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 FACTORS Of 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

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).

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

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: 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)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