The Healthy Diet »

VITAMIN 'A' DEFICIENCY
In between age of 1-4 years mostly children are seen deficient in Vitamin A leading to blindness. It occurs due to deficiency of milk and milk products, green and yellow vegetables and fruits in the diet. These products have Vitamin 'A' and its precursor.

Night blindness may be present in the young children, which is difficult to detect. Conjunction of the eye becomes dry wrinkled and muddy resulting in xerosis. Bitot spots are also seen. Later keratomalacia develops with the cornea becoming soft and ulcerated, leading to blindness.

Treatment
Xerosis is treated with 5000-6000 units of Vitamin A daily by mouth, which can be given in food materials or pills. In case of cloudiness of cornea, 100,000 to 200,000 IU is given for 1 week either by injections or mouth, followed by 5000-6000 IU of Vitamin A daily, Govt of India has started a programme in several states where 200,000 IU of Vitamin A' by mouth is given to pre-school children, every 6 months as a prophylactic measures.

VITAMIN 'B' DEFICIENCY

Thiamine
Beriberi results due to deficiency but fortunately it is not seen in India. The affected baby may have husky voice, rapid breathing and Oedema and develops signs of heart failure.

Treatment
The treatment consists of an injection of thiamine (50 mg). If that is not possible it may given by mouth 10 mg daily for 2 weeks. Parboiling the rice preserves Vitamin B. Adequate amount of pulses and vegetables if included in diet then this deficiency can be prevented.

Riboflavin
Ulceration and fissuring at the angles of mouth i.e. Angular Stomatitis is seen. Chilosis i.e. fissured, red and swollen lips, is also there. The tongue may be bright red, smooth, bald & painful.

Nicotinic Acid
Pellagra results due to deficiency of this vitamin. In this all exposed areas become red, swollen and cracked with itching and burning sensation.

For treatment B complex, Vitamin should be given as tablets or syrups, diet should contain vegetables, milk, nuts etc which are all rich in these vitamins.

VITAMIN 'C' DEFICIENCY
Cooking vegetables and fruits or boiling cow's milk destroys ascorbic acid. Deficiency is not often seen. It is present in raw vegetables and fruits. Deficiency is seen as marked irritability, tenderness of bones, spongy bleeding gums.

200-300 mg of ascorbic Acid when given daily shows great improvement. Tablets are rather costlier so a large amounts of Citrus fruits, raw vegetables, tomatoes, etc. should be added in the diet.

VITAMIN 'D' DEFICIENCY
Deficiency results in rickets, enlargement at the ends of the long bones, rounded projections on the ribs on both sides of chest (rickety rosery), Bones become soft and bend under pressure of walking or standing, knock knees is also noticed, muscle tone is reduced and the child cannot sit, crawl or walk. In female children it may be very dangerous as it deforms the pelvis which may interfere with normal delivery in later life. Main source is sunlight. Adequate intake of Calcium & Phosphorus is necessary. In doubtful cases X-rays of the wrist is necessary.

Massive doses of 600,000 IU of Vitamin D either by mouth or intramuscular injection should be given followed by 1000 IU daily, till healing occurs in 3-4 months. Prophylactic dose is 400-500 IU a day.

ANAEMIA :
Mainly it is due to Iron deficiency but folic acid deficiency and B12 deficiency also play an important role. Child's conjunctive lips, tongue and under nails are pale. Nails may become flat or spoon shaped. It can be due to hookworm infestation. It is seen in infants under 6 months due to lack of iron stores in the liver.

Treatment : Hookworm should be treated. Ferous sulphate salt (50 mg elemental) daily is enough for child under 5 years of age. 10 mg of elemental iron in first year and 20 mg after that can be given as prophylactic measure.

Tablets issued by govt. of India having 20 mg of elemental Iron and 0.5 mg folic
Acid are very good. 1 tablet a day is enough.
Pregnant women should be given 60 mg of elemental iron and 0.5 mg of folic acid a day during last 100 days of her pregnancy.
Meats, organ meats, green leafy vegetable etc. should be added to the diet.

CONCLUSION
The goal of proper management of the child is to permit him to come into adulthood at his optimal state of development, physically, mentally and socially. So that he can compete at his most effective level. The study of the child begins with examination of the patterns of growth of normal children. These must serve as guides to detection, diagnosis treatment of the disorders and deficiencies of childhood.

A clear understanding of the fundamentals of nutrition is required for skillful supervision of the health of children. ICMR has established tables of Recommended dietary allowances as a guide to the attainment of good nutritional status for healthy children of all the ages.

Although the range for good nutrition must be accorded considerable variability, it is well to remember that mild excess of caloric intake may prove to be as undesirable as mild deficiencies. The peoples poverty, superstitious, ignorance and a sort of timid faith in the physician's advice about nutrition which vary often conflicts with their cultural and social bindings and the spell, like influence of the grandmother at home, are all responsible for the deficiencies etc. Timely and proper management of diverse manifestations of the nutritional disorders is well rewarding. A short account of the more important and common entities is expected to be of help in daily practice.

SUMMARY
First five years of life is the most vulnerable period for anybody. Health and proper growth during this period has a great influence on his future personality, his physical and mental state. This period of life should be given extra care.

Parents must check up that child is properly growing. Assessment of proper growth is seen by height and weight, Mid arm circumference, head and chest circumference, eruption of teeth is related to age and by other anthropometric measures. Parents must note down their child's milestones and by comparing these milestones with standard milestones, can come to know whether their child is growing normal. Of course some variation is always seen depending upon hereditary factors and environment.

After assessing the proper growth and development, parents must checkup if any deficiencies are there. If any, they must be properly met for which mother must have at least a rough picture of child's nutritional requirements.
Even to a normal child, mother must take care of their proper nutrition and growth to make them healthier.