About the Book
Book 1: Introduction to Nutrition and Health
Book 2: Basic Concepts in Nutrition
Book 3: Nutrition and Health Care During Pragnancy and Lactation
Book 4: Nutrition and Health Care During Infancy and Early Childhood
Book 5: Nutrition Related Disorders In Early Childhood
Book 6: Nutrition and Health Pragrammes
Book 7: Common Childhood Illness, Their Prevention and Management-1
Book 8: Common Childhood Illness, Their Prevention and Management-2
Book 9: Practical Manual
This being the first Block of the Course on Child Health and Nutrition, the focus would naturally be on explaining the fundamental concepts of health and nutrition.
We are going to begin with nutrition. Unit 1 will talk about what is food and what are its functions, what is meant by the terms nutrition and nutritional status, the interrelationship between nutrition and health as well as the interaction between malnutrition and infection.
Unit 2 will explain to you the changing concept of health, the multiple dimensions of health and the various determinants of health. You will also learn from this Unit about the importance of good health for the development of the child.
In order to assess the health status of an individual or community, you need objective measurements of the various components of health. Unit 3 will tell you about the various indicators of health that are commonly used. This Unit will also broadly depict the health situation in India, acquaint you with the National Health Policy and the health care delivery system in our country.
In Block 1 you were introduced to the concepts of nutrition and health. You learned about the close interrelationship between the food you eat and health status.
Block 2 takes you further in your study of nutrition. Units 4 and 5 will give you details about the nature, functions, sources, digestion, absorption and utilization of carbohydrates, water, proteins and fats. These nutrients are also called macronutrients. The micronutrients - their functions, food sources - will be the focus of Units 6 and 7.
Unit 8 introduces you to the concepts and principles involved in planning balanced diets and in planning meals and snacks. You will find detailed information on planning meals and diets for pregnant and lactating women in Unit 9, Block 3. Nutrition in infancy and early childhood would be the focus of Units 12 and 13, Block 4.
So far, in this Course, you have made a study of the fundamental aspects of nutrition and health in general. Now in this Block, we shall focus on the nutritional and health needs of pregnant and lactating women, the importance of meeting them and how this may be done.
In Unit 9, we have talked about meal planning for pregnant and lactating women. We have discussed the reasons for increased needs for certain nutrients during pregnancy and lactation and how these increased nutrient needs as well as the physiological changes which occur during these stages influence meal planning.
Units 10 and 11 deal with health care of the mother and the child during the antenatal, intranatal and postnatal periods, that is, during pregnancy, childbirth and the weeks after the child has been born. The various physiological changes that occur, health assessment, minor and major disorders during pregnancy and other related aspects have been dealt with in Unit 10, which focuses on health care during pregnancy. Health care during the intranatal and postnatal periods has been dealt with in Unit 11, which includes aspects related to labour, immediate care after delivery as well as later care of the newborn and the mother and lactation management.
In the previous Block, you read about nutrition and health care during the periods of pregnancy and lactation, which is so vital for the wel1-being of both the mother and the child. In this Block, we shal1 study the nutritional and health care aspects that need to be paid attention to with regard to infants and preschoolers.
Unit 12 deals with nutrition during infancy. It emphasizes the importance of breast feeding and supplementary feeding in infancy, and also, the recommended dietary intakes for infants. As you study this Unit, you will also find out about what and how you may feed infants of different ages and the emotional and psychological aspects of infant feeding.
Units 13 wil1 tell you about nutrition during early childhood. In this Unit, you will learn about the recommended dietary intakes of toddlers and preschoolers, and planning balanced diets and snacks for them.
Unit 14 wil1 acquaint you with the different aspects of health care of the young child. This Unit deals with the healthy child. Caring for the sick child and dealing with specific ailments is the subject matter of Blocks 7 and 8 of this Course.
The first step in understanding health care of a child is to recognize a healthy, normal child. A number of medical details that have been, given in Unit 14 are only common sense ones. Though it appears like a health manual initially, it is mostly information that anyone looking after children should have. This Unit covers mostly observation and examination of every child as wel1 as measures for maintenance of health.
You were introduced to the major nutrients and their functions in Block 2. What would happen if the diet provides too much or too little of these nutrients? Read this block to find out. At this stage we will just give you a hint. We have earlier talked about malnutrition and its two forms - under nutrition and over nutrition. In this block we will mainly focus on the problem of under nutrition.
The period of childhood, especially the first few years of life are the vulnerable period. This is a period of rapid growth with a high need for all nutrients. It is also the time when the child comes in contact with succession infections. The child is prone to Marasmus, Kwashiorkor and less severe forms of protein-energy malnutrition. Certain vitamin and mineral deficiency diseases may occur with varying frequency.
Units 15 to 17 in this block are related to the disorders caused by deficiency of energy, protein, vitamins and minerals. The units talk about the clinical features, prevention and 1 treatment of these important deficiency diseases.
In unit 15 the focus is on the protein-energy malnutrition and vitamin A deficiency.
Unit 16 talks about nutritional anaemias and iodine deficiency disorders.
In unit 17. our attention shifts to other nutritional disorders, which include vitamin deficiencies such as, B-complex, Vitamin D and Vitamin C deficiencies. Further, problems related to excess intake of a particular nutrient or condition caused by the intake of toxin are also described in this unit.
In the previous block you have learnt about the various deficiency disorders - their nature, causes and treatment. Can you recollect the names of the four major deficiency disorders which are important from the public health point of view? These are - Protein Energy Malnutrition, Xerophthalmia (Vitamin A deficiency), Anaemia (iron deficiency) and Iodine Deficiency Disorders.
Realising the widespread nature and harmful effects of these deficiency diseases, the Government of India initiated a few .nutrition programmes. The term 'nutrition programmes' here refers to organised programmes through which nutritional benefits are provided to vulnerable sections (who are more susceptible to nutrient deficiency disorders i.e. young children and women of childbearing age) of the population.
In this block you will learn about the major nutrition and health programmes. The two specific kinds of nutrition programmes discussed in the block are nutrient deficiency control programmes and supplementary feeding programmes.
Unit 18 discusses the nutrient deficiency control programmes/prophylaxis (preventive) programmes - National Prophylaxis Programmes for Prevention of Nutritional Blindness, National Nutritional Anaemia Control Programme and National Iodine Deficiency Disorder Control Programme. Under these programmes Commercially prepared produce of Vitamin A, iron and iodine are given to vulnerable sections of the community. Unit 18 also focusses on supplementary feeding programmes. These programmes aim to tackle the problem of protein energy malnutrition. Under these programmes nutritional supplements (food supplements given to fill the energy and protein gap between the home diet and RDIs) are provided to vulnerable sections of the community. The programmes discussed in the unit are - The Integrated Child Development Services Programmes (ICDS), the Mid-day Meal Programme (MDM), Applied Nutrition Programme (ANP), Special Nutritional Programme (SNP), Composite Nutrition Programme and Balwadi Nutrition Programme (BNP).
Unit 19 talks about the health programmes. The concept, infrastructure and delivery of services/activities are discussed in details. A critical analysis on programme functioning is also included.
How do the health workers (who are distributing the benefits of nutrition programme) decider about the people who should get benefits of the programme? They screen people according to their nutritional status. The various ways for assessment of nutritional status are discussed in Unit 20.
You read about health care of the child in terms of taking care of a healthy child in Unit 14 (Block 4) of this Course. Now we shall come to dealing with sickness in children. Unit 21 "Caring for the Sick Child" is a general Unit, while the subsequent Units deal with specific kinds of disorders. Unit 21 has a certain amount of repetition of initial procedures mentioned in Unit 14. This has been done deliberately in order to emphasize the importance of this exercise. In this Unit, while emphasizing the holistic approach to child health, we have talked about recognising and caring 'for the sick child, advising the parents, and other
related aspects.
The subsequent Units deal with the physiological systems whose functioning determine health or illness in the child. They are presented in a somewhat different format. The main signs and symptoms that indicate malfunctioning of the system are described, and their significance explained. Additional information is given on recommended treatment and, even more importantly, preventive measure against disease.
While you are not expected to give medication to the child and treat her medically, it is important that you learn to recognize signs of illness, symptoms of specific diseases, and the measures to take before the doctor reaches the child or the child is taken to the hospital. This will help you to reduce the distress of the sick child and reassure the parents. In case of a minor illness, you will be able to tell the mother how to treat the child at home; if the illness is a severe one, you shall be able to take some 41 measures to prevent deterioration in the child's condition, during the time it takes to reach the hospital. In many cases, you as an educator in the child care centre may be the only person easily accessible to the parents to cons t with. Also, if you are able to recognise an illness and obtain information from the mother as to how it came about, you will be able to help the doctor health worker. It is also important to know how to care for the sick child so that if a child in the centre shows signs of illness, you are able to take appropriate measures. In many cases, you may be the one who points out to the parents that the child is ill.
Having detected an illness, it is important that you call for/send the parent with the child to the Primary Health Centre (PHC)/the Lady Health Visitor (LHV)/the Auxiliary Nurse Midwife (ANM) or to a private local doctor - whatever is appropriate to your situation. They are the ones who are qualified to give medication to the child.
In Block 7 you have read about taking .care of the sick child in general. You have also learnt how to recognise symptoms of illness. particularly with reference to the alimentary system, respiratory system, the mouth and the throat as well as the eyes.
In this Block you shall learn about common problems and diseases of the skin and ears in Units 26 and 27 respectively. Unit 28 will tell you about fevers and the underlying infection they indicate. Lumps and swellings in the body are indicative of some underlying problem. These have been dealt with in Unit 29 of this Block. As explained earlier. while you as a child care worker are not expected to treat the child medically, you must be able to recognize symptoms of illness. take immediate action to make the child comfortable in the time it takes to reach the health worker/doctor and explain to the parents how to prevent these diseases.
The final Unit of this Block gives you practical guidelines for providing first aid. This knowledge is a must for a child care worker -indeed, for anybody;
This Practical Manual contains the practical exercises that form 2 credits of this 8 credit Course. The remaining 6 credits are accounted for by the eight Blocks that comprise the theory portion of this Course. These practical exercises will help you to translate into practice the various theoretical concepts that you have studied in the Blocks. You are well aware that Nutrition and Health are specifically applied areas. Knowing of the principles simply at the theoretical level is not really of much avail. What is of significance is learning how to apply them in real life. These practical exercises have been designed to help you achieve this end.
Kindly note that IGNOU no longer provides the Practical Kit needed for doing Practical Exercise I of DECE-2 Practical Work. This Practical Exercise involves using standard measures, and for that purpose, IGNOU used to earlier provide a practical kit consisting of a measuring glass, measuring cups and spoons. However, the practice of providing the kit has now been discontinued.
If you wish, you may purchase these standard measures, commonly available in the market, and do the Practical Exercise.
Exercise 1 will enable you to use the standard measures provided in the practical kit, that you would have received along with the Course material. Information on how to use the practical kit, as well as how to find the weight of food stuffs with the help of the practical kit and tables relating weight to standard measures has been provided in the exercise itself. There are five inbuilt activities, that you must do.
Exercise 2 requires you to suggest basic mixes as well as multimixes for infants as per the guidelines provided. A few examples of these supplementary foods have been provided to give you a better idea of what you have learnt and what you need to do.
Exercise 3 would help you learn how to plan suitable nutritious snacks for preschoolers in a day care centre.
Exercise 4 builds further on planning snacks for preschoolers. It will give you practice in evaluating as well as planning a cycle menu for snacks to be served to preschool children in a day care centre.
Exercise 5 is based on assessment of nutritional/health status of a child through growth monitoring, mid-arm circumference measurement and assessment of clinical signs.
Exercise 6 involves the assessment of dietary intake of toddlers using the 24-hour recall method of diet intake with the mothers.
Exercise 7 requires you to make a brief survey regarding the occurrence and management of illnesses among children in the 1-6 year age group.
Exercise 8 involves visiting a nursery school/day care centre to find out about maintenance of health records of children and how situations of emergency/accidents are dealt with.
For doing Exercise 9, you will be required to visit a family where there is a child between one and two years of age to find out about her/his health and nutritional status by interviewing the parent(s).
Contents
Block 1 Introduction To Nutrition And Health
UNIT 1
The Concept of Nutrition
7
UNIT 2
The Concept of Health
23
UNIT 3
Indicators of Health
35
Block 2 Basic Concepts in Nutrition
UNIT 4
The Macronutrients-I : Carbohydrates and Water
5
UNIT 5
The Macronutrients-II : Proteins and Fats
16
UNIT 6
The Micronutrients-I : Vitamins
UNIT 7
The Micronutrients-II : Minerals
33
UNIT 8
Planning Balanced Diets 43
Block 3 Nutrition And Health Care During Pregnancy And Lactation
UNIT 9
Meal Planning, for Pregnant and Lactating Women
UNIT 10
Health Care during Pregnancy
30
UNIT 11
Health Care during Intranatal and Postnatal Periods
54
Block 4 Nutrition And Healm Care During infancy And Early Childhood
UNIT 12
Nutrition during Infancy
UNIT 13
Nutrition during Early Childhood
21
UNIT 14
Health Care of the Child
38
Block 5 Nutrition Related Disorders in Early Childhood
UNIT 15
Major Deficiency Diseases - I : PEM and Xerophthalmia
UNIT 16
Major Deficiency Diseases - II: Anaemia and Iodine Deficiency Disorders
UNIT 17
Other Nutritional Disorders
Block 6 Nutrition And Health Programmes
UNIT 18
Major Nutrition Programme
UNIT 19
Major Health Programme
28
UNIT 20
Assessment of Nutritional Status
41
Block 7 Common Childhood Illnesses, Their Prevention and Management - 1
UNIT 21
Caring for the Sick Child
UNIT 22
Some Disorders of the Alimentary System
18
UNIT 23
Some Disorders of the Respiratory System
45
UNIT 24
Some Infections of the Mouth and Throat
55
UNIT 25
Some Problems of the Eyes
60
Block 8 common Childhood Illnesses, Their Prevention And Management - 2
UNIT 26
Common Diseases of the Skin
UNIT 27
Common Problems of the Ears
17
UNIT 28
Fevers
UNIT 29
Lumps and Swellings
31
UNIT 30
First Aid
39
Block 9 Practical Manual
Introduction
3
Exercise 1
Exercise 2
32
Exercise 3
36
Exercise 4
Exercise 5
42
Exercise 6
46
Exercise 7
49
Exercise 8
53
Exercise 9
57
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