23 per cent of ‘rich’ babies are malnourished; expert stresses on breastfeeding

For 15 years Dr Rupal Dalal has been raising awareness on how the correct technique for breastfeeding can battle malnutrition The associate professor at IIT Bombayrsquos IITB Centre for Technology Alternatives for Rural Areas CTARA trained as a paediatric and then went to the US to pursue a Masterrsquos degree When she returned in 2006 she noticed that many of the babies she treated in hospitals were malnourishedThis was also the case with the children she met in the slums that she worked inDr Rupal Dalal coaches pregnant women and healthcare workers in Nandurbar on the right way to breastfeed and tackle malnutritionIt came down to nurturing them well in the formative days As per the report Childhood Malnutrition in India by Abhishek Singh nearly half of all underfive child mortality can be attributed to undernourishment ldquoPoor nutrition in the first 100 days of a childrsquos life can also lead to stunted growth which is associated with impaired cognitive ability and reduced school and work performancerdquo the report published in March 2020 said In 2021 former state Women and Child Development Minister Yashomati Thakur said that over 4000 children suffered from acute malnutrition in MumbaiDalal noticed that ldquowhile working in urban slums it was difficult to help older stunted malnourished children gain weight and height Stunted children had shorter bones so such children always stayed underweight despite recommending nutritious diet Their stunting was irreversible We shifted our focus to lactating women and young babies under the age of twordquo With a steep learning curve Dalal developed techniques and methods to hold the baby to ensure better breastfeeding Her method also focuses on the first 1000 daysDr Rupal DalalIn 2017 she was approached by IITB to be a part of their Health Spoken Tutorial and together they developed 91 tutorials and hope to cross 100 soon To ensure seepage at grassroot level these come in 15 languages such as Hindi Marathi Bengali Odia Tamil Telugu Malayalam Sindhi and also in tribal languages and dialects ldquoWe trained healthcare workers on 45 counselling points of breastfeeding skills in many districts of India including those in Gujarat and Uttar Pradesh says the Mumbai resident They reached out to new mothers and guided themThe solution is the crosscradle hold technique in which the woman holds the baby with the hand opposite to the side she is breastfeeding from This gives her full control over the babyrsquos neck and she can bring him or her close to the breast by helping extend it Also unlike the traditional style the lower areola should go in the infantrsquos mouth for better gripEdited excerpts from the interviewWhy is malnutrition still a problem in IndiaAccording to WHOrsquos World Health Organisation growth chart a male child should gain 200 grams per week and a female child should gain around 100 grams in the first week After that average weight is around 300 grams per week for next few weeks A child regardless of sex should gain approximately 1 to 12 kg in a month However in India healthcare workers are taught that babies should gain around 500 grams in a month this gap is the problem The average weight of a newborn in India is 27 kgmdashas per WHO it should be 32 kg for a girl and 33 kg for a boyFurthermore babies should double their weight in three months as per the international health body But in India with a lower target of 500 grams per month results in 4 to 45 kg from 27 kg at three months as opposed to over 6 kg as stipulated by WHO The target weight gain is erroneous and healthcare workers need techniques to increase it But after our training session in Nandurbar district in March we noticed that children are gaining 3040 grams a day which was previously only 1215 grams per dayWhy the stark difference in average weightsIt comes down to faulty techniques of breastfeeding and misinformation about nutrition Mothers and healthcare workers are not taught about protein at all they keep talking about fruits vegetables paneer milk pulses and seeds There are many food taboos and children suffer due to it Mothers require a lot of protein through sprouts eggs and nonvegetarian sources including red meat So instead of generic advice healthcare workers and nurses should be able to educate a pregnant woman about the amount of protein needed and how to calculate its consumption We also share recipes of foods for children right from six monthsHow are babies from urban areas born to welloff families malnourishedDue to lack of awarenessmdasharound 23 per cent of children in the highest wealth quintile are malnourished There are different kinds of malnourishmentmdashundernutrition and overweight Within undernutrition Type 1 is Functional Nutrition Deficiency which means inadequate iron calcium and other minerals Type 2 is deficiency in growth nutrients including protein good fats magnesium potassium zinc and sulphur which are crucial for weight height and muscle gainEducated mothers donrsquot understand the importance of breastfeeding they think formula milk is good Formula fed babies tend to be overweight as it is high in sugar and oils It makes the infant more prone to infections allergies blood pressure diabetes etc These women are aware of protein consumption but because they eat junk food the newborn weighs only 2527 kgHas anything changed over the years What needs to be doneNothing has changed Everyone blames poverty but the fault lies in the lack of awareness The Indian Academy of Pediatrics should teach pregnant women about the benefits of breastfeeding and the correct technique as well as about protein intake Government bodies such as the Integrated Child Development Service ICDS and the National Health System also have a big role to play The education department should absorb these in their curriculum as we have a high rate of teenage pregnancy This is a life skill