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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