Correcting Nutritional Deficiencies in Children Below the Age of 36 Months

By Nachiket Mor

Given the strong links between nutritional levels in children below the age of 36 months and overall childhood development, there is a strong desire amongst the ICTPH and the SughaVazhvu staff to launch a nutrition-focussed intervention for this age group, living in the vicinity of the SughaVazhvu Rural Micro Health Centres (RMHCs) in Karambayam and Allakudi villages in the Thanjavur District of Tamil Nadu.  However, the following are several critical questions that need to be answered first:

1. What are the nutritional deficiencies in this age group? The hypothesis at this stage is that there is less an issue with calorie deficiency but there exist severe and almost universal deficiencies in micronutrients – particularly iron.  I understand though that this is not something that the Government of Tamil Nadu (and perhaps even the Government of India) is persuaded of, which is why the Integrated Child Development Scheme (ICDS) in Tamil Nadu does not include universal iron supplementation and the recommended guidelines and protocol require each child to be tested for anaemia before putting her on a supplementation regime.  Perhaps more empirical work is needed to ascertain the levels of anaemia amongst children of this age group.

2. What are the specific links and transmission paths between these deficiencies and the overall development of the child? For example, the current research shows that iron deficiency is associated with a number of adverse outcomes including, on average, a 13 point reduction in IQ levels.

3. For children below the age of 6 months (from conception to 6 months), the recommended guidelines are exclusive breastfeeding (post-birth to 6 months) and working with the iron levels of the mother from the pre-pregnancy stage to 6 months of age.  Is the standard Iron and Folic Acid (IFA) supplementation regime adequate for this?  What is the Government already doing about this and if the scheme is not working, what are the reasons for that? The hypothesis here is that there is very poor take-up amongst women on account of various perceived as well as real problems with following this regimen.  This would imply that alternate methods may need to be explored if iron supplementation is to be successful.

4. What are the various ways to address these nutritional gaps for children between 6 months to three years?  The hypothesis at this stage is that the significant gap to be addressed is in the area of iron deficiency and that a sprinkle-based universal food supplementation campaign needs to be launched aggressively and soon as time is of the essence.  Sprinkles appear to be an effective solution as they maintain the current dietary patterns of the child while merely adding more iron to the food intake in a manner that is easy for the child to ingest.  If this is done properly, what are the risks of possible adverse side effects amongst children – in terms of increased infection, increased diarrhoea, etc.?

5. If one does decide to pursue a sprinkle-based iron supplementation campaign for children between the ages of 6 months and 36 months, who would be the best partners to work with and what mechanisms should be used to ensure that this is a sustainable campaign and that we are able to find a “permanent” way to address this issue for the current cohort of children in this age group, as well as all subsequent cohorts? These logistical questions will be critical for ICTPH and SughaVazhvu staff to answer in planning this critical intervention strategy.

6. Food-based supplementation is the alternate route.  The hypothesis here is that fortified foods are not yet available to the population, at large, and more research is needed in this area.  Changes in dietary habits are also a possibility but our  current hypothesis is that (a) it would take a great deal of research to determine what the specific required changes would be and (b) for children below the age of 36 months it is simply impossible to supply an adequate amount of iron through non-fortified foods.

It is very important for us to get viable answers to these questions and we would be grateful for your detailed comments and guidance so that we may evolve a well-thought out action plan.

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6 Comments on "Correcting Nutritional Deficiencies in Children Below the Age of 36 Months"

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Nachiket Mor
6 years 8 months ago
“Iron Fortification Strategies for the Control of Childhood Anemia in Brazil”, a review article published by Lamounier et al (March 3rd, 2010) in the Journal of Tropical Pediatrics, finds that while a generalised fortification of foods such as wheat and corn flour are not as effective, if foods consumed by children such as milk, drinking water and biscuits are targetted a rapid reduction in iron deficiency anemia can be achieved. They for example, report on a 1992 study by Nogueira and Cozzolino which found that with the use of iron fortified biscuits within three months they were able to… Read more »
Shabana Tharkar and Lindsey Peugh
Shabana Tharkar and Lindsey Peugh
6 years 8 months ago
The desire to launch nutrition based interventions for the infants is very well appreciated. Incidentally I (along with Lindsey ) had been to all four ICDS centres at Karambayam just before reading the blog post and infact we were excited on seeing the post at the relevant time. We would like to share our thoughts briefly. However, many issues have to be explored and addressed for an effective implementation of the intervention program. I agree that iron deficiency anemia is the most common deficiency disorder among the target age group but it is also prevalent among women in the reproducing… Read more »
6 years 8 months ago


I opened this page with ernest eagerness to read but sorry to say that the black background with white letters has poor visibility in regular CRT monitors. Couls you please change the background colour.


6 years 8 months ago

Dear Girija,

Thanks for your feedback. We have now brightened the text on the blog to improve readability.

Hope you find the articles easier to read now. Do continue following the ICTPH Blog.


Senthil Kumar
6 years 5 days ago
The questions that are raised by Nachiket need to be analyzed in food & agriculture sector perspective. I too noticed that iron deficiency is one of the common deficiencies for children in the pilot region. In this context, I put some of my thoughts that are coming out from ICAAP (IKP Centre for Advancement in Agriculture Practice), Subsidiary of IKP Trust in partnering with International Food Policy Research Institute (IFPRI) 1. Child care development is governed by women and they need to be educated through awareness creation on dietary plan with inclusive of iron and Vitamin C based foods i.e.… Read more »
Rajiv Bhole
4 years 9 months ago
Hi Nachiket, I just heard about the good work you’re doing, and thought maybe you can use the information that my research on healthcare has reveled to me. 1) The main nutritional deficiency we suffer from is the amino acid deficiencies. 50% of the organic matter in the body is made up of proteins, which are nothing but chains of amino acids linked together. So if we don’t get any of the amino acids in adequate amounts our health is bound to suffer. And children have high requirements of certain amin acids, like the growth hormone releasers, tryptophan and tyrosine.… Read more »
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