Appetite in children is an important determinant of nutritional intake and growth. The information used by caregivers to understand children's appetite can help inform infant and young child feeding promotion and appetite assessment. We conducted a qualitative study to (a) explore maternal perceptions and responses to children's appetite and (b) to identify how these factors differ by type of caregiver, level of maternal experience, and urban versus rural context. We used purposive sampling to recruit mothers and alternate caregivers into 14 total focus group discussions (six to eight participants in each group; N = 95) in both urban and rural settings in Bangladesh. To understand children's appetite, caregivers monitor children's dietary patterns, emotional signs, and physical and verbal cues. Healthy appetite was observed by willingness to eat diverse foods, finish offered portions, and by acceptance of foods without excessive prompting. Child illness was cited for a cause of low appetite, which was manifested through fussiness, and avoiding commonly consumed foods. Mothers described a limited set of feeding practices (offering diverse foods, playing, and cheering children with videos) to encourage consumption when children lacked appetite. Mothers' stress related to work was noted as a barrier to identifying appetite cues. Urban mothers described a lower access to instrumental social support for child feeding but informational support than mothers in the rural setting. Understanding caregivers' perceptions of children's appetite may inform strategies to improve responsive feeding and tool development to assess changes in appetite as early indicators of change in health or nutrition status among high-risk children.
Understanding the procurement behaviors of ECE programs helps to illuminate and prioritize potential interventions that would support healthy food purchases.
Child undernutrition has multifactorial causes, ranging from food insecurity to etiologies refractory to conventional nutritional approaches, such as infections, environmental enteric dysfunction, and other conditions that lead to systemic inflammation. Poor appetite may be an important symptom of these causes and may be a useful marker of an undernourished child's ability to recover. We conducted a systematic review to characterize the methods and tools to measure appetite among children <5 y old in low- and middle-income countries. A systematic search of 8 databases identified 23 eligible studies published since 1995. Thirteen described methods based on direct feeding observation or quantification of nutrient intake from caregiver report, 16 described tools that assessed caregiver perceptions of appetite, and 6 reported assessments in both categories. Four studies that gauged caregiver perceptions assessed multiple appetite domains, whereas 12 assessed 1 domain—often with a single question. Only 6 studies reported validation processes, the most common of which compared an observed test meal with daily energy intake. No studies reported the use of a method or tool that was validated in multiple cultural or linguistic contexts. Although dietary intake measures and observed feeding tests have shown validity in some contexts, they are resource intensive. Subjective caregiver questionnaires may offer a more efficient appetite evaluation method, but they have been evaluated less consistently. A rigorously developed and validated tool to rapidly assess child appetite is needed and could be best addressed by a questionnaire that leverages the multiple domains of appetite. The application of interventions that target causes of undernutrition that are not amenable to food-based interventions in clinical or research contexts could be facilitated by an efficient appetite screening tool to identify appetite-related causes of undernutrition and to monitor children's response to such interventions.
Background: Globally, PEM continues to be a major health problem in developing countries and the most important risk factor for illnesses and death especially among young children. The research was conducted to study the effect of thyroid profile in malnourished children (6 month-5 years) admitted in tertiary care center in Central India.Methods: A cross sectional hospital based observational study was carried out in tertiary care hospital NSCB MCH Jabalpur. 80 malnourished children were included in the study. The cases were categorized into moderate and severe malnutrition as per WHO classification. Detailed clinical assessment of nutritional status followed by anthropometric measurement (weight for height) was recorded in predesigned proforma. Triiodothyronine (T3), Thyroxine (T4), thyroid stimulating hormone (TSH), serum total protein and serum albumin were estimated. The parameters were compared among SAM and MAM groups using appropriate tool.Results: Mean serum protein, serum albumin, T3, T4 were significantly low in SAM group, when compared to the MAM group (p <0.001). while level of TSH was not found significant among SAM and MAM groups.Conclusions: Malnutrition is associated with decrease level of thyroid hormone levels and were positively correlated with serum total protein and albumin levels. The decrease level of thyroid hormone may have a contributory role in retarded growth and development.
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