of certain highly unsaturated fatty acids, such as Omega-3 (Richardson et al., 2005). Furthermore, researchers have found that antisocial behavior in prisons, including violence, can be reduced by supplementing diets with vitamins, minerals and essential fatty acids (Gesch et al., 2002). This research provides important evidence for the beneficial effects, both to individuals and society, of ensuring that our children receive the nutrition they deserve.

Who is at risk?
Malnutrition affects people of every age, although infants, children, and adolescents may suffer the most because many nutrients are critical for normal growth and development. A survey carried out on behalf of the Food Standards Agency of the UKs most materially deprived households on low incomes highlights that children and teenagers growing up in impoverished and disturbed circumstances are particularly at risk of poor diet and nutritional status (LINDS, 2007). Major barriers to a healthy diet include; Material deprivation. Abuse and neglect. Substance abuse.  Parents and care givers who experiencing psychiatric, emotional and learning difficulties. Parent and care-givers with poor awareness of good nutrition. The most recent data on the dietary patterns, nutritional intakes and status, and physical activity levels of British children is provided by the Governments National Child Measurement Programme published in 2010. The survey of school children reported that nearly a quarter of children aged 4-5 are overweight rising to one in three for children aged 10-11. The survey recorded 11,317 children in England as being underweight. With more in Year 6 (1.3%) than in Reception Class (0.9%) possibly highlighting the difficulties faced by adolescents who require sustained and reliable nutrition whilst they are rapidly developing. There is no data whatsoever for children living below the radar such as those who attend Kids Company, many of whom have either been excluded from school or have never attended. We observe substantially higher levels of obesity and low weight mostly due to chronic deprivation, maltreatment and the stress this causes.

For further information of on health diet and nutrition visit: http://www.nutrition.org.uk/ nutritionscience/life http://www.eatwell.gov.uk/ agesandstages/children

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Registered Charity No. 1068298

What can be done?

A healthy, balanced diet is essential for optimal growth and development, and healthy tissue and organ function. Whilst malnutrition can have severely damaging consequences for health and wellbeing, scientific research demonstrates that improving the nutritional status of poorly nourished children can have therapeutic effects. It is important that we recognize this need and stop hunger from ruining the lives of our most vulnerable children. Kids Company is committed to supporting the emotional and practical needs of vulnerable children and to campaigning for the way in which vulnerable children are supported throughout the U.K. Kids Company are working with other third sector organisations such as FARESHARE the TRUSSELL TRUST and The School Food Trust to help reduce the nutritional aspect impact of poverty and deprivation. www.fareshare.org.uk www.trusselltrust.org

References: Grantham-Mcgregor, S. (1995). A Review of Studies of the Effect of Severe Malnutrition on Mental Development. The Journal of Nutrition. 125: 2233S-2238S Richardson, A.J. (2003) The role of omega 3 fatty acids in behaviour, cognition and mood. Scandinavian Journal of Nutrition. 47(2) 92-98 Gesch B.C., Hammond S.M., Hampson A. E. & Crowder M.J. (2002). Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behavior of young adult prisoners. Randomised, placebo-controlled trial. British Journal of Psychiatry, 181, 22-28 Martorell R. (1997) Undernutrition during pregnancy and early childhood and its consequences for cognitive and behavioral development. Early Child Development: Investing in Our Childrens Future. Amsterdam, the Netherlands: Elsevier; 1997:3983 Textbook of Paediatrics, 6th Edition Forfar and Arneil 2003 Churchill Livingstone ISBN 0443071926 Kleinman et al, Paediatrics 101(1),e3, 1998 Dunifon & Kowaleski, The influences of participation in the national school lunch program and food insecurity on child well being, Social Service Review, 77(1), 72-92, 2003 Lui J., Raine A.D., Venables, P.H.,& Mednick S.A.(2004). Malnutrition at Age 3 Years and Externalizing Behavior Problems at Ages 8, 11, and 17 Years. American Journal of Psychiatry. 161:20052013 Department for Work and Pensions, Households Below Average Income: an analysis of the income distribution 1994/95-2006/07, National Statistics, 2008. Gregory J,Collins DL,Davies PSW,Hughes JM,Clarke PC.National Diet and Nutrition Survey: children aged 1 to 4 years.London:HMSO,1995. Gregory, J., Lowe, S., Bates C. et al. 2000. National diet and nutrition survey: young people aged 4 to 18 years. Volume 1: Report of the diet and nutrition survey. The Stationery Office: London.http://www.food.gov.uk/science/dietarysurveys/lidnsbranch/ Shor, S., (2011) Children at risk for Poor Nutrition: Expanding the approach of future professionals in educational institutions. Child Abuse and Neglect 35, 606-612 National Child Measurement Programme: England, 2009/10 school year, NHS Information Centre, Dept of Health, 2010