In this presentation, i have discussed the normal growth in children. the focus of attention must be an infant as it is the time of maximum growth and chances of growth faltering are also high. if one has to reduce underfive mortality and promote child survival than aBIGWIN APPROACH is to be followed. i have also shared few success stories of low birth weight babies attaining the target at one year of age.causes of malnutrition are also discussed and what type of opportunities are there for public health professional in the community settings.focus from under six has to be shifted to ist year of life

1. DR. HARIVANSH CHOPRA
MD.,DCH
PROFESSOR & EX. HOD,
COMMUNITY MEDICINE,
LLRM MEDICAL COLLEGE,
MEERUT

2. 2
KNOWLEDGE / EDUCATION IS
MADE SIMPLE BY EXPERIENCE

3. 3
DEFINED AS THE LEVEL OF GROWTH WHICH IS
(AND CAN BE) ATTAINED BY THE CHILD WHEN ITS
INNATE GENETIC POTENTIAL FOR GROWTH FINDS
FULL EXPRESSION – IN A SITUATION WHEREIN
DIETARY AND ENVIRONMENTAL CONSTRAINS ON
GROWTH ARE ELIMINATED.
NORMAL GROWTH

4. 21-11-2020 4DR HARIVANSH CHOPRA

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7. 7
Anthropometry
Growth in Childhood
Growth Velocity is maximum
in the first year of life.
Even in the first year Growth
Velocity is maximum in first 4
months.
Growth velocity

8. 8
Anthropometry
Weight Gain in Childhood
From 7 – 12 yearsFrom 1 to 6 years
(Age in years X 2) + 8 (Age in years X 7) – 5/2

9. 9
Anthropometry
Gain in Height / Length
During 2 -
12 years
At 2 YearsAt 1 YearAt Birth
50 cm 75 cm 87 cm (Age in years * 6) +
77

10. 10
Anthropometry
Head Circumference
At 2 YearsAt 12 MonthsAt 3 MonthsAt Birth
34 cm 40 cm 47 cm 49 cm

11. 11
Success Story
At 1 Year
& 10 Months
At 10 Months
At 6 Months
At Birth
1.9 kg
6.8 kg
8.6 kg
11.5 kg

12. 12
Success Story
At 14 Years
At 2 Years
At 8 Months
At 2 Months
11 kg
48 kg
Birth Weight – 1.6 & 1.7 KG
3.5 kg
7.8 kg

13. 13
Birth Weight - 900 GM
Won bronze medal in Malaysia in junior badminton
Weight @ 1 Yr
9 Kg

14. 14
Birth Weight - 900 GM
NOW 15 YRS
56 KG
5 feet 4 inches

15. 15
Another Twins
BIRTH WT.
1.6 AND 1.7 KG
NOW 3 YRS
13KG

16. PREVENT
MALNUTRITION
PROMOTE
CHILD
SURVIVAL
21-11-2020 DR HARIVANSH CHOPRA 16

17. 17
Causes of Malnutrition
Inadequate
Food Security
Infection Low weight of
adolescent
girls

18. 18
Causes of Malnutrition
Low
Immunization
Coverage
Maternal &
Childhood
Anemia
Low
Literacy
Level in
Females

19. 19
9Lack of knowledge
regarding normal
growth of children
Causes of Malnutrition
8
Low birth weight
7
Poor sanitary
conditions

20. 20
12
Inaccessible and
Inadequate
health services
Causes of Malnutrition
11
Incorrect child
rearing practices
10
Poor hygiene

21. 21
Causes of Malnutrition
1413
Lack of political will
Lack of
Comprehensive Child
Health Care
Programme

22. 22

23. 23
Big problem
needs a Big
solution
If one wants to Win
the battle, the
effort has to be
intensive and
focused
So, it has to be a
BIG WIN against
MALNUTRITION
BIGWIN
approach is to
be applied
Malnutrition

24. Shift Strategy
A shift in strategy is the need of
the hour. Infants must be made
the focus of attention for mothers
as
NEITHER a mother would like to
deliver a low-birth weight baby
NOR any mother would like
to have a malnourished child

25. 25
The Approach
Exclusive Breast
Feeding for 6
months
Infection
Prevention/Treat
ment and
Immunization.
Growth
Promotion /
Monitoring
Appropriate
Weaning Practice
Safe Water
Iron
Supplementation
IB G W I N
Nutrition
education &
Extra-Nutrition in
pregnancy &
lactation, and
illness in child

26. Exclusive Breast Feeding
for 6 months
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27. Immunization
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Infection Prevention / Treatment
DR HARIVANSH CHOPRA

28. 21-11-2020 28
Growth Monitoring/ Promotion
DR HARIVANSH CHOPRA

29. Appropriate Weaning Practices
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Safe Water Hand Washing
DR HARIVANSH CHOPRA

30. 21-11-2020 30
Iron Supplementation
DR HARIVANSH CHOPRA

31. Nutrition Education
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Extra-Nutrition in
pregnancy &
lactation,
and illness in child.
DR HARIVANSH CHOPRA

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No to next
pregnancy
No to home
delivery
No to teenage
marriage
DR HARIVANSH CHOPRA

33. 33
The Approach
Exclusive Breast
Feeding for 6
months
Infection
Prevention/Treat
ment and
Immunization.
Growth
Promotion /
Monitoring
Appropriate
Weaning Practice
Safe Water
Iron
Supplementation
IB G W I N
Nutrition
education &
Extra-Nutrition in
pregnancy &
lactation, and
illness in child

34. 34
BIG-WIN Status across 4 NFHS
NHFS 1
(under 3)
NHFS 2
(under 3)
NHFS 3
(under 5)
NHFS 4
(under 5)
Exclusive Breast
Feeding
46.0 %
(Up-to 4
months)
55 %
(Up-to 4
months)
46.4 %
(Up-to 6
months)
54.9 %
(Up-to 6
months)
Infection – ARI
6.5 % 19.2 % 5.8 % 2.7 %
Infection -
Diarrhea
10.0 % 19.3 % 9.0 % 9.2 %
Growth
Monitoring
(weight
recordings under
ICDS)
--- --- 11.3 % 43.3 %

35. 35
BIG-WIN Status across 4 NFHS
NHFS 1
(under 3)
NHFS 2
(under 3)
NHFS 3
(under 5)
NHFS 4
(under 5)
Nutrition
Weight
for Age
53.4 % 47.0% 42.5 % 35.7 %
Height
for Age
52.0 % 45.5 % 48.0 % 38.4 %
Weight
for
Height
17.5 % 15.5 % 19.8 % 21.0 %
Anaemia --- 74.3 % 69.4 % 58.5 %
Immunization 35.4 % 42.0 % 43.5 % 62.0 %

36. Nutritional status of under-five
children in relation to living index
0
10
20
30
40
50
60
UNDER WT STUNTED WASTED
20.1
22.2
17.9
33.2
36.4
20.2
48.6
51.4
24.2
Percentage
HIGH
MEDIUM
LOW
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NFHS IV
DR HARIVANSH CHOPRA

37. 0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
NFHS 2 NFHS 3 NFHS 4
33.60%
38.70%
78.90%
INSTITUTIONAL DELIVERIES
NFHS 2 NFHS 3 NFHS 4
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38. 38
ANAEMIA &
MALNUTRITION
FREE UHTC/RHTC
AREAS
IRON
SUPPLEMENTATION
IMMUNIZATION
Child
Survival
BFCI
OPPORTUNITIES IN
PREVENTION/ACTION

39. FEW PUBLICATIONS
• Status of routine immunization in an urban area of Meerut
H Chopra, AK Singh, JV Singh, M Bhatnagar, SK Garg, SK Bajpai Indian Journal of Community Health 19 (1), 19-22
• Anemia in children: early iron supplementation
S Jain, H Chopra, SK Garg, M Bhatnagar, JV Singh The Indian Journal of Pediatrics 67 (1), 19-21
• Status of infant and young child feeding practices with special emphasis on breast feeding in an urban area of Meerut
P Singhal, SK Garg, H Chopra, S Jain, SK Bajpai, A Kumar IOSR Journal of Dental and Medical Sciences 7 (4), 7-11
• Nutrition status of children (1-6 Years) in slums of Ghaziabad city
SK Garg, JV Singh, M Bhatnagar, H Chopra Indian Journal of Community Medicine 22 (2), 70
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40. FEW PUBLICATIONS
• Socio-demographic determinants of malnutrition among children of 1-6 years of age in rural Meerut
AK Singh, S Jain, M Bhatnagar, JV Singh, SK Garg, H Chopra, SK Bajpai Indian J Prev Soc Med 43 (3), 278-82
• Maternal Co-relates of Anaemia among Children Aged 1–3 Years of Age in a Rural Area of Meerut
T Bano, A Agarwal, SK Garg, H Chopra, S Jain, G Singh International Journal of Community Medicine and
Public Health 5 (8), 3532-6
• Impact of infant & young child feeding & caring practices on morbidity.
A Chaudhary, H Chopra, SK Garg, SK Bajpai, T Bano, S Kumar Indian Journal of Community Health 31 (3)
• Identifying Strategies For Universal Coverage Of Immunization
SK Garg, VN Mishra, H Chopra, RB Singh, M Bhatnagar, A Garg, ... Indian Journal of Community Medicine 13
(03), 127
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41. 21-11-2020 DR HARIVANSH CHOPRA 41
https://www.youtube.com/watch?v=p7QP5O0Q0Tc
LINK OF TALK ON YOU TUBE

42. THANK YOU
harichop@yahoo.comhttps://www.youtube.com/c/
HARIVANSHCHOPRA
https://t.me/joinchat/AiuLJB0eH-
itB0R5VclNtQ
https://www.facebook.com/
harivansh.chopra
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