When a child needs “catch-up growth”, it’s because he has been experiencing a period of stagnated or reduced growth. A child will need to “catch up” when he has been failing to thrive and is falling behind in his height-and-weight-for-age score.
There can be many reasons why a child may not be growing as he should. Sometimes it may be caused by malnutrition. Or it may be due to medical conditions such as congenital hypothyroidism, or a growth hormone deficiency or other genetic and endocrine disorders. However, only a paediatrician will be able to diagnose your child’s condition and tell you why.
To make sure your child is hitting all his height and weight milestones, parents should put up a wall height chart and a bathroom scale to monitor his growth and to keep to regular check-up appointments with the paediatrician, at least to age five. This is because one of the most critical phases of physical development, health, well-being and learning is from birth to five years as this is the period that sets their overall trajectory in life in various ways. If your child shows little or no weight or height gain over a period of two to three months and appears sickly during this phase, it may be time for you to take him for a thorough medical evaluation.
Both Sides of Malnutrition
Most times though, stagnated or reduced growth can be caused by something as straightforward as malnutrition. Most people associate the word malnutrition with pictures of bone-thin, starving children with hollow eyes and bloated stomachs crying in hunger in the dirt roads of East Africa. To a great extent, this is a true representation of malnutrition as poverty and famine in Africa and other parts of the world have not abated in the last 40 years.
However, not many people would associate malnutrition with an overweight child. It may seem surprising but malnutrition can occur when one is undernourished or overnourished. For the former, the result can be stunting (too short for the child’s age) and wasting (low weight for age and weak) or becoming overweight and obese, predisposing the child to high blood pressure, high cholesterol, Type 2 Diabetes, breathing problems like asthma and sleep apnea as well as detriments to social and emotional well-being and self esteem.
According to the 2022 National Health and Morbidity Survey (NHMS), 6% of Malaysian children under 12 are obese, one in five is too short for their age, and 1 in 10 is too thin for their height. What’s worse is – 80.3% of parents are unaware that their children are obese and 74.4% are unaware that their children are too thin for their height. In the same survey, it was also found that one-third of Malaysian teens are overweight or obese.
Either way − whether underweight or overweight − malnutrition can occur. A malnourished child may be anaemic (and 46.5% of Malaysian children have been found to have anemia in the 2022 NHMS), exhibit poor cognitive, motor and speech development, show listlessness, anxiety, irritability, moodiness or other mental or behavioral issues. He could also experience frequent diarrhoea, have lung infections or fall sick constantly due to a weakened immune system.
What is Malnutrition?
Malnutrition occurs when the body is deprived of vitamins, minerals and other nutrients to maintain healthy tissue and organ function. Undernutrition occurs when not enough essential nutrients are consumed or when they are excreted before the body can absorb the nutrients. Overnutrition occurs when one eats too much, eats the wrong things, don’t exercise enough and consumes a diet high in processed foods, sugar, salt and fat.
As elucidated by UNICEF on the changing face of malnutrition, an undernourished child is one who eats too little of what he needs and an overnourished child is one who eats too much of what he doesn’t need.
Preventing Malnutrition
The best way to prevent malnutrition in any form is by inculcating healthy, balanced eating habits from young. This is to ensure your child receives the right nutrition in the right amounts. Try not to let your child miss or skip meals, especially breakfast, and aim to let him eat three small balanced meals and up to two or three snacks a day if his appetite is small. The meals should comprise fruits and vegetables, starchy food such as rice, noodles, bread and potatoes, milk and dairy products and meat, fish, eggs and other sources of protein. Drink only after the meal, not before or during and ensure the child does not lead a sedentary lifestyle.
Macronutrients and Micronutrients Needed for Catch-up Growth
To maximise catch-up growth in a child, ensure an adequate intake of macronutrients and micronutrients.
Macronutrients are the compounds consumed in the largest quantities to provide energy, support the immune system, build hormones and neurotransmitters and aid in the absorption of micronutrients. Macronutrients are classified as carbohydrates, proteins and fats.
Micronutrients are the vitamins and minerals which should be consumed in small but adequate quantities required for growth.
Macronutrients
1: Carbohydrates:
Carbohydrates are the macronutrients that often form the staple in a child’s diet. However, consumption of carbohydrates should not be made up of simple carbohydrates like deep-fried white flour snacks and kueh which all Malaysians are so fond of, chocolate and candy bars, pastries, biscuits and cakes, syrups and carbonated drinks. Where carbohydrates are concerned, they should instead be nutrient dense complex carbohydrates that are digested more slowly and release glucose into the blood stream more gradually. Complex carbohydrates also keep the stomach full for longer periods thus preventing over eating.
Some complex carbohydrates include whole grains like brown rice, wholegrain Basmati rice, oats, potatoes, sweet potatoes, wholemeal bread, as well as legumes, fruits and vegetables.
It is alright to eat white rice as it is our staple food. Despite the argument that polished white rice is a simple carbohydrate because it is missing its germ and bran during its milling process, it is still considered a complex carbohydrate because of its structure. White rice is not totally devoid of nutrition. Although it has been stripped of its fibre, it is still a good source of magnesium, phosphorus, manganese, selenium, iron, folic acid, thiamine and niacin. However, it has a high glycemic index and can cause spikes in blood sugar if eaten in vast quantities. The trick then is to consume only a balanced portion together with the other food groups.
2: Fats
Fat is one of the core macronutrients that is essential for your child’s optimum growth and development. Although we have been told that consuming fat is bad for health, this is not entirely true for all fats.
Among the different types of fats classified as saturated, mono-unsaturated, poly-unsaturated and trans fatty acids, there are two specific fatty acids known as Omega-3 and Omega-6 that deliver proven health benefits for your child during their most demanding growing up years.
Omega-3 fatty acids such as Docosahexaenoic acid (DHA), Eicosapentaenoic acid (EPA), and α-Linolenic acid, or alpha-Linolenic (ALA) play a critical role in a toddler’s brain growth, cognitive, neural and eye development. They also improve behaviour, sharpen focus, reduce inflammation and support cardiovascular health.
DHA and EPA fats are found in fatty fish such as salmon, mackerel, sardines, light tuna and barramundi (Ikan Siakap).
ALA is found in plant foods such as walnuts, chia, flax seeds as well as soybean and canola oils.
Some toddler foods and milk are fortified with these fats and can provide additional sources for your child to get the goodness of DHA, EPA and ALA omega-3 fatty acids.
Although a lot of emphasis is placed on omega-3 fatty acids, omega-6 fatty acids also have a critical role in a child’s growth and development. In fact, omega-6 fatty acids are a key component of a healthy diet but must be consumed in a proper ratio to omega-3 fatty acids.
Omega-6 fatty acids are found in a variety of foods such as nuts, seeds, tofu, peanut butter, avocado, eggs and almonds.
One of the commonest forms of omega-6 is linoleic acid. Other forms include arachidonic acid (ARA) and gamma-linolenic acid. They work together for brain development, repair, maintenance and neuron protection.
ARA, in particular, gives cell membranes fluidity and flexibility. It is therefore necessary for the function of all cells especially in the nervous system, skeletal muscle and immune system of a developing child. Because ARA and DHA are both found in breast milk and need to work in tandem with each other, ARA is often an essential addition to formula milk fortified with DHA.
3: Protein
Protein is a very important macronutrient that provides the essential amino acids children need to support their rapid growth, development and immune health. Protein has often been called the building blocks of life because it is a part of every cell in the body. Not only is it needed to build, repair muscle, tissue, skin, nails and hair, it is also needed to build hormones, enzymes and antibodies for a healthy functioning immune system. Protein is also present in blood.
In a study done on the importance of protein for catch up growth in Indonesian stunted children, it was found that providing high protein foods to meet the stunted children’s protein needs prevented further decline of their cognitive functions and also improved their height and weight gain.
Protein from food comes from meat and fish, eggs, milk and milk products, seeds and nuts, and legumes like beans and lentils.
It is important to ensure that children are given adequate amounts of protein in their diets especially in their first 1000 days as this is the golden period to prevent growth delays and abnormalities to their development.
Micronutrients
To encourage linear growth (height), include foods that are rich in or fortified with calcium and Vitamin D such as milk, dairy products, fortified cereals and oatmeal.
As everyone knows, the body needs calcium to build strong bones, teeth and the skeletal structure. Deficiencies may cause a loss of bone density contributing to fractures, Rickets (soft bones that bend), muscle weakness and other delayed motor development.
But why must calcium be taken with Vitamin D? Because calcium works best when paired with Vitamin D, although it is not necessary to take both micronutrients at the same time. The body needs the presence of Vitamin D to actively absorb calcium from the small intestines. Without it, too much calcium would be excreted through the kidneys and not enough will remain in the bloodstream to mineralise and strengthen bones.
To get calcium naturally, eat more spinach, kale, soybeans and some fish such as salmon and sardines. To get vitamin D naturally, eat more fatty fish, beef liver, cheese and egg yolks.
Iron is a crucial mineral needed for the formation of healthy red blood cells in the blood stream that helps to carry oxygen from the lungs to the rest of the body. Iron is also a vital component of brain tissue and supports brain development, tissue growth and the generation of effective immune responses. A strong iron status is therefore a prerequisite for optimal child growth and development.
Studies have shown that iron is associated with faster catch-up growth with improvements in weight and height as well as motor development and haemoglobin level in children experiencing slow or stagnated growth, and iron deficiency anaemia. As mentioned earlier, the 2022 NHMS report shows that 46.5% of Malaysian children are anaemic. That’s almost half of all children in Malaysia.
You can help your children get more iron from their diet by giving them all kinds of meats, tofu, dried beans and peas, dried fruits, leafy dark green vegetables and iron fortified breakfast cereals and breads. Do note that iron from animal sources is more easily absorbed by the body than iron from plant sources.
Zinc is a trace mineral that is only required in small amounts but plays a giant role in the body. It is necessary for cell function, cell repair, wound healing, metabolism, neurological and immune function, eye health, skin health, and digestive system health and function. Zinc has anti-inflammatory properties too and is important for your sense of taste and smell and for supporting growth. Numerous studies have shown that diets with zinc fortification given to children who fail to grow and achieved significant improvements in height, weight and overall health.
Conversely, zinc deficiency is associated with stunting in young children. Typically, the signs would be growth retardation, rough skin, poor appetite, diarrhoea, mental lethargy, abnormal neuro sensory changes, hair loss, frequent infections, irritability and infertility − especially in males later in life.
Fortunately, zinc is easily obtainable from diets that contain meat − especially red meat, fish and poultry, and whole grains, nuts and seeds such as pumpkin seeds, legumes and vegetables.
Vitamin A plays a crucial role in vision development and of course, visual-cognitive learning in the child’s developmental years. Not only is Vitamin A necessary for eye health, it is also a regulator of the immune system and reproductive system and it helps the heart, lungs and other organs work properly.
Additionally, Vitamin A works with calcium and Vitamin D to support your child’s bones’ growth. The vitamin has been found to play a crucial role in the proper functioning of the growth plates, allowing optimal bone growth and elongation while it regulates various hormones including the growth hormone to help your child achieve height gain.
Feed your child foods that are rich in Vitamin A such as red and yellow vegetables, milk, cheese, eggs, apricots and liver.
Morinaga Chil-kid
Milk is one of the foods that is abundant in some of the macro and micronutrients needed for catch-up growth. Better yet, when it is a fortified formula milk packed with 45 essential nutrients to support and complement the dietary demands of fast-growing children like Morinaga Chil-kid.
Morinaga Chil-kid is a Japanese growing up milk that contains a balanced ratio of protein, fats and energy plus 27 vitamins and minerals including the ones mentioned above such as calcium, Vitamin D, Vitamin A, zinc and iron.
Additionally, it contains vitamins B1, B2, B6, and B12, plus other essential Bs such as Niacin, Folic Acid, Pantothenic Acid and Biotin. Other vitamins and minerals in Morinaga Chil-kid include vitamins C, D, E and K1 as well as magnesium, manganese, copper, iodine, phosphorus, taurine and many others.
As for the necessary fats, the essential ones are all there including DHA, ARA, ALA and other omega 3 and 6 long-chain polyunsaturated fatty acids (LCPs). And to ensure a healthy digestive system, Morinaga Chil-kid also contains prebiotics Galacto-oligosaccharides (GOS) and five Nucleotides, the building blocks of DNA.
Morinaga Chil-kid is formulated for children aged one to seven and comes with a mild vanilla taste that is appealing to children.
For more information on Morinaga Chil-kid, please visit the website here.