Nutrition and access to food

This section looks at issues which affect the nutrition of orphans and other vulnerable children and their access to food. Other sections cover general issues of health and nutrition and details of access to health care. Key points about nutrition are:

1. Good nutrition is essential for the physical growth and development of children. It is also necessary for full development of their immune system, which defends the body against infections.
2. Certain groups of children are particularly vulnerable to nutrition problems. These include young children and children living with HIV/AIDS.
3. Children's need for good nutrition starts before they are born. Children and young people of different ages have different nutritional needs.
4. HIV is known to be transmitted from mother to child through breastfeeding.

Good nutrition is essential for the physical growth and development of children. It is also necessary for full development of their immune system. Certain groups of children are particularly vulnerable to nutrition problems. These include young children, orphaned children and children living with HIV/AIDS. Although some studies have shown no nutritional problems among orphans compared with non-orphaned children in the same community, many studies have shown that orphans are more likely to suffer stunting, wasting and reduced weight.

Children's need for good nutrition starts before they are born. Children and young people of different ages have different nutritional needs. Young children are particularly at risk of problems with nutrition. For this reason, many of the documents focus on the nutrition of children under the age of five years. These children can also be broken down into groups, 0-6 months, 6-11 months, 12-23 months and 24 months to 5 years. Issues to consider in the nutrition of children under the age of 5 include:

• The role of breastfeeding. It is well-known that breastfeeding is very good for children. It protects them against many diseases and greatly increases their chances of survival. However, breast milk can transmit HIV. Deciding on how to feed an infant can be very difficult for women because of HIV. This choice will depend on whether the woman knows if she is HIV positive and whether or not she can safely feed her baby in another way. Policy principles on infant feeding were agreed by leading UN agencies in 2002. Approaches to infant feeding form an important part of measures to prevent mother to child transmission (PMTCT) of HIV. However, there are other important ways to prevent mother to child transmission, including preventing HIV infection in women, preventing unintended pregnancy and providing long-term support to women.
• Other foods. Breast milk provides all the energy and nutrients a child needs for the first few months of life. Children need other foods apart from breast milk from the age of 3-6 months. There is some evidence that exclusive breastfeeding before that time reduces the risk of transmission of HIV from an HIV positive mother. UNICEF recommends that women who are known not to be HIV positive and those who do not know their HIV status should exclusively breastfeed for six months.
• Feeding practices can affect whether or not a child is well-nourished. A child should be provided with food they can digest on their own plate. Good hygiene is very important when preparing food for children. Particular care is needed to ensure that a child continues to receive nutrients when they are ill. Children need a range of nutrients including those which provide energy and a range of micronutrients. Important micronutrients include vitamin A, iron and vitamin C.
• Access to food. Many documents which talk about nutrition of children overlook a key problem. Many families do not have enough food throughout the year. They do not always have the right kinds of food. Ensuring children and families have enough food is important to ensure that orphans and other vulnerable children are well-nourished.

All Children and their Health and Nutrition

This section looks at issues which affect the health and nutrition of all orphans and other vulnerable children. This is distinct from issues affecting children living with HIV/AIDS. More details are available in other sections on nutrition and access to health care. Key points about health and nutrition are:

1. HIV/AIDS is having severe effects on the health and nutrition of children. In countries with severe HIV/AIDS epidemics, this is seen in increasing rates of under 5 mortality.
2. HIV/AIDS affects the health of children directly and indirectly.
3. It is possible to approach this issue by considering the rights that children have regarding health, and examining how these rights are abused in relation to HIV/AIDS.
4. Ways in which the effects of HIV/AIDS on the health of children can be reduced include effective HIV prevention; health education for children and caregivers; strengthening nutrition and food production; and improving access to health services. More details on these key points are available in the section on health and nutrition. A review of a large number of studies concluded that:

• Children born to HIV positive mothers are more likely than others to die before the age of 5
• Children whose mother has died recently have an increased chance of dying themselves
• There is no strong evidence of ill-health among orphans who survive their mother's death
• There is some evidence of greater nutritional deficiencies among orphaned children than among non-orphans
• provide 'safety nets' for vulnerable children.