Over the last one month Kaitesi  has had trouble with the poor eating habits of her  baby.  The baby loathes food and she has to force him  to eat albeit unsuccessfully. Like many other mothers what Kaitesi doesn’t know is that feeding  a child under five requires a  regular consultation of nutrition experts.  Kaitesi ‘s worry is that the poor appetite of the baby could lead to malnutrition.

However, according to Nutrition experts establishing if your child is suffering from malnutrition cannot be based on their level of  appetite.  Even a child with a health appetite can suffer from malnutrition if they are not eating the right quantities and quality of food.

 The best way to determine if the child is eating the right quantity and type of nutrients is regular medical visits to monitor the weight and health of the child.

A child is given a health card at birth.  Every month the child should be monitored to ensure  that the growth and eating habit is within the normal health curve.

 On a monthly basis the child’s weight should be taken and plotted against the health card.  If a child is doing well, the graph should be going up and not declining.

However, based on the latest Hunger report findings released  by African Union Commission , many mothers in Rwanda could be seated on a time bomb as far as the nutrition of their children is concerned.

According to the report, Rwanda lost Rwf503.6bn in 2012 due to cases of malnutrition-a sum which is equivalent to a third of the national budget. The report further says that in the same year, 280, 385 clinical episodes associated with under nutrition in children under five years were recorded. 21.9 per cent of all mortalities of children under five were linked to under nutrition.   

The cost of hunger report established that the effects of under-nutrition seem to stalk the child throughout his/her entire life holding them back academically and later in life at their productive phase of life.  The same report shows that if malnutrition can be avoided in the first 1000 days, the child is saved the burden that could hold them back throughout their lifetime.

The report shows that children who were malnourished were more susceptible to recurring illness.

 The report findings warned that in Rwanda malnourished children under five years are more susceptible to fever, malaria, respiratory infection, diarrhea and anemia. 

Dr Fidel Ngabo, the coordinator of maternal health and nutrition at the Health ministry says that the first thousand days of a child’s life  are the most critical in ensuring that a child is free of dangers posed by malnutrition.

Dr Melanie Barasa a visiting Kenyan pediatrician who was in Rwanda for the food and nutrition summit last week explains that the best ways for parents and care givers to detect symptoms of under-nutrition in an under-five year old child is by the plotting a graph of the weight to height of a child.

"If plotted on a graph, there should be a proportional percentage increase in both that is somewhat related causing the graph to rise, but when it seems to decline or stagnate, there is cause for alarm. If stagnant, it is probably due to illness or there is a chance of malnutrition.”

The doctor notes that cases of rapid weight loss in children, say 10 per cent in about two or three months could also be an indicator for malnutrition.

"For a long time parents and caregivers have not been able to detect signs of malnutrition in children often seeing it as a complex process. Though one is recommended to regularly take his or her child to the clinic at least once a month, some basic signs can point you to the problem. If you constantly monitor the child’s weight and notice that at some point it has not been proportional and there has not been any illness, don’t just assume,” Dr Barasa advises.

She adds that malnutrition should not be confused with underfeeding as most times it is usually the lack of or imbalance in nutrients intake.

"Imbalance in nutrient requirement and intake, results in cumulative deficits of energy, protein, or micro-nutrients that may negatively affect growth of an infant. Malnutrition typically occurs along a continuum of inadequate intake, impaired absorption of key nutrients.”

She says breast milk is the best source of nutrients for children in the first 1000 days of a child’s life. 

"Breast milk is the best milk for a baby. It contains the nutritional elements which are necessary for physical and mental development. It also contains antibodies which protect the child from infection. Breast-fed babies are less exposed to infection than non-breastfed babies. It is also important for the mother to maintain proper feeding habits before and after the birth of a child since the 1000 days begin before birth of a child and most of the feeding in the first 1000 days is through the mother.”

Minister of Health Dr Agnes Binagwaho , who is a Pediatrician by training advises that good feeding should not be only about filing up but also providing the child with nutrients and micronutrients.

"It is important for a child to eat at least one good meal a day. Good meal meaning, with enough nutrients and micro-nutrients, because feeding is not only about filling up but also about ensuring proper nutrients supply,” Binagwaho explains.

Many children go through phases of resisting eating certain foods or anything at all. This is particularly common for children up to the age of five, and it is quite common. Doctors say it is normal for young children to refuse a new food without even trying it. Research shows new foods often need to be offered several times before some children will try them. Offer regular meals and snacks to establish a structured eating pattern rather than allowing your child to pick at food throughout the day.

Parents are at times advised to use simple incentives like using brightly coloured plates and presenting the food in attractive ways.

Child physicians advise that fatty and sugary foods like fats, cooking oils, sugar, biscuits, cakes, crisps, sweets, chocolate, ice cream and sugary drinks should be handled with caution.

These foods shouldn’t be given too often and, when they are, only in small amounts. Many of these could affect your child’s intake of more nutritious foods and lead to a less healthy diet.

Sugary foods and drinks (including fruit juice) can also significantly contribute to nutrient imbalance especially when consumed between meals. Milk or water are the best drinks to have between meals.