Childhood is a critical time in the growth and development of a person and is a key stage in the establishment of their physical and mental abilities. Early childhood is a basic stage that will impact the child later in life. During this period, apart from the physical one, the brain development, as well as the foundations for cognitive development and social-emotional skills, is laid. Proper nutrition plays a key role in optimal healthy growth. Eating defects during this period may affect the growth, the cognitive skills and behavior of the child during school years. Modern data shows that diet seems to be one of the most important growth and maturation factors in infancy and childhood⁽¹⁾. The relationship between nutrition, health and learning is undeniably strong: nutrition is one of the three major factors that impact the child’s development. As genes and environment are the other two factors, eating a certain food cannot guarantee that your child will be smarter. Nevertheless, research studies show that nutrition in a child’s early years is linked to their health and academic performance in the later years⁽²⁾. A proper nutritional diet and healthy lifestyle can affect young children throughout the rest of their lives. During early development, children are highly impressionable and start to implement routines and tools that they carry into their adulthood. Adequate nutrition is one of the important factors influencing growth & immunity and should not only maintain the current body weight but should be adequate enough to support their normal growth and development. Since parents act as models for their children, they are called upon to educate and strengthen the adoption of healthy dietary habits, to ensure their healthy growth as studies show that having a balanced and nutritious diet directly impacts all aspects of a child’s growth and development⁽³⁾. A healthy diet is the one which meets the energy requirements and supplies essential macro and micronutrients for supporting the functioning of all vital processes. Growth during infancy is rapid. During this period, the requirements for energy and nutrients are highest relative to body size when compared with other growth periods. Also, this period is critical for neurocognitive development⁽²⁾. Physical effects: Inadequate nutrition during infancy and childhood can restrict growth, weaken immunity and increase the incidence of infections and diseases. Poor or insufficient diet can also cause catabolism of body tissues and failure to provide energy substrate. An inadequate diet usually causes multiple deficiencies of macro and micronutrients. Aside from habits and routines created, children who do not obtain proper nutrients as they develop, can suffer from physical ailments as well⁽²⁾. Child malnutrition includes under-nutrition and over-nutrition, both of which are deficiency diseases caused by inadequate nutrition. During childhood, under-nutrition causes children to have less energy and less interest in learning, which negatively influences cognitive development and academic performances. Under-nutrition will also affect physical growth and maturation, thus affecting growth rate, body weight and ultimately height⁽³⁾. Some of the most common issues for malnourished children include obesity, osteoporosis, decreased muscle mass, fatigue, irritability, and type 2 diabetes. • When children consume sugary, processed, and high-fat foods, it takes a toll on their digestive system and gut flora. • Lack of Calcium absorption can lead to osteoporosis. • Children who do not have a well-balanced diet and consume high amounts of fat, sugar, and processed carbohydrates are at risk of obesity. Obesity is a special form of malnutrition; children who are overweight tend to have fatigue and irritability that can lead to depression. Children that are overweight have difficulty with physical activity and often cannot participate in these activities alongside their peers. This can cause emotional isolation and can set the groundwork for poor social interactions and low self-esteem. Overall, a well-balanced and healthy nutritional diet is of paramount importance in developing children⁽⁴⁾. Evidence suggests that the timing of nutritional deficiencies can also significantly affect growth and development. The childhood period is also very sensitive to dietary deficiencies, particularly as the brain is undergoing major structural and cognitive maturation. Cognitive development in children involves the maturation of higher mental functions such as attention, memory, learning and perception. During these years, optimal brain development has been shown to be associated with better academic ability. If cognitive development is positively influenced by nutrition then, conversely, cognitive development is therefore vulnerable to dietary deficiencies⁽³⁾. Effects on the Nervous System: Diet has a dual role in cognitive development: • It provides substrates from which the brain is constructed • It provides energy for the adequate functioning of the brain The adverse effects of malnutrition on the brain during early life include, decrease in brain cells, number of synapses, leading to smaller brain size and changes in neurotransmitter systems⁽²⁾. All these changes are associated with: • Delay in cognitive and motor functions • Lower IQ scores • Impaired school performance • Learning disorders • Poor memory • Reduced social skills A nutritionally adequate and balanced diet is crucial for the optimum growth, development and boosting of the immune function in children and to prevent the above mentioned physical and psychological ill-effects⁽²⁾. Adequate intake of both macronutrients (carbohydrate, protein and fat) as well as micronutrients (vitamins and minerals) is essential during toddler years to ensure optimal growth and brain development. Providing toddlers with a healthy balanced diet will optimize their physical and cognitive development, promote attainment of a healthy weight and reduce the risk of chronic disease later in life. Achieving a balanced diet is all about eating a variety of foods, in the right proportions, providing a good combination of protein, carbohydrate, fat, vitamins and minerals. Each of these nutrients has a vital role in the all-round growth and development of children⁽³⁾. Macronutrients Carbohydrates: Major energy sources for all cells are carbohydrates which are the primary source of energy for the CNS. They should provide 45% to 65% of total calories in a diet. Fruits are a good source of simple carbohydrate and are also rich sources of vitamins and fiber. Whole fruit instead of fruit juices should preferably be given to children. Protein: Protein energy malnutrition hampers the brain, the immune system and the intestinal mucosal functions. Protein requirement is greater for infants and growing children than for adults. It is important that all the essential amino acids be provided through dietary intake. For children, milk is an important source of good quality. Proteins in addition to other animal and vegetables food sources. Fats: In addition to being energy dense, fats provide essential fatty acids and have important structural and functional roles that are important for neurological and ocular development⁽²⁾. Micronutrients Calcium: During childhood and adolescence, adequate Calcium intake is important for bone health during growing years as well as later in life. Calcium is needed to develop strong, healthy, bones and teeth. Adequate milk and dairy products are a good source of calcium. Iron: Iron deficiency is very common among children and is associated with anemia and neurocognitive deficits. Vitamin C rich foods promote the absorption of Iron in the body. Vitamin A: Vitamin A is an important micronutrient as it is required for clear vision, it also plays a role in maintaining resistance against common infections. Yellow, orange, and dark green fruits and vegetables are rich sources of beta-carotene, which is the precursor of Retinol. Vitamin D: Vitamin D is critical for Calcium and bone metabolism, and its adequate intake is important for long-term bone health. In infants, Vitamin D deficiency can cause rickets and very severe deficiency can also lead to hypocalcemic seizures. Darker skin, little sun exposure and fat malabsorption are the risk factors for Vitamin D deficiency⁽²⁾. Summary Nutrition plays an important role in the growth and development of children, with a healthy diet synergistically enhancing physical and mental abilities. Malnutrition in children is detrimental to the development of their physical growth, cognitive abilities, and psychosocial skills, with multiple downstream effects in the short-term and long-term. Healthcare professionals are ideally placed to have a frank and open conversation with parents about child’s nutrition, and should be encouraged to do so in order to guide them on the best choices for balanced foods and growing up milks which ensure the proper nutrients for their age. Dr. Bassam GHANEM Pediatrician 1. https://www.researchgate.net/publication/335379195_The_Role_of_Nutrients_in_Child's_Brain_Development 2. http://www.signutra.com/nutripedia/role-of-nutrition-in-overall-growth-and-development-of-children-and-adolescents/ 3. https://www.all4kids.org/news/blog/importance-of-good-nutrition-for-young-children/ 4. https://www.ausmed.com/cpd/articles/nutrition-for-children Bledina is not the author of this article, as it has been written by Dr Bassam GHANEM who is the owner of the content.

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