Psychosocial aspects of Infant and Young Child Feeding

What is feeding a child for

you ?

Video: John

At least two axes when looking at nutrition/malnutrition

• Types of context:Emergency situation/present

environment of the population

• Prevalence and types of malnutrition Stunting, micronutrient deficiencies,

wasting, breastfeeding problems, etc.

1/ Emergency situation/present environment of the populations

AGGRESSIONS – TRAUMAS 

Direct:

Weapons

Torture/Epidemics

Rapes

 

Indirect:

Terrifying events

Separation

(death, people missing)

Absence of schooling

Destruction of homes,

sanitary conditions…

CONSEQUENCES 

Somatic:

Death

Diseases

Handicaps

Malnutrition

 

Social:

Loss of landmarks

Breaking up of

emotional bonds

Social chaos

 

Psychological

(objective and subjective):

Immediate

Medium term

After-effects

SUFFERING

MODULATING FACTORSOf aggressions: Suffering and psychological after-effects

- intensity - the person himself (his background and actual

- length of time experience and his capacity to cope)

- family (cohesion, death of close members)

- environment

- assistance (quality, rapidity)

 

Michèle Bertrand (Les enfants dans la guerre et les violences civiles – approches cliniques et théoriques, l’Harmattan, 1997, p.17)

Culture and beliefs

The factors that impact the social structure and the mental health

Type of contexts:

Natural Disasters

Armed conflicts

Political Violence

Extreme precarity

Present environment:

Camps, security…

Hunger and malnutrition

SOCIAL STRUCTURE AND MENTAL HEALTH

Intentionality ?

Psychological time versus objective time

•Care practices and mental health as cause of malnutrition

•Mental and psychological changes due to hunger and malnutrition

•Psychological mid and long-term effects of malnutrition: impact on development

2/ MENTAL HEALTH/CARE PRACTICES

AND MALNUTRITION

Child survival

Growth Development

Child Care Practices

Care f or women

Breast-f eeding and f eeding practices Psychosocial Care

Hygiene practices Home health behaviour

Food preparation

Resources of caretaker

Knowledge, belief

Health and f ood status Mental health, stress

Control of resources, autonomy Workload and time constraints

Social support

Food and economical

resources Food production

I ncome Work

Land property

Health resources

Water supply

Sanitation equipment Health services

availability Environment and

housing security

Health care and

healthy environment

Health Adequate

f ood intake

Food security on the

household level

Availability of resources

Cultural, political, social context

Urban/ rural surrounding

Interesting points• Nutrition is not separated from the growth, the survival and the development of the child,

showing that malnutrition is only one consequence of the causal factors but not the only one. Malnutrition is strongly correlated with growth, survival and development.

• Most of the time, there is not one sole cause of a child’s malnutrition but several causes linked together. For each beneficiary, it’s important to find out what causes lead to malnutrition. This will help us to give adequate responses and advice to the beneficiary.

• The causes are not linear but systemic: the child and the caregiver are living in a context. All these factors are like a system and you cannot isolate one factor only without taking into consideration the other factors. One cause might have different effects and the effect might have a feedback on the previous cause.

• Taking care of the caregiver is an important issue because the child as other vulnerable populations is dependent on the caregiver. To support the caregiver will help him to improve the caring practices.

Causes of malnutrition:Care Practices

•“The behaviours and practices of caregivers that provide the food, stimulation and emotional support necessary for children’s healthy growth and development. These practices translate food security and health care into a child’s well-being. Not only the practices themselves, but also the way they are performed (with affection and with responsiveness to children) are critical to children’s survival, growth and development” (Engle, 1995).

Child survival

Growth Development

Child Care Practices

Care f or women

Breast-f eeding and f eeding practices Psychosocial Care

Hygiene practices Home health behaviour

Food preparation

Resources of caretaker

Knowledge, belief

Health and f ood status Mental health, stress

Control of resources, autonomy Workload and time constraints

Social support

Food and economical

resources Food production

I ncome Work

Land property

Health resources

Water supply

Sanitation equipment Health services

availability Environment and

housing security

Health care and

healthy environment

Health Adequate

f ood intake

Food security on the

household level

Availability of resources

Cultural, political, social context

Urban/ rural surrounding

The caring practices have to be considered in two aspects

-  Quantity: how much time does the caregiver spend with the child?

-   Quality: o responses, sensibility and continuity of the

responses to the child’s needs

o warmth, affection and acceptation

o autonomy, support for exploration and learning.

Care Practices Approach

Observational, factual and psychoaffective/ emotional approach:

Global caregiver-child relationship

Little research, mainly in development contexts

Factors that affect the relationship between the caregiver and the child (Engle, P.L., Ricciuti, N. (1995), Psychosocial aspects of care and nutrition, Food and Nutrition Bulletin, Vol. 16, n°4.)

Resource constraints

Support systems

Caregiver characteristics

Child characteristics

Characteristics of the

relationship child-caregiver

Type of relationship between caregiver and child: - Quantity of care given to the child - Quality: - responsiveness, sensitivity and continuity in

responses - warmth, affection and acceptation - encouragement of autonomy and exploration

All these elements are affected by the culture and the context

Psychological and Sociological Factors intervening in Malnutrition

in Chronic Situations

Recent urbanisation/acculturation

Absence of group support Isolation of the

mother/caretaker

Other causes: - Death of a close

relative - Family conflict - Poverty as a

predisposing factor… Mother’s depression/anxiety

Elements regarding the child:

- Not very attractive/demanding

- Apathetic after mother’s malnutrition during pregnancy for example…

Disruption in mother/child relationship

Parent’s traumas

Emotional aspect of weaning:

- change in feeding habits

- less close contact with the mother…

Child malnutrition

Separation from the mother

Mental and psychological changes due to hunger and malnutrition

From Grantham-MacGregor and al (1994), the long-term follow-up of severely malnourished children who participated in an intervention programme, Child Development, 65: 428-439.

Malnutrition and development

Examples of ACF

interventions and tools

Systematic integration of some activities in treatment of acute malnutrition

• Stimulation of child development

• Mother-child bonding

• Family and Mother’s support

• Suckling technique and breastfeeding support

Play session video

Liberia: Adolescent mothers and

neglected children

Intervention

- In the nutrition centres : psychological support and care practices

- For the prevention: group sessions in the communities on child development and malnutrition.eria)

Kabul - Afghanistan

Malnutrition in Kabul

• Mother’s Milk Insufficiency and percentage of under 6 months old children admitted

• 20% of defaulters

Sri Lanka: baby-boom post-tsunami

Intervention

• Group sessions with pregnant and lactating mothers

• Psychological assessment after birth ; Individual and/or family support when needed

• Recruitment of a « nanny »

Argentina: Stunting and child development