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Supplementary feeding - a lifeline for undernourished children in Madhya Pradesh
" Mother's milk is the best food "

Guna: It was a busy Monday morning for mothers of toddlers at Mahugarha village, in Guna district, M.P.  Women with young children aged up to 5 years gathered at the village anganwadi centre where the little ones were getting weighed.  Infants are weighed once every fortnight under the guidance of the anganwadi worker (a child development worker).

Shivam, one of the little ones to be weighed, is 3 months old and weighs 4.5 kgs. Chanda, the village anganwadi worker, looked pleased with the boy's growth.  “Shivam is the healthiest baby in the village”, Chanda said as the boy's mother Seema Lodha beamed. Taking Shivam back in her arms, Seema said, ``I'm breast feeding him as you have told me, but when do I start giving him something solid?''

``Not now'' Chanda explained. ``Breast-feed him exclusively until six months. After that start with home made food like suji ki khir (porridge), kichri, dal, boiled potato, etc. When he is one year old give him all the varieties of food you eat.''

But not all babies in Mahugarha are as chubby-cheeked as Shivam. Poorti is a seven-month old baby girl from the same village. While little Shivam laughs, gurgles, cries and even shouts to get his mother's attention, Poorti looked frail and tired. She weighs 5.2 kgs and Chanda, was concerned as she wrote down the details in her register. ``This baby is malnourished. She is underweight'', she told Boondibai, the girl’s mother.

``What are you feeding her? Have you started feeding her food at home as I had told you? You can give her suji ki khir (porridge), kichri, dal, boiled potato etc. In case you want you can mash them together, but do feed her at least five to six times a day.''  Poorti is not the only feeble infant. As of May 2006, there were 66,086  malnourished children out of a total of approximately 112,000 children in Guna District, of which 1,531 are severely malnourished''.

``The problem of malnourishment in infants starts mainly after the completion of the sixth month,'' explained Asha Thakur, a supervisor with the state government's Integrated Child Development Services. ``We advise early initiation of breast-feeding and exclusive breast-feeding for the first six months of the baby's life. Thereafter, we ask mothers to start on complimentary feeding. This is when nutrition problems develop and we notice a drastic reduction in the weight of the child.”  The village anganwadi workers go from door-to-door teaching mothers on what to feed infants and young children.

During visits and camps when the anganwadi worker or the auxiliary nurse midwife see severely malnourished children (grade III and IV scale), they are immediately taken to a nutritional rehabilitation centre where they are given urgent medical attention for the next 14 days. The nutrition rehabilitation centre is usually located in the district hospital.
A pediatrician, a feeding counselor, a cook and support staff take care of the ailing malnourished infant and supervise his special diet. The child's mother is counseled on how to cook nutritious food. The child is monitored during his stay at the rehabilitation centre. According to Saurav Singh, Child Development Officer in Guna, children in the 4th degree of malnutrition come with acute respiratory infections, “often they have skin ailments and even tuberculosis”, he says. 
These children are brought to the rehabilitation centre for treatment. The child should gain 10 grams per day per kilo of body weight. If the child weighs 5 kgs, then he should gain 50 grams per day.

Rural anganwadi workers make home visits weighing new-borns and then monitoring their weight as they grow through the initial years. Camps are organised by the state government with technical assistance from UNICEF to educate mothers of infants on child hygiene, care and nourishment. The camps generally take place at the village Anganwadi Centres.

During the camps vitamins and iron supplements are also handed out to young women and children. UNICEF trains staff at the grassroots level on infant and child feeding practices.

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