“Undernutrition’s most damaging effects occur in utero and during the first two years of life and the effects of this early damage on health, brain development, intelligence, educability, and productivity are largely irreversible.”*
A top priority of Calcutta Kids’ MYCHI is assuring that our children are well nourished and growing normally during this critical period. All over the world, Growth Monitoring and Promotion (GMP) is an important tool used in pediatric and public health practice to monitor the growth of children, and promote behaviors and practices that promote proper child growth. As such, children enrolled in MYCHI attend a GMP camp once a month for 36 months. GMP was started in Fakir Bagan in 2006. All our health workers (AICs and CHWs) are present during the GMP camp, which happens during the first three days of every month. At the GMP camp, children age 0-3 years old are accurately weighed and measured in length/height. The child’s weight is recorded on the growth chart, which, using WHO growth standards, will let Calcutta Kids staff and the caretaker know whether the child is growing normally. If a child is found to be growth faltering, his or her parents are notified and given extra counseling on proper growth, growth faltering, and health promoting behaviors.
During the GMP camp, our focus is on the ‘monitoring aspect’- making sure that we have anthropometric measurements for each child and that these measurements are accurately recorded on the child’s growth chart. It also enables us to observe the child’s growth visually and most importantly share this critical information with the parents. During the measuring process, mothers are fully involved in measuring the child and recording the weight in the growth chart. The Calcutta Kids growth chart is based on international best practices and is used as a communications tool used to encourage parents to take action to improve their children’s nutritional status before it turns into serious malnutrition.
The real value of GMP, however, lies in the ‘promotion aspect’, which too often gets left out of GMP in public health programs. With a large number of children and parents attending, it is challenging for health workers to engage in individual counseling sessions during the camp itself. Calcutta Kids has addressed this challenge by incorporating the promotion aspect into home visits and community meetings. The home visit provides a safe platform for one-on-one counseling and is thereby the best medium to listen to the mother’s concerns, share information, and come up with possible solutions together. In the home visit, the mother is taught why it is important for her child to follow a healthy growth trajectory as shown on the growth chart. She is taught the meaning behind the numbers and colors, and given counseling on effective means of dealing with growth faltering. Through the close counseling sessions, women see the value of GMP and its importance in keeping children healthy, and they are motivated to become the primary change agent in their child’s health and growth.
Identifying the Severely Malnourished
For children in GMP who are found to be severely malnourished (severely underweight of below -3 weight-for-age z-score), their mothers are asked to bring the child to the CK doctor for a clinical assessment in order to address any medical complications or causes of malnutrition, assess nutrient deficiencies to be corrected, and prescribe a regiment of micronutrient supplements as required. These mothers are also invited to participate in group meetings with other mothers facing the same situation.
The Importance of Proper Growth
The first three years of a child’s life are extremely important. These first three years, known as the “critical window,” are essential to a child’s physical and emotional development. Proper growth does not only ensure that the child is physically healthy, it ensures that the child fully develops mentally, emotionally, and socially. A child who experiences proper growth will be a smarter, more energetic and more productive member of society. If the child is not growing properly during this period, irreversible damage is done. Malnutrition in the first three years leads to poor health, stunted growth, cognitive and physical impairment. This damage is permanent and will limit the individual for the rest of their life.