Why Children’s Diets Matter
The 1,000 days from the start of a woman’s pregnancy until her child’s second birthday offers a unique opportunity to shape not only a child’s future, but the future of a society. The right nutrition during this crucial period can have an enormous impact on a child’s ability to grow, learn and develop to his or her full potential. Poor infant and young child feeding is typically characterized by poor timing of complementary feeding (too early or too late); infrequent feeding; and poor feeding practices, hygiene, and child-care practices. Added to these is the poor dietary quality of the foods served, characterized as too little variety; inappropriate consistency (food is too thin or too thick); too few essential micronutrients. Globally, only about half (52%) of infants and young children are meeting the minimum meal frequency and less than one third (29%) are meeting the minimum dietary diversity, with large disparities across and within regions. Beyond the crucial 1,000-day period, diets of children of preschool (usually 24 to 59 months of age) and school-age (ﬁve to 12 years of age) remain critical for physical and cognitive development, educational outcomes and the establishment of healthy eating habits. Furthermore, recent evidence indicates that accelerated linear growth in childhood following stunting in infancy can occur (i.e. catch-up growth).
Despite the considerable progress made over the past decades, millions of children are still affected by acute and chronic malnutrition and many more suffer from some degree of sub-optimal health and/or development due to micronutrient deficiencies. Globally 159 million children are stunted and more than 2 billion people suffer from micronutrient deficiencies; specifically, 43% (range 38% to 47%) suffer from anaemia. Concurrently, childhood obesity affects approximately one-in-five children worldwide and child feeding practices are implicated in the aetiology of obesity.
With the ongoing nutrition transition, households are becoming more reliant on the food industry, food vendors and markets causing concerns for high intakes of sugar-containing beverages, unhealthy snack foods and highly processed foods. Furthermore, urbanization and increases in female labor market participation have increased the demand for non-parental childcare in many low and middle-income countries.
 Bhutta, Z. A., T. Ahmed, et al. (2008). “What works? Interventions for maternal and child undernutrition and survival.” Lancet 371(9610): 417-40.
 Alive and Thrive. Complementary Feeding. http://aliveandthrive.org/technical-focus/complementary-feeding/ (January 2018)
 Brown, K.H. The importance of dietary quality versus quantity for weanlings in less developed countries: a framework of discussion. Food Nutr Bull 1991, 13, 86–92.
 White, J.M.; Begin, F.; Kumapley, R.; Murray, C.; Krasevec, J. Complementary feeding practices: Current global and regional estimates. Matern Child Nutr 2017, 13 Suppl 2.
 Georgiadis, A. and M. E. Penny (2017). “Child undernutrition: opportunities beyond the first 1000 days.” Lancet Public Health 2(9): e399.
 Reference used in previous GAIN strategy.
 Stevens, G. A., M. M. Finucane, et al. (2003). “Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data.” Lancet Glob Health 1(1): e16-25.
 Ng, M.; Fleming, T.; Robinson, M.; Thomson, B.; Graetz, N.; Margono, C.; Mullany, E.C.; Biryukov, S.; Abbafati, C.; Abera, S.F., et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014, 384, 766-781.
 WHO, Globalization, Diets and Noncommunicable Diseases. 2002, WHO: Geneva.
 Michaelsen, K.F.; Grummer-Strawn, L.; Begin, F. Emerging issues in complementary feeding: Global aspects. Matern Child Nutr 2017, 13 Suppl 2.
GAIN’s Approach to Improving Children’s Diets
In close collaboration with governments, private sector and NGO’s, GAIN’s program aims to protect and promote optimal breastfeeding and adequate complementary feeding of infants and young children, as well as healthy diets for pre-schoolers and school-aged children to address all forms of malnutrition.
Despite numerous program actions, it has proven difficult to meet the nutrient adequacy of the diets of children required for optimal growth and development. Programme strategies to improve the diets of children have relied heavily on the use of nutrition education and behavior change communication (BCC) approaches, locally available foods and food systems, and/or supplementary foods and food fortification initiatives, with varying success. GAIN proposes to shift its emphasis from a single-commodity driven intervention towards developing new approaches to improve the diets of children. For the complementary feeding age, GAIN identifies four different pillars to improve the quality of the diet: (i) improve the nutritional quality and safety of foods consumed by children through fortification, reformulation, packaging and ensuring safety; (ii) applying emotion and motivation driven behavior change techniques; (iii) specialized foods that fill specific nutrient gaps; (iv) and improving the consumption of foods that are already known and liked but which consumption is limited because of access barriers.
Strategies to improve the quality of diets of children encompass a wide variety of interventions designed to improve not only the quality and quantity of these foods (the ‘what’), but also improve feeding behaviours (the ‘how’).
Improving the ‘what’:
- Food-based approached at the community or household level: Supporting household foods and dietary diversity can significantly contribute to adequate diet. GAIN aims to strengthen the enabling environment to improve demand, availability and affordability of safe, nutritious family foods.,,
- Complementing the diet with specialized nutrient-dense foods of products: Children have high nutritional requirements and gaps typically remain for specific ‘problem nutrients’. GAIN aims to create demand and sustained use of existing locally accessible nutrient-dense foods (e.g. eggs, dairy products and dried meat), specialized complementary food preparations (e.g. enriched porridges) and products (e.g. micronutrient powders) by strengthening delivery channels which are both sustainable and scalable.
- Improving the quality of foods eaten outside the home: With the global nutrition transition and increased female labour market participation, households have become more reliant on the food industry, food vendors and markets. GAIN aims to utilize institutional meals (e.g. day-care centers and schools) as an entry point to improve overall diets.
Improving the ‘how’:
- Barriers and facilitators towards adequate IYC feeding practices are numerous, spanning from individual to system-level GAIN aims to develop innovative strategies to promote IYC feeding practices which are achievable, practical and sustainable
 Thompson, B.; Amoroso, L. Improving Diets and Nutrition – Food-based Approaches. Food and Agriculture Organization of the United Nations (FAO) and CAB International: Wallingford (UK) and Boston (USA), 2014.
 Frongillo, E.A. Evaluation of programs to improve complementary feeding in infants and young children. Matern Child Nutr 2017, 13 Suppl 2.
 Amugsi, D.A., M.B. Mittelmark, and A. Oduro, Association between Maternal and Child Dietary Diversity: An Analysis of the Ghana Demographic and Health Survey. PLoS One, 2015. 10(8): p. e0136748.
 de Brauw, A., P. Eozenou, and M. Moursi, Programme Participation Intensity and Children’s Nutritional Status: Evidence from a Randomised Control Trial in Mozambique. The Journal of Development Studies, 2015. 51(8): p. 996–1015.
 Nguyen, P.H., et al., Maternal and child dietary diversity are associated in Bangladesh, Vietnam, and Ethiopia. J Nutr, 2013. 143(7): p. 1176-83.
 Osendarp, S.J., et al., Complementary Feeding Diets Made of Local Foods Can Be Optimized, but Additional Interventions Will Be Needed to Meet Iron and Zinc Requirements in 6- to 23-Month-Old Children in Low- and Middle-Income Countries. Food Nutr Bull, 2016. 37(4): p. 544-570.
 Bazzano, A.N., et al., Qualitative Studies of Infant and Young Child Feeding in Lower-Income Countries: A Systematic Review and Synthesis of Dietary Patterns. Nutrients, 2017. 9(10).
Implications for program portfolio
The GAIN portfolio of programs that aim to improve children’s diets includes, span from micronutrient powder supplementation innovations, to new approaches of BCC promotion. All programs have the overarching objective of stimulating markets and health systems to give more ownership to communities and entrepreneurs in the distribution and consumption of appropriate foods for children.
GAIN works in Bangladesh (MNP commercial model), India (production of complementary food), Indonesia (MNP and IYC BCC through the health system), Ethiopia (sales model of IYC products, development of a fortified yoghurt), Mozambique (Complementary feeding SBCC project), Nigeria (promoting animal sources protein for children under 5).