Abbott’s “Grow Right” Initiative to Help Parents Achieve Holistic Growth in Toddlers

Ambar Bhattacharya, abptakmaa, Kolkata, 7th Feb 2020 : Abbott brought together leading experts to form India’s first ever Grow Right Guild that developedthe Grow Right Charter guidelines across four critical growth parameters – nutrition, play, nurture, and impact. The Grow Right charter defines right growth as a combination of physical, cognitive and mental progress that should be observed carefully and holistically during the foundational years of childhood. The guidelines include:

• Right Nutrition guidelines will help parents better manage mealtimes and ensure a complete and balanced diet for their toddlers.
• Right Play addresses the growing concern among parents about unchecked screen-time and inadequate playtime by defining appropriate ways to creatively engage with toddlers.
• Right Nurture guidelines are designed to assist evolving behavioral trends in response to increasingly dynamic influences a toddler faces in today’s digitized world.
• Right Impact guidelines will help toddler parents identify and manage red flags in key growth and development markers.

Dr. Irfan Shaikh, Head Pediatric Nutrition – Scientific & Medical Affairs, Abbott Nutrition said, “Problems with eating habitsmay lead to significant negative nutritional, developmental and behavioral issues in toddlers. Early recognition and management are key to addressing this concern. During early childhood, the brain develops rapidly and is particularly sensitive to the external environment. WHO also recommends 60-minutes of vigorous physical activity or play per day as it provides additional health benefits.It is alarming to see that most Indian children are not meeting the recommended levels of physical activity*.”

Addressing a frequently asked query by toddler moms, Grow Right Guild member, nutritionist Dr. Eileen Canday,decoded micronutrient deficiency saying, “Hidden hunger or micronutrient deficiencies are the most common issues we see in toddlers today. As foods become more accessible outside homes — at malls, restaurants, and through online food delivery, parents’ job of ensuring that their toddler is receiving the right nutrition becomes tougher. While these make the child seem full, they lack key micro and macronutrients. One way to deal with this is to, pick the occasions carefully to eat out! You can eat out, but make sure to choose healthy foods, and let the selection of the meals be guided by the ingredients.”

Dr. Suman Poddar, emphasized on the importance of understanding growth in toddlers, “Childhood is a period of rapid growth and development and is a critical phase, which lays the foundation for markers of a healthy adult life. The average growth* of a child from the age of two till the growth spurt at puberty continues at a rate of approximately 6–8 cm per year, and 2 kg per year. However, every child has a unique pace of growth which may vary, and parents must rely on established standards – like the World Health Organization growth charts for growth measurements.”

*Source: Khadilkar VV, Khadilkar AV, Choudhary P, et al. IAP growth monitoring guideline for children from birth to 18 years. Indian Pediatrics 2007; 44: 187-97 * Abbott-Momspresso Survey.

RIGHT NUTRITION

1. Address mallnutrition* now :: As foods become more accessible outside homes — at malls, restaurants, and through online food delivery, parents’ job of ensuring that their toddler is receiving the right nutrition becomes tougher. While this kind of “mall” food may satiate hunger for the short-term, it is typically deficient in essential micronutrients. Carbohydrates, fats and proteins are macronutrients, which are needed in large quantities in children – but it’s essential for children to also get  micronutrients – including vitamins and minerals. When children consume food that’s high in carbohydrates, fats and proteins, it might appear their hunger is satisfied, but the micronutrient deficiencies lead to their bodies still wanting good nutrition. This is often referred to as hidden hunger.^1,2

Insight: A simple way of avoiding micronutrient deficiencies is to consider the ingredients, rather than the complete dish. The ingredients must have the right balance of both macronutrients and micronutrients. Macronutrients are nutrients that are required in large quantities like protein, carbohydrate, fats – and can be found in foods such as cereals, millets, pulses, milk, oils, meat, fish, poultry. Micronutrients are nutrients that are required in small quantities like iron, magnesium, zinc, calcium, vitamins, and selenium – which can be found in fruits, green leafy vegetables, nuts and oilseeds, milk, meat, fish, poultry).^1,2 

Guideline: While eating out is an inevitable part of modern life, pick the occasions carefully! You can eat out, but make sure to choose healthy foods, and let the selection of the meals be guided by the ingredients.^1,2

• Structure mealtimes, have a timetable : Problems with feeding have significant impact on the nutritional, developmental and psychological growth of the child. Early recognition and management of feeding patterns are the key to its resolution. It’s a frustrating experience for parents to manage children who have strong food preferences or those that take unusually longer time to eat.

Insight: Overcoming feeding difficulties with simple yet effective changes in the physical and physiological environment of the child, results in pleasant and favorable mealtimes.

Guideline: Have a structured mealtime schedule (once every 4 hours) for children. Meals should have a time limit of about 20 mins for snacking and 40 minutes for a major meal. The child should be fed in a place with few distractions (e.g. no loud radio or television, electronic devices or toys at the table.).^3,4

• Portion size control : Serving larger portions may give children the impression they should eat more than they really need.^5,6

Insight: Children are naturally good at determining how much to eat, but it’s important to know they are influenced by those around them. Parents must choose what and when to eat but allow children to decide on the portion size. Children who “listen” to their own fullness cues stop eating when they are full and are less likely to become overweight and eat based on visual cues.⁵

Guideline: Help children realize when they’ve had enough. They should be taught to serve and eat by themselves, starting with portions and then taking subsequent helpings if they are still hungry. Parents must avoid lauding a child who has finished their meal and rather encourage them not to over eat when they feel full.⁶

• Encourage food diversity : Sometimes, in the interest of getting children to finish their meals, parents give in to their demands and make only what we know the child will eat. This encourages food biases.

Insight: Parents must encourage toddlers to share the same meals that are cooked for the family, instead of cooking separate meals for them.⁶

Guideline: If the child does not like a new food at the first instance, don’t be upset. Try again.  Recent studies found that repeatedly exposing children to a new food item, within a positive social environment, and from an early age was especially effective in increasing children’s willingness to try it.⁷

And, when a child sees their family members trying new foods – they are more likely to try it themselves – encouraging food diversity!

RIGHT PLAY

• Play every day : All work and no play makes Jack a dull boy – this adage has never been more true!

Insight: A child needs specific stimuli from the external environment for appropriate development of the brain’s neural networks. Outdoor play is especially critical in helping toddlers absorb Vitamin D, which plays a crucial role in bone growth as well as improving the child’s immune system.^8,9

Guideline: It is important that the child gets at least three hours of play every day, of which, at least an hour should include moderate to high intensity physical activity. ⁹

• Limit screen time : Several studies connect delayed development in kids with extended exposure to screens.^9,10

Insight: During early childhood, the brain develops rapidly and is particularly sensitive to the external environment. Parents can help their toddlers to power-off by creating screen-free zones and screen-free times.⁹

Guidelines: Unplug! Limit screen time for your toddlers, to not more than one hour per day.Power-off regularly to help a child understand boundaries between the real world and a virtual world.¹⁰

RIGHT NURTURE

• Practice what you preach : When parents demonstrate dislike towards certain vegetables or fruits, children observe and copy the same behavior.

Insight: When parents eat healthy foods that are high in micronutrients and fibers, children learn to relish these foods as well.⁶ An effective way of ensuring that toddlers get the right nutrition is to encourage healthy food choices from a young age, by practicing and displaying healthy eating habits as a family.

Guideline: Remember, parents are the first role models. Try new healthy food and positively describe the taste, texture, and smell to the toddler. ⁶

• Appreciate the power of ‘no’ : Parents think saying “no” will upset their child and make matters worse.

Insight: There’s a subtle difference between assertion and admonition, and children can understand it. It is advisable to avoid giving in to a child’s demands, use “no”’ when appropriate, and remember to praise and acknowledge the child’s good behavior.¹¹

Guideline: Show involvement when the child is well-behaved and demonstrate disinterest when the child is making unreasonable demands related to food, toys or even mobile devices. play objects. Children understand that parents pay attention to their outbursts, therefore as parents you need to time yourself as your give them rationale and firmly communicate a ‘no’.¹¹

• Deal with temper tantrums like a pro : Even at the age of two, they have a mind of their own!

Insight: Children keenly observe parents’ reactions to situations and often modify behavior to get what they want. It is advisable to minimize anger when enforcing rules and increasing positive interactions with the child. Parents must clearly define the desired or undesired behaviors of the child while establishing rules and limits and tracking consistency. Parents must provide appropriate rewards for success and consequences for inappropriate behavior.¹²

Guideline: Get involved, don’t dictate. Empower children to participate in small daily household activities, like laying the table, bringing their own plate to the table, and cleaning up. Help them understand open communication helps and tantrums don’t.

1. Choose the right rewards : Food should never be a reward.¹³ A child should not expect a chocolate or a dessert as an incentive to finish a healthy meal.

Insight: Reward a child with complete attention and kind words, not food. Incentivising a child with sweets gives an impression of sweets being better than other foods. This will affect the child’s ability to learn about healthy eating. Bad behavior can be deterred by rewarding good behavior and by creating certain boundaries for the children.^7,13

Guideline: A reward can be tailored depending on its benefit to the child. Consuming a new food can be rewarded with words of praise or a small gift, but not with another food. ^7,13

RIGHT IMPACT

1. Don’t go gaga over growth : It is not Olympics and children aren’t a scorecard for parenting skills.

Insight: The average growth of a child from the age of two till the growth spurt at puberty continues at a rate of approximately 6–8 cm per year, and 2 kg per year. However, every child has a unique pace of growth which may vary.

Guideline: Respect the pace at which the toddler is growing. Rely on established standards – like the World Health Organization growth charts for growth measurements. Talk to your pediatrician to understand if the child’s growth pace is adequate.¹⁴

1. Keep calm – call the specialist : Parents take it all upon themselves. Parenting is not a solo sport!

Insight: Parenting is an evolving science. People usually refer to strategies or ideas from their parents, books, internet, television, workshops, doctors, friends and family members. As a parent, one needs to find strategies and support that works best for the child. However, parents must look out for red flags in feeding, playing, sleeping patterns. Persistent outbursts, as well as other inappropriate behaviors might indicate the need for a comprehensive evaluation by either a pediatrician or a child psychologist.¹⁵

Guideline: Recognize red flags in a child’s behavior, attitude, and more than usual sick days. Do not hesitate to seek professional help.^16,11 Visitthe pediatrician regularly to understand growth and behavioral development of the child. 

References

* Mallnutrition is a term used by Indian pediatricians to address food consumption outside home.

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3. Kerzner B, Milano K, Maclean WC, et al. A practical approach to classifying and managing feeding difficulties. Pediatrics 2015; 135(2):344-353.
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12. Guiding children’s behavior [Internet]. Accessed [July 22, 2019]; downloaded from: https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/child-day-care/guiding_childrens_behaviour_april_2017.pdf
13. Perez-Escamilla R, Segura-Perez S, Lott M. Feeding guideline for infants and young toddlers: a responsive parenting approach [Internet]. Accessed [July 22, 2019]; downloaded from: https://healthyeatingresearch.org/wp-content/uploads/2017/02/her_feeding_guidelines_report_021416-1.pdf
14. Khadilkar VV, Khadilkar AV, Choudhary P, et al. IAP growth monitoring guideline for children from birth to 18 years. Indian Pediatrics 2007; 44: 187-97.
15. Positive discipline: A guide for parents. Accessed [July 22, 2019]; downloaded from: https://www.childrensmn.org/images/family_resource_pdf/027121.pdf
16. Ong C, Phuah KY, Salazar E, et al. Managing the ‘picky eater’ dilemma. Singapore Med J. 2014 Apr; 55(4): 184–190. Publicity : Carpediem Communique.