CHAPTER TWO

REVIEW OF RELATED LITERATURE

2.1. Introduction

This study investigate on assessment of knowledge child Nutrition and weaning practice
among mothers of children with severe malnutrition in Tarauni Local Government Area Kano
[Link] Literature ware reviewed under the following sub -headings .

2.2 Overview of child Nutrition

2.3 Factors affecting child Nutrition

2.4 Overview of Weaning practice

2.5 Harmful weaning problem

2.6 Severe Malnutrition among Children

2.7 Health problems associated with child malnutrition and harmful weaning practice

2.8 Empirical studies on knowledge of child Nutrition and weaning practice among mothers of
children with severe malnutrition.

2.9 Summary

2.2 Overview of Child Nutrition

Child nutrition refers to the adequate intake of essential nutrients needed for the growth,
development, and health of children, particularly in the first five years of life. According to
UNICEF (2019), proper nutrition during early childhood is critical to reduce the risk of illness,
promote brain development, and prevent stunted growth.

Child nutrition is the practice of providing children with the right nutrients and foods at the right
times to support their growth, development, and overall health. This includes everything from
exclusive breastfeeding for the first six months of life to introducing complementary foods and
ensuring a balanced diet of fruits, vegetables, and other nutrient-dense foods as they grow.

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Proper nutrition during early childhood, especially in the first 1,000 days from conception to age
two, is crucial for long-term physical and mental health, and can reduce the risk of chronic
diseases later in life.(Abebe , 2016).

Child nutrition is a critical aspect of promoting healthy growth and development in children.
Ensuring that children receive a balanced diet rich in essential nutrients is vital for their physical
and cognitive development. PowerPoint presentations can serve as an effective medium to
educate parents, caregivers, and educators about the importance of child nutrition. These
presentations can cover various topics, including the nutritional needs of children at different
stages of development, the significance of vitamins and minerals, and the role of healthy eating
habits in preventing childhood obesity and related health issues .(Brown , 2010).

Child nutrition is vital for healthy growth, cognitive development, and disease prevention,
with the first 1,000 days (from conception to a child's second birthday) being a critical window
for establishing long-term health. Key aspects include exclusive breastfeeding for the first six
months, introducing diverse, nutrient-dense complementary foods from six months, and ensuring
a diet rich in complex carbohydrates, lean proteins, fruits, vegetables, and dairy. Limiting added
sugars, salt, and unhealthy fats is crucial, and maintaining good hygiene during food preparation
supports overall well-being. (Whitehead, 2017).

2.3 Factors Affecting Child Nutrition

Factors affecting child nutrition span individual, household, and community levels, including
access to food and clean water, household income and food security, parental education and
feeding practices, and the child's health, age, and gender. Infectious diseases and inadequate
sanitation can also hinder nutrient absorption, while broader global issues like food availability
impact child nutrition on a large scale.

1. Individual Factors

Child's health: Child health and nutrition have a reciprocal relationship: poor nutrition impairs
a child's health, while poor health, such as from infections, can worsen nutrition. Adequate
nutrition is crucial for a strong immune system, proper growth, and cognitive development, while
illnesses can cause appetite loss, poor nutrient absorption, and a diversion of nutrients away from

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growth, creating a cycle of poor health and malnutrition. Illnesses like diarrhea, measles, and
chronic diseases increase the risk of malnutrition by hindering nutrient absorption.(Brown et al,
2010).

Birth factors: Birth factors affecting child nutrition include birth weight, birth spacing, and
birth order, which can influence a child's health and nutritional status throughout their early life.
For example, low birth weight is a significant risk factor for stunting and underweight, while
short birth intervals can lead to poor maternal nutritional reserves, affecting subsequent child
health. Birth order can also play a role, as later-born children may receive fewer resources
compared to their older siblings. Low birth weight and being born to a young mother are
significant risk factors for poor nutritional outcomes. (Brown ,2010).

Age and gender: Age and gender significantly affect child nutrition by influencing physiological
needs and social/cultural factors like food allocation and dietary habits. Age-related needs
change dramatically, from infants requiring specific fats and iron to adolescents needing higher
calories and nutrients for rapid growth. Gender impacts nutrition through factors like intra-
household food distribution, maternal health during pregnancy, and differing dietary patterns and
lifestyle habits that can emerge between boys and girls. Younger children are more vulnerable to
malnutrition than older children. Gender can also play a role, though the specific impact varies
by context. (Brown, 2010).

Breastfeeding: Inadequate or lack of breastfeeding can negatively impact a child's nutritional

status. (Okeke, 2018).

2. Household Factors

Food security: Consistent access to sufficient, affordable, and nutritious food is crucial for a
child's [Link] other way food security it leads to a lack of sufficient, diverse, and nutritious
food, resulting in malnutrition, stunting, and poor health outcomes. Households that lack
consistent access to food often have lower dietary diversity, which directly impacts a child's
nutritional status, while chronic insecurity can also contribute to cognitive and developmental
problems. (Okeke et al, 2018).

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Household income: Household income is a significant factor affecting child nutrition because it
influences access to nutritious food, healthcare, and sanitary conditions. Low income limits
purchasing power for a balanced diet, leading to a higher risk of malnutrition, while higher
income is linked to better nutritional outcomes. Income level, source, and distribution within a
household can also affect how food and other resources are used to support a child's health and
development. Low income limits purchasing power and access to healthy food, contributing to
food insecurity and poor nutrition. (Okeke , 2018).

Parental education: Parental education is a significant factor in child nutrition, as higher levels
of education in both mothers and fathers are linked to better nutritional outcomes for children.
This connection is often explained by more educated parents having better knowledge about
health and nutrition, leading to healthier food choices, improved healthcare access, and greater
economic stability. While both parents' education is important, mothers' education is frequently
found to have a particularly strong influence, as research indicates their education is more crucial
for a child's well-being. Higher parental education, especially maternal education, correlates
with better nutritional knowledge and practices. (Eze , 2018).

Parental feeding practices: Parental feeding practices significantly affect child nutrition by
influencing eating behaviors and health outcomes, with positive practices like modeling healthy
eating and encouraging variety leading to better nutrition. Conversely, negative practices such as
excessive pressure to eat or overly strict restriction can be linked to adverse outcomes like
obesity. Factors like parental knowledge, socioeconomic status, and cultural norms also play a
role in shaping these feeding practices. Caregivers' knowledge of appropriate infant and child
feeding is essential for ensuring proper nutrition and establishing healthy eating habits. (Kimanii
et al, 2015).

Household infrastructure: Household infrastructure significantly affects child nutrition through

its impact on sanitation, water access, cooking methods, and food storage. Factors like clean
water, proper sanitation, and electricity for cooking can reduce infection and nutrient loss, while
improved storage allows for a more diverse diet. Conversely, poor household infrastructure like
unimproved water sources, open defecation facilities, and solid fuel stoves is linked to higher
rates of childhood malnutrition, stunting, and underweight. Poor sanitation, lack of access to

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clean water, and other poor infrastructure conditions at home increase the risk of infectious
diseases.(Kimani, 2015).

3. Community & Environmental Factors

Water, sanitation, and hygiene (WASH):Water, sanitation, and hygiene practices are
fundamental human rights and contribute significantly to the nutritional status of under-five
children. However, these practices are hampered by poor infrastructure and low socioeconomic
status of many households in low-income countries. Lack of access to clean water and proper
sanitation facilities increases the risk of diarrheal diseases, which impair nutrient absorption.
(Wenlock, 1980)

Access to healthcare: Access to health care is a significant factor affecting child nutrition by
providing crucial prenatal and postnatal support, disease prevention, and treatment for
malnutrition. Limited access to services can lead to higher rates of malnutrition due to factors
like inadequate care during pregnancy, poor treatment of childhood illnesses, and insufficient
access to nutritional supplements and guidance. Proximity to health facilities and access to
health services improve nutritional outcomes. (Wenlock, 1980)

Socioeconomic status: is a significant factor in child nutrition, as it impacts access to resources

like food, healthcare, and education. Lower SES is linked to higher rates of malnutrition,
including underweight and stunting, due to factors like food insecurity, limited access to
nutritious foods, and poor sanitation. Conversely, higher SES can lead to better nutritional
outcomes and a lower risk of chronic diseases later in life, although it is also linked to an
increased risk of childhood obesity in some contexts.A community's overall socioeconomic
status influences access to resources like healthy food and healthcare. (kimani ,2015).

Cultural and religious beliefs: Cultural and religious beliefs significantly affect child nutrition
through food taboos, specific dietary practices, and perceptions of malnutrition. These beliefs
can limit the intake of essential nutrients by restricting certain foods during critical life stages
like pregnancy, or by causing delayed medical treatment for malnourished [Link]
cultural norms and beliefs can shape food consumption patterns and dietary practices.
(Wenlock ,1980).

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2.4 Overview of Weaning Practice

Weaning practice is the process of switching an infant's diet from breast milk or formula to other
foods and fluids. In most cases, choosing when to wean is a personal decision. It might be
influenced by a return to work, the mother's or infant's health, or just a feeling that the time is
right. (Nemour, 2014).

Weaning an infant is a gradual process. The American Academy of Pediatrics (AAP)

recommends feeding infants only breast milk for the first 6 months after birth. After 6 months,
the AAP recommends a combination of solid foods and breast milk until the infant is at least 1
year [Link] Academy advises against giving cow's milk to children younger than 1 year old.
(Ben - Joseph, 2022).

You may have difficulty determining how much to feed your child and when to start introducing
solid foods. The general guidance below, as reported by the National Library of Medicine,
demonstrates the process of weaning for infants up to 6 months of age.4 You should speak with
your infant's health care provider before attempting to wean your infant to make sure that he or
she is ready for weaning and for complete guidance on weaning.(Elana et al ,2022).

Birth to 4 months of age By comparison, formula-fed infants may need to be fed about six to
eight times per day, with newborns consuming about 2 to 3 ounces per feeding. The number of
feedings will decrease as the infant gets older, similar to breastfeeding.(Ben- Joseph, 2022).

4 to 6 months of age

At 4 to 6 months of age, an infant needs to consume 28 to 45 ounces of breast milk or formula

per day and often is ready to start being introduced to solid food. Starting solid foods too soon
can be hazardous, so an infant should not be fed solid food until he or she is physically
[Link] solid feedings (1 or 2 tablespoons) of iron-fortified infant rice cereal mixed with
breast milk or formula, stirred to a thin consistency.(Mmbaga , 2015).

Weaning is the gradual process of introducing an infant to solid food while still breast feeding
till he/she can handle adult food physiologically. It is the process of gradual introduction of solid
food toban infant’s feeding schedule with the ultimate aim of replacing breast or bottle feeds

6
with adult diet . To support this, adequate and proper infant weaning practices adopted by
nursing mothers are very crucial to achieve stipulated growth .( Baye et al, 2016).

Weaning practices are all the activities carries out by nursing mothers during the process of
weaning. Нe practice involves what weaning practice means to the mothers, types of food
substances used, as well as food mixes utilized. Нere is no particular food substance or formula
to use. Нe approach di‫وٴ‬ers from country to country and from one community to another. Same
is guided by culture, individual beliefs, custom, attitudes, values, the types of local food
substances available, level of education, the stage of development, and technology the particular
community has attained.(Ehiemere, 2018).

Weaning is defined as the gradual replacement of breast milk with other sources of nutrition for
your baby. Weaning also involves some physical and emotional changes for you. As you
breastfeed or pump less often, your body will gradually adapt by producing less breast milk and
your baby will adapt by learning new ways of feeding.(Ehiemere,2018)

When should I wean? — Weaning may be initiated by you or your child, or it may be a shared
decision. Most children who "self-wean" do so between two and four years of age; it is
uncommon for a baby younger than 12 months to self-wean. The duration of the weaning process
varies from child to child. Some wean quickly, while others take months to completely wean.
(Brown,2010)

Weaning is the process of transitioning an infant from breastfeeding to solid foods or formula,
which is a significant developmental milestone. The American Academy of Pediatrics (AAP)
recommends exclusive breastfeeding for the first six months of life, followed by continued
breastfeeding alongside solid food until at least twelve months. Signs of readiness for solid foods
include the ability to hold the head up, showing interest in food, and the capability to move food
to the mouth without pushing it out with the tongue. The weaning process can be influenced by
various factors, including cultural beliefs, family dynamics, and personal preferences, and
typically occurs during phases of rapid child development.(Ben-Joseph et al, 2022)

Weaning is the gradual replacement of breastfeeding with other [Link] is the process by
which a baby slowly gets used to eating family or adult foods and relies less and less on breast
milk. Time of weaning It is a gradual process starting around the age of 6 months, because the

7
mother’s milk alone is not sufficient to sustain growth beyond 6 [Link] foods
During weaning, suitable foods rich in protein and other nutrients are given to the child. These
foods are called supplementary foods. These are usually cow’s milk, fruit juice, soft cooked
rice, dhal, vegetables and egg yolk. As far as possible, locally available foods should be used in
weaning the child. The weaning/ supplementary foods do not replace breastmilk, they
complement it. As the baby gets older it needs more food to grow and stay healthy. (Abebe et al,
206).

Weaning practice It is a gradual process through which an infant moves from total dependence
on milk to eating normal family meals. The most widely used definition is the process of
introducing semisolid food into the infant’s diet in addition to milk. Definitions of weaning vary
from country to country and include ‘the process of expanding the diet to include food and
drinks other than breast or infant formula,’ ‘cease to be suckled,’ or ‘complete
discontinuation of breast-feeding.’ As many of the foods initially introduced are not truly solid,
the German word ‘beiokost’ is sometimes used to refer to these foods as a group.(Macdonald
et al, 1993).

Weaning practice is include:-

1- Baby led weaning

2- Spoon feeding,

3-combination weaning

4vegetarian and vegan weaning.

1-Baby Led Weaning:-(BLW) is an approach to adding complementary foods to a baby's diet of

breast milk or formula. It facilitates oral motor development and strongly focuses on the family
meal, while maintaining eating as a positive, interactive experience. Baby-led weaning allows
babies to control their solid food consumption by "self-feeding" from the start of their experience
with food.(Brown, 2010).

Baby led weaning Over the past 15 years, the traditional, complementary feeding scheme, more
commonly referred to as ‘weaning,’ has undergone several changes leading to the generation

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of the alternative and more flexible BLW approach. The BLW differs from the classic approach
because infants are encouraged to feed themselves from the complementary feeding period.
During the BLW, parents select a range of foods to offer to their babies, who decide what to eat,
quantity, and feeding pace. The acquisition of four abilities has been suggested to indicate the
readiness of a child for the BLW the child can adequately sit upright without the need for
support; the child can coordinate his eyes and hands to observe, grasp, and bring food to his
mouth; the child can swallow solid foods; and once sitting at the table with the rest of the family,
the child shows interest in what other people are eating and actively ask to eat the same foods.
(Ehiemere, 1998)

Potential advantages of the BLW approach include a lower risk of obesity, as it may encourage
improved self‐regulation of energy, and better diet quality, as BLW may promote acceptance of a
broader range of foods due to early exposure to different tastes and textures from a wide variety
of foods. Nevertheless, the positive effect of BLW on the child's diet strictly depends on whether
the family eats healthy and suitable foods for the child's development. Indeed, if the family's diet
is inadequate, BLW exposes the child to the risk of excessive sodium intake, saturated fat, and
protein overload, with an increased risk of obesity in childhood and adolescence. Therefore,
when a family chooses this BLW, the pediatrician should remember the fundamental role of a
healthy diet for the whole family members. In addition, there are several concerns about
detrimental effects associated with BLW, such as the potential risk of iron deficiency, as the
most common first foods introduced with BLW, including fruit and vegetables, are naturally low
in iron. In contrast, the consistency of iron‐rich foods, such as meat, makes it difficult for babies
to self‐feed, the risk of choking, as infants have tiny airways, and the risk of failure to thrive, as
not all infants have the motor skills or motivation to feed themselves the amount of food they
need. (Dewey, 2001).

2- Spoon feeding:- Is best done by using small amounts of expressed milk or formula on a
sterile, shallow spoon, allowing the baby to control the process. Gently touch the spoon to the
baby's lower lip, let them lap or suck the milk, and always stop if they close their mouth or turn
their head away. It's a helpful technique to supplement breastfeeding or for when babies have
trouble latching, and it can be a way to avoid bottle preference (Brown, 2010).

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Spoon-feeding a baby involves actively and passively supporting the baby's learning to eat from
a spoon, encouraging them to take the food by letting them guide the spoon and clear it with their
own mouth. To begin, offer soft, easily digestible foods and let the baby control the pace by
bringing the spoon to them and allowing them to take it in. Provide a second spoon for them to
hold, let them get messy while they practice, and stop feeding if they show disinterest, as forcing
them can lead to aversion. spoon feeding which is a convenient, hygienic and non-invasive
technique providing weight gain and which does not remove the baby from breastfeeding can be
recommended as a supportive feeding method for preterm babies until they reach the maturation
level where they can meet their nutritional requirements by way of breastfeeding (Dowling ,
2001).

3- Combination Weaning:-Combination weaning is when parents combine two different

weaning methods: traditional spoon-feeding (starting with puréed foods) and baby-led weaning
(allowing the baby to feed themselves finger foods). This approach offers a mix of both, where
some meals might involve spoon-feeding purées while others offer soft finger foods for the baby
to pick up and explore.(Bassey et al , 2024).

Combination weaning is when you do a mixture of baby-led weaning and traditional weaning.
Some meals will use puree, others solid [Link] weaning at around 4 months
involves a mix of both baby-led weaning and traditional spoon-feeding, where some meals
feature purees given with a spoon and others are finger foods offered for the baby to self-feed.
This approach allows babies to explore a variety of textures and learn to use their hands, while
still providing the control and ease of spoon-feeding for other meals. (Imuwahen, 2024).

combination weaning schedule can involve alternating between breastfeeding and formula, or
offering solids before milk feeds. Start with one small meal of purees or soft, mashed foods once
a day, and offer milk feeds as usual. Gradually increase the variety and amount of solid foods,
moving to three meals and snacks, and place a greater emphasis on offering a variety of food
groups, as well as ensuring iron-rich foods are included. Combination feeding, also known as
‘combi feeding’ or ‘mixed feeding, is just one of the options available when deciding what
your particular feeding journey looks like. For many parents, combi feeding is the ideal way to
ensure that their baby still gets some of the benefits of breastfeeding, whilst allowing their
partner or other family members can be involved in the baby feeding routine.(Oche , 2018).

10
4- Vegetarian and Vegan Weaning:- Weaning a vegetarian or vegan baby involves introducing
solid foods around six months, similar to any baby, but with a focus on ensuring adequate iron,
vitamin B12, and other essential [Link] purees of fruits and vegetables, then
introduce other food groups and textures. It is important to offer a variety of iron-rich plant foods
like beans, lentils, and tofu, paired with vitamin C-rich foods to enhance absorption.(Foster et al ,
2014).

Consultation with a healthcare professional about potential supplements is also recommended.

Vegetarian and vegan weaning Over the last few years, vegetarian and vegan diets have become
more popular worldwide. Thus, it is not uncommon for a pediatrician to ask parents for
vegetarian‐ or vegan‐based weaning. Since vegetarian and vegan diets allow a limited variety of
foods, infants following alternative weaning methods may be exposed to clinical or sub‐clinical
nutritional deficiencies.(Suuman, 2014).

However, despite the concerns of many pediatricians, available data show that these types of
weaning are feasible and allow adequate growth, only if these diets are appropriately planned
and implemented to prevent nutritional deficiencies that are a real threat for infants and can lead
to neurological symptoms and brain atrophy. Indeed, infants following a vegan diet may suffer
from protein deficiency; thus, a rice protein‐based infant formula supplemented with lysine,
threonine, and tryptophan or soy‐based infant formula fortified with methionine is needed to
ensure an adequate protein intake. Vitamin B12 supplementation is necessary for vegans at any
age because it is almost exclusively present in products of animal origin, though it can also be
found in some algae or fungi with limited bioavailability. Vitamin B12 deficiency in infants may
be responsible for anemia and developmental delay, failure to thrive, and neurological
symptoms. Thus, it is essential to carefully monitor the values of vitamin B12, protein, vitamin
D, and iron, and, if possible, breastfeeding should be continued for all the first year of life.
(Foster, 2014).

2.5 Harmful Weaning Practice

Harmful weaning practice include introducing solids food too early, sudden or abrupt weaning,
given unsafe food like honey(under 12 month), adding salt or sugar to food and delayed
introduction of complementary food.(Sinkiss et al, 2014).

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1- Introducing Solid Food Too Early:-Introducing solid food before 6 months is harmful
because it increases the risk of diarrhea, poor growth, and illness due to an immature digestive
system and the potential replacement of breast milk or formula. Early introduction can also
interfere with the development of a healthy gut microbiome and is associated with a higher risk
of future chronic diseases like obesity, allergies, and celiac disease. (Sinkiss et al, 2014)

A baby's digestive system is not mature enough to handle solid foods, leading to a higher risk of
diarrhea, stomach upset, and other illnesses. Nutritional deficiencies: Solid foods can displace
nutrient-rich breast milk or formula, leading to a shortage of vital nutrients and potential iron
deficiency anemia. Decreased breast milk supply. If a baby breastfeeds less often because of
early solids, the mother's milk supply may decrease, which is harmful since breast milk is crucial
for the first six months of life. Chronic disease risk: Research links early introduction to a higher
risk of chronic diseases later in life, such as obesity, eczema, and celiac disease.(Semali et al,
2015).

While introducing allergenic foods between 6-9 months may reduce allergy risk, introducing
solids too early has been linked to an increased risk of developing allergies. Starting solids at 4
months, especially if the baby is not developmentally ready, can lead to an increased risk of
choking, digestive issues, and potentially lower intake of breast milk or formula. It may also
increase the risk of food allergies and can cause them to not get enough vital nutrients for proper
development. It's recommended to wait until babies are around 6 months old and show signs of
readiness, such as being able to sit up with support and having reduced tongue thrust.(Tengia,
2015).

2- Sudden or Abrupt Weaning:- Sudden weaning often referred to as abrupt or unexpected

weaning, implies the rapid cessation of breastfeeding. Sometimes, the weaning process occurs
hastily due to an unexpected situation or emergency. Additionally, it may stem from the mother's
deliberate decision to stop breastfeeding at a certain time. (Eze, 2018).

Overall, whether weaning is intentional or unavoidable, it can have a considerable impact on the
health of both mother and baby at that time. Stopping breastfeeding suddenly can increase an
infant's susceptibility to ear and respiratory infections. Sudden weaning in order to take a
medication comes with risks and difficulties for mother and baby. Sarah looks at the implications

12
of an early end to breastfeeding and explains that many medications are compatible with
breastfeeding.(Okeke et al , 2018).

When a mother is pressured to stop breastfeeding in order to take a medication, those doing the
pressuring often don’t understand the implications of weaning for mother and baby. A health
professional may not have much or any breastfeeding experience and may feel that breastfeeding
into toddlerhood is strange. They may see nursing as the baby’s food and not be aware of the
relationship. They may think that breastfeeding is a nice thing to do if all is well, but that it is
stressful if a mother is ill. (Calvert, 2014)

3-Given unsafe food like honey (under 12 month):-Occasionally, honey contains bacteria that
can produce toxins in a baby's intestines, leading to infant botulism, which is a very serious
illness. Do not give your child honey until they're over 1 year old. Honey is a sugar, so avoiding
it will also help prevent tooth [Link]'s a known hazard for infant botulism. Honey can contain
the spores of the bacteria Clostridium botulinum. (Hogeback et al, 2025).

The spores can germinate in a baby's immature digestive system and cause infant botulism.
Infant botulism is rather uncommon or even rare, but potentially [Link] problem with feeding
honey to babies stems from their developing microbiome—the array of microorganisms, such as
bacteria and archaea, that live inside and on humans and that assist in the regulation of diet and
affect many bodily functions. Clostridium botulinum is a potentially poisonous bacterium that, in
addition to causing the illness known as infant botulism, is often found in raw and processed
honey. 25% of honey products have been found to contain spores of that bacterium.(Hogeback,
2025).

4-Adding Salt or sugar to food:- Adding salt or sugar to a baby's food during weaning is a
harmful practice that should be avoided. Health organizations like the World Health
Organization (WHO) and the NHS strongly recommend against adding these ingredients to
infant food, as their developing bodies cannot process large amounts, and early exposure can
lead to long-term health problems. Babies' kidneys are still immature and cannot effectively filter
out excess sodium. (Grimes et al , 2011).

salt is a compound that all humans need in their diets, babies should not get too much of it
because their developing kidneys are not yet able to process large amounts of it. Giving your

13
baby too much salt over time may cause health problems, such as high blood pressure. In
extreme and rare cases, a baby that’s had a large amount of salt may even end up in the
emergency room.(Grimes,2011).

Too much salt during infancy and childhood may also promote a lifelong preference for salty
[Link] organizations and experts are in agreement that salt and sugar should be avoided
during the first two years of life and limited later on Sodium and sugar intake in childhood was
linked with many adverse seee health effects, including high blood pressure and cardiovascular
diseases ,obesity or dental caries. Another possible implication of early exposure to salt and
sugar refers to the development of preference for salty and sweet tastes. (Campbell, 2011).

It has been suggested that exposure to salty or sweet foods leads to an increase in acceptance and
preference of saltiness and sweetness, but results are equivocal .Moreover, adaptation to salty
and sweet tastes during childhood may be transferred into adulthood, leading to higher sodium
and free sugars intake throughout the lifespan. Studies reported that sodium and added sugar
intake increases with age by ~250 mg of salt/day per year from the age of 5 years and from 2.3%
of energy from added sugars in infancy to 13.4% in primary school pupils.(Campbell et al,
2011).

5- Delayed introduction of complementary food:-Delayed introduction of complementary

food is harmful because it can lead to malnutrition, stunted growth, and micronutrient
deficiencies. While it may seem protective in some poor sanitation environments, it risks missing
the infant's developmental window for learning to eat, potentially causing later feeding problems.
(Okeke et al , 2018).

The delayed start, often seen as a response to a fear of food contamination or allergies, can result
in the infant not receiving enough energy and nutrients, as breast milk alone becomes insufficient
around six months of age. Malnutrition and growth [Link] milk may not provide adequate
energy and nutrients for growth after six months, and a delayed introduction can lead to under-
nutrition, stunted growth, and lower height-for-age.(Eze , 2018).

Micronutrient deficiencies Delayed feeding can result in insufficient intake of key micronutrient
like iron, which are crucial for a baby's development. Increased risk of infection Delaying
complementary foods may increase the risk of infection, particularly diarrheal diseases, as the

14
infant's body isn't getting the nutrients and potential "training" from the food to build a stronger
immune system.(Okeke,2018).

Feeding difficulties Introducing foods later than nine months can lead to a greater incidence of
feeding problems, such as a dislike of fruits and vegetables and pickier eating habits later in life.
Developmental delays Delayed introduction can miss the optimal developmental window for
infants to learn to eat and tolerate different textures and tastes, which can make the transition
harder at a later age. Along with the dietary sources, the pattern of feeding and the time of solid
food introduction also matter. Early introduction of complementary foods can also be unhealthy
for infants. During weaning an infant, extreme caution should be used because delaying it can
cause issues like delayed growth, difficulty in feeding, malnutrition, and iron deficiency.(Dewey,
2001).

2.6 Severe Malnutrition Among Children

Severe malnutrition in children is a life-threatening condition characterized by very low weight

for height, edema, or a very low mid-upper arm circumference. It is a major cause of child
mortality and can be caused by a lack of proper nutrition, with contributing factors like poverty,
disease, and lack of access to healthcare. Treatment involves medical supervision and therapeutic
foods, while prevention focuses on improving maternal nutrition, exclusive breastfeeding, and
providing children with a nutritious diet. (Helen, 2005).

Severe Acute Malnutrition (SAM) is a life-threatening condition in children, defined by a very

low weight-for-height (wasting), edema of both feet, or a very low mid-upper arm circumference
(MUAC). It stems from inadequate intake of energy, protein, and other essential nutrients,
leading to compromised immunity and increased susceptibility to infections and metabolic
disturbances. Diagnosis is based on these key physical indicators, and treatment, guided by the
World Health Organization (WHO), involves ready-to-use therapeutic foods (RUTFs),
addressing medical complications like hypoglycemia, hypothermia, dehydration, and infections,
and providing crucial care and feeding education to caretakers. (Hellen et al , 2005).

Malnutrition is a violation of children’s rights, while good nutrition sets children on the path to
grow, develop, learn and reach their full potential. Despite significant progress over the past two

15
decades, the UNICEF, WHO, World Bank global and regional child malnutrition estimates
reveal that we are still far from a world without malnutrition.(Unicef 2013).

Measures of child malnutrition are used to track development progress. Estimates of child
malnutrition will help determine whether the world is on track to achieve the Sustainable
Development Goals – specifically, target 2.2, to “end all forms of malnutrition by 2030”,
which falls under goal 2 to “end hunger, achieve food security and improved nutrition, and
promote sustainable agriculture”.(Helen , 2006).

Causes

SAM arises from a combination of factors, often within resource-limited settings:

1- Insufficient Nutrition-: Undernutrition is a deficiency of nutrients. You may be

undernourished if you don’t have an adequate diet, or if your body has trouble absorbing
enough nutrients from your food. Undernutrition can cause visible wasting of fat and muscle, but
it can also be invisible. You can be overweight and [Link] of adequate energy
(calories), protein, vitamins, and minerals to meet the body's needs. (Ben- Joseph , 2022).

Macronutrients are the main building blocks of your diet, the nutrients that your body relies on
to produce energy to maintain itself. Without them — or even just one of them your body soon
begins to fall apart, breaking down tissues and shutting down nonessential functions to conserve
its low [Link] are vitamins and minerals. Your body needs these in smaller
amounts, but it does need them, for all types of functions. Many people are mildly deficient in
certain vitamins and minerals from a lack of variety in their diet. You might not notice a mild
vitamin deficiency affecting you, but as micronutrient under-nutrition becomes more severe, it
can begin to have serious and lasting effects.(Abebe, 2016).

2- Infections:- Infections cause severe malnutrition in children through a vicious cycle where
they reduce nutrient intake, impair absorption, cause nutrient loss, and divert nutrients to immune
responses. This leads to a weakened state that makes the child more susceptible to further
infections, creating a cycle of increasing malnutrition and illness. (Semali et al, 2015).

Reduced nutrient intake Illness can cause a loss of appetite, leading to less food being
[Link] nutrient absorption Infections, particularly gastrointestinal ones like

16
diarrhea, damage the intestinal lining, reducing the body's ability to absorb nutrients from
[Link] nutrient loss Illnesses like diarrhea lead to significant losses of essential nutrients,
such as protein, vitamin A, and zinc. Diversion of nutrients The body needs to use its nutrient
stores to fight the infection. This involves converting amino acids into proteins for the immune
response, diverting them from growth and repair. Increased metabolic demand The body's
metabolic rate increases during an infection to fight it off, requiring more energy and nutrients
than when the child is [Link] immune function. (Tengia et al, 2015).

Malnutrition weakens the immune system, making children more vulnerable to new or secondary
infections. This is often seen as a "vicious cycle" where malnutrition makes infections worse,
and infections make malnutrition [Link] infections long-term infections can lead to a
condition called cachexia, which involves the wasting away of lean tissue. Intestinal parasites
also contribute to anemia and nutrient deprivation. Common illnesses like diarrhea and malaria
can worsen nutritional status.(Leyna, 2015).

3- Socioeconomic Factors: Socioeconomic factors cause severe malnutrition in children through

limited income and poverty, which restricts access to nutritious food, healthcare, and clean
water. Factors like low maternal education, unemployment, and living in unstable or conflict-
affected environments create further disadvantages, leading to poor feeding practices and
inadequate [Link] and low income ,Limited financial resources make it difficult to afford
and access a variety of nutritious foods, leading to food insecurity.(Baye et al, 2016).

Unemployment household joblessness can lead to a lack of income, exacerbating poverty and
making it harder to provide for a child's nutritional needs. Lack of access to clean water and
sanitation Poor sanitation and lack of clean water increase the risk of disease, which can worsen
malnutrition by impairing the body's ability to absorb nutrients. Household instability Difficult
family conditions, such as unemployment, parental separation, or having many children, can
strain household resources and lead to less adequate care.(Haki, 2016).

4- Environmental Factors: Environmental factors cause severe malnutrition in children through

poor sanitation, lack of clean water, and exposure to disease, which lead to gastrointestinal
infections and poor nutrient absorption. Other factors include environmental pollutants,
contaminated food containing mycotoxins, and unhealthy housing conditions like dirt floors and

17
indoor air pollution from fuel use, all of which impede growth and health. Climate change can
also exacerbate these problems by affecting food availability and quality. Contaminated water:
Unsafe drinking water can lead to waterborne diseases like diarrhea, which prevent the body
from absorbing nutrients effectively.(Schaible et al, 2017).

5- Poor sanitation: A lack of proper latrines and waste disposal increases exposure to
pathogens, leading to a cycle of infection and malnutrition. Inadequate hygiene,poor
handwashing practices contribute to the spread of disease, particularly in households lacking
proper sanitation facilities. (Kaufmann, 2017)

Forms of Severe Malnutrition

1- Marasmus:-Marasmus is a severe form of malnutrition — specifically, protein-energy under-

nutrition. It results from an overall lack of calories. Marasmus is a deficiency of all
[Link], fats, and protein. If you have marasmus, you lack the fuel
necessary to maintain normal body functions.(Titi et al, 2021).

People with marasmus are visibly depleted, severely underweight and emaciated. Children may
be stunted in size and development. Prolonged marasmus leads to starvation. Marasmus is severe
under-nutrition — a deficiency in all the macronutrients that the body requires to function,
including carbohydrates, protein and fats. Marasmus causes visible wasting of fat and muscle
under the skin, giving bodies an emaciated appearance. It causes stunted growth in children.
(Gupta, 2021).

Marasmus can affect anyone who lacks overall nutrition, but it particularly affects children,
especially infants, who require more calories to support their growing bodies. It is more common
in developing countries with widespread poverty and food scarcity, and where parasites and
infectious diseases may contribute to calorie depletion. In the developed world, elderly people in
nursing homes and hospitals or who live alone with few resources are more at [Link] signs and
symptoms of the marasmus include Dry, brittle hair or hair loss,Sunken fontanelle in
infants,Lethargy, apathy and weakness and Weight loss of more than 40% etc (Titi, 2022).

2- Kwashiorkor: Kwashiorkor is one of the two main types of severe protein-energy under
nutrition. People with kwashiorkor are especially deficient in protein, as well as some key

18
micronutrient. Severe protein deficiency causes fluid retention in the tissues (edema), which
distinguishes kwashiorkor from other forms of malnutrition. People with kwashiorkor may look
emaciated in their limbs but swollen in their hands and feet, face and belly. The distended
abdomen typical of kwashiorkor can be misleading in people who are actually critically
malnourished. (Bassey,2024).

Kwashiorkor is a type of malnutrition characterized by severe protein deficiency. It causes fluid

retention and a swollen, distended abdomen. Kwashiorkor most commonly affects children,
particularly in developing countries with high levels of poverty and food insecurity. People with
kwashiorkor may have food to eat, but not enough [Link] and symptoms of kwashiorkor
include Edema (swelling with fluid, especially in the ankles and feet),bloated stomach with
ascites (a build-up of fluid in the abdominal cavity), brittle hair, hair loss and loss of pigment in
hair,dermatitis and enlarged liver etc (Imuwahen 2024).

2.7 Health Problems Associated witha Child Malnutrition nd Weaning Practice

Health problems associates to child malnutrition and weaning practice include

1 Stunted growth

2 Impaired cognitive development

3 Increase the risk of infectious diseases

4 Micronutrient deficiencies

5 Immune system weakness etc

1- Stunted Growth:-Stunted growth in children is a health problem caused by chronic

malnutrition, particularly during the critical first two years of life, with weaning practices being a
major factor. Inadequate complementary feeding, improper weaning times, and poor nutrition
during this period can lead to poor physical and cognitive development, with long-term
consequences for both the individual and the nation. (Imuwahen et al,2024).

Stunting this is the result of long-term nutritional deficits and is characterized by a child being
too short for their [Link] development chronic malnutrition and stunting can lead to delayed

19
brain development, which results in poor school performance and reduced intellectual capacity
later in [Link]-term consequences adults who experienced early childhood malnutrition may
have impaired intellectual performance and reduced physical work capacity.(Elana, 2022).

Stunted growth is the impaired and slow physical and/or mental growth of a child, often due to
long-term poor nutrition, repeated infections, or other health issues. It results in a child being
shorter than is normal for their age and can lead to irreversible physical and cognitive
consequences that affect their health, education, and economic future. The consequences extend
beyond poor physical growth to include impaired brain development, which can lead to long-
term deficits in intellectual performance and productivity. (Leyna ,2015).

Delayed introduction of complementary foods: Waiting too long after six months to introduce
solid foods can lead to nutritional deficiencies, as breast milk alone becomes insufficient to meet
the infant's needs for nutrients like [Link] complementary foodsProviding foods that
are not nutrient-dense or introducing them at the wrong age can cause problems. Lack of hygiene
early introduction of weaning can be dangerous in environments with poor sanitation due to the
risk of microbial [Link] knowledge lack of education among mothers about proper
weaning practices and the nutritional requirements of infants can result in poor feeding practices
and subsequent malnutrition. (Mmbaga, 2015).

Stunting is a process that can affect the development of a child from the early stages of
conception until the third or fourth year of life, when the nutrition of the mother and the child are
essential determinants of growth. Stunting is defined as the percentage of children whose height-
for-age is below minus two standard deviations for moderate and minus three standard deviations
for severe stunting from the median of the 2006 WHO Child Growth Standards . Similarly,
children are considered severely stunted if their length/height is below −3 SDs from the WHO
child growth standards median for the same age and sex.(Salloum, 2013).

Wasting is defined as the tendency to be too thin for one’s height, sometimes called weight-for-
height. While wasting is the result of acute significant food shortage and/or disease, stunting
represents chronic malnutrition, and the effects are largely irreversible. Underweight, or low
weight for age, includes children under 5 with low weight for height (wasting) and low height for
age (stunting) and considered a proxy indicator for under-nutrition if data on wasting is not

20
[Link] malnutrition in stunted children is associated with diminished levels of insulin-
like growth factor 1 (IGF-1) synthesis.(Semali , 2015).

Stunted children have impaired behavioral development in early life, are less likely to enroll at
school, enroll late, and tend to achieve lower grades. They have poorer cognitive ability than
non-stunted children. Furthermore, stunted children are more apathetic, display less exploratory
behavior and have altered physiological arousal. Malnourished children performed poor on tests
of attention, working memory, learning and memory and visuospatial ability except on the test of
motor speed and coordination. Age related improvement was not observed on tests of design
fluency, working memory, visual construction, learning and memory in malnourished children.
(Tengia, 2015).

2- Impaired cognitive development:- Malnutrition at age 3 years is associated with poor

cognition at age 11 years independent of psychosocial adversity. Promoting early childhood
nutrition could enhance long-term cognitive development and school performance, especially in
children with multiple nutritional [Link] of cognitive processes appeared to be
governed by both age and nutritional status. Malnourished children performed poor on tests of
attention, working memory, learning and memory and visuospatial ability except on the test of
motor speed and coordination. (Agawal,1992).

Age related improvement was not observed on tests of design fluency, working memory, visual
construction, learning and memory in malnourished children. However, age related improvement
was observed on tests of attention, visual perception, and verbal comprehension in malnourished
children even though the performance was deficient as compared to the performance level of
adequately nourished [Link] developing human brain requires all essential nutrients to
form and to maintain its structure. Infant and child cognitive development is dependent on
adequate nutrition.(Uphadhyaya et al, 1992).

The developing human brain requires all essential nutrients to form and to maintain its structure.
Infant and child cognitive development is dependent on adequate nutrition. Children who do not
receive sufficient nutrition are at high risk of exhibiting impaired cognitive skills. On the other
hand, B-vitamin, iodized salt, and guava powder interventions failed to display significant

21
results. The effects can include deficits in executive function and motor skills, and a higher risk
of behavioral problems and social disabilities. (Elana, 2022).

malnutrition has a significant impact, the outcome can be improved by high-quality subsequent
care, education, and psychosocial support, as seen in some studies where children who were
adopted or received interventions showed marked improvements. Malnutrition is associated with
poor school achievement, lower educational attainment, and a lower probability of achieving a
high level of education(Haki ,2016).

3- Increase the risk of infectious diseases:- Child malnutrition and improper weaning practices
significantly increase the risk of infectious diseases by weakening the immune system and
creating a vicious cycle where infections further worsen malnutrition. This heightened
susceptibility is caused by compromised immune function, leading to more severe, frequent, and
prolonged infections, particularly gastrointestinal and respiratory illnesses like diarrhea and
pneumonia.(Schaible, 2007).

Child malnutrition, compounded by poor weaning practices like the early or abrupt cessation of
breastfeeding and the introduction of contaminated complementary foods, increases the risk of
infectious diseases by weakening the immune system. This creates a vicious cycle where
malnutrition makes children more susceptible to infection, and infections then lead to further
nutrient loss and worsen malnutrition. Protein-calorie malnutrition impairs the immune system,
including immune cells and their ability to produce antibodies, making children more vulnerable
to [Link] weaning, introducing contaminated food from sources like unsafe water,
unclean hands, or unhygienic utensils can lead to gastrointestinal infections like diarrhea.
(Kaufmann ,2007).

Exclusive breastfeeding for the first six months provides essential nutrients and antibodies that
protect against infections, especially gastrointestinal ones. Early or abrupt weaning removes this
protective barrier, increasing infection [Link] makes a child more susceptible to
infection, and the infection itself increases the body's energy needs and decreases appetite,
leading to further nutrient loss and more severe malnutrition.A malnourished child is at a higher
risk for more severe disease, longer-lasting illness, and higher rates of hospitalization and death
from [Link] deficiencies, such as those in vitamins (like vitamin C, D, and E) and

22
minerals (like zinc and selenium), are essential for a healthy immune response. A lack of these
nutrients directly compromises the immune system. (Dowling , 2001).

Infections and the malnutrition associated with them are responsible for a significant proportion
of the 13 million deaths among infants and children under 5 years of age worldwide each year.
After respiratory infections, diarrheal diseases are the commonest illnesses and have the greatest
negative impact upon the growth of infants and young children.(Haki , 2016).

4- Micronutrient deficiencies:- Micronutrient deficiency refers to the inadequacies of essential

vitamins and minerals in human food, leading to health issues such as brain damage, anemia,
night blindness, and stunted growth. It is a global health concern, particularly affecting pregnant
women and children in developing nations.(Kirby et al , 2009).

Micronutrient deficiencies compromise immune systems, hinder child growth and development,
and affect human potential [Link] micronutrient deficiencies that are most commonly
associated with protein-energy malnutrition in children are discussed here. Deficiencies of fat-
soluble vitamins, iron, and zinc are particularly common, but deficiencies of other water-soluble
vitamins, minerals, and trace elements also may be found, varying with the region and chronicity
of the [Link] deficiency is a major problem affecting many people in
developing countries who solely depend on maize as their single source of calories. (Danner,
2009).

Vitamin A deficiency is one of the health problems associated with micronutrient deficiency. It
is caused by insufficient intake of food rich in vitamin A among vulnerable groups leading to
impaired growth, reduced life span, and economic losses among resource-poor families.
Strategies such as vitamin A supplementation, food fortification, and diet diversification have
been adapted to combat vitamin A deficiency (VAD).Deficiencies in these micronutrient are an
important global health issue. They can result in poor physical and mental development in
children, vulnerability or exacerbation of diseases, mental retardation, blindness, and general
losses in productivity and potential.(Jung, 2019).

5- Immune system weakness:- Childhood malnutrition affects innate and adaptive immune
functions, reducing the ability of the immune system to produce an appropriate immune response
against infections. Micronutrients are essential for the regulation of immune system function,

23
especially zinc and vitamin [Link] A is an essential micronutrient that maintains proper
physiological well-being. It is not synthesized in our bodies and, subsequently, it should come
from the [Link] A is associated with higher CD4 and Tβ4 concentrations in children aged
from 3 to 17 years old with sufficient vitamin A levels.(Brown, 2015).

The immune system relies on a balanced and adequate supply of nutrients, including amino
acids, to function optimally. For instance, arginine is important for the function of immune cells,
including T cells and macrophages; thus, its deficiency may cause impaired immune responses
and a decreased ability to combat infections, similar to lysine or tryptophan. In addition,
histidine, being a precursor to histamine, which is involved in inflammation and immune
responses, is important as a deficiency of this element may affect the body’s ability to mount an
appropriate inflammatory response to infections.(Danner et al ,2015).

Malnourished children have increased risk of dying, with most deaths caused by infectious
diseases. One mechanism behind this may be impaired immune [Link] most infections
and deaths in malnourished children occur in low-income settings, the organisms causing disease
are rarely identified. Therefore, little is known about whether these differ from pathogens
infecting well-nourished children, and whether malnourished children are susceptible to
opportunistic [Link] system in children with malnutrition shows that it impairs
various immune functions, leading to increased susceptibility to infections and mortality.
Malnutrition causes immune cell dysfunction, reduced gut barrier function, and atrophy of
lymphatic tissues like the thymus.(Carsetti et al. 2014).

2.8 Empirical Study on Knowledge on Child Nutrition and Weaning Practice Among
Mothers of Children With Severe Malnutrition

The review of the study is include the following ;-

Al-Gashanan (2021) in his reaserch study of knowledge, Attitude and Practice of Weaning
among Mothers in Najran Region, Saudi Arabia. The results find is that two - third of the
mothers has a knowledge and good attitude about good weaning practice and they use Baby Led
Weaning (BLW) .While the other mothers does not has knowledge of weaning practice and use
different method of Weaning practice.

24
 Ahumah, (2017) In his reseach study of Nutritional knowledge and practices of
mothers/caregivers and its impact on the nutritional status of children 6–59 months in Sefwi
Wiawso Municipality. The results find from the mothers is that 60% of mothers has a knowledge
on nutrition , 27% has a little knowledge about nutrition , the other mothers does not have
knowledge about child nutrition.

Akerele (2019) in her research work of Mother’s nutrition-related knowledge and child
nutrition outcomes..Find that 58% of children under five years of age in Nigeria are stunted (i.e.
too short for their age or with height for age <2), which represents about 9.7 million stunted
Nigerian children. Likewise, approximately 41.6% of under-five children are wasted ([Link] thin
for their height or with weight for height <2).

Sambu (2019) in his reaserch work of Parents,knowledge, attitude, and practice on nutrition
of child with severe acute malnutrition in Awi Zone public Hospitals, Northwest Ethiopia. The
results find that, the majority of parents were aware of the positive impact of child nutrition on
overall wellbeing. Only few are not aware of child nutrition on overall well-being.

Yirga, (2019) conducted a research on Nutritional knowledge and practices of mothers with
malnourished children in a regional hospital in Northeast Namibia. The results find is that two -
third (65%) of the mothers does not have knowledge about nutrition, while one - third (34%) has
knowledge about nutrition..There is high level of malnutrition among children due to lack of
nutritional knowledge.

Sachithananthan, (2012) conducted a research study on Mother’s Nutritional Knowledge

and Practice towards Children under Two Years of Age and Its Impact on Their Health in
Abuzaid Albuluk Pediatric Specialized Hospital. The results find is that 67% of the mothers has
a knowledge and good practice toward child nutrition where the other mothers has little
knowledge about child nutrition.

Yokok, (2023) did a research study on The effect of mothers’ nutritional education and
knowledge on children’s nutritional status. The results shows that 68% has an enough
nutritional knowledge, 27% of the mothers has a little knowledge about nutrition, while the
other mothers does not have good education and information about child nutrition.

25
Similarlly Tunyaro et al,. (2020) Conducted a research study on Feeding and weaning practice
among mothers of under five children in selected primary health care center in ado ekiti , ekiti
[Link] find that 72% of the women practice the same method of weaning (Baby Led
Weaning), about 22% use spoon feeding method, only few of the mothers use combination
method of weaning.

Rajesh, (2017) on research study of (Knowledge, attitude and practices regarding

complementary feeding among mothers of children 6 to 24 months of age in Konaseema region).
The results find is that one - third of the mothers has enough knowledge about complementary
feeding , more than 50% of the mothers has a little knowledge about complementary feeding,
while only few does not has knowledge about complementary feeding.

Ogunsuyu, (2015) did a research study on Assessment of Weaning Practices of Mothers of

Under-Five Children Attending Infant Welfare Clinic, Wesley Guild Hospital, Ilesa, Osun State.
The results find is that two-thirds (64%) practice the same method of weaning, while the other
mothers practice different method of weaning.

2.9 Summary

This chapter presented an extensive review of literature on child nutrition and the multiple
factors that influence nutritional among infant and [Link] review highlighted that child
nutrition is shape by a complex interplay of individual level determinants such as as the child
age, health status, feeding behaviour,and genetic factors. Household level determinants including
parental education,socio-economic status, household security,and care giving practice,as well as
broader community and environmental factors such as cultural feeding norms,access to health
services, sanitation conditions,and availability of nutritious [Link] Interconnected element
collectively determine the quality of a child's diet,the diversity of foods consumed,and the
adequacy of essential nutrients require for optimal growth and development.

This chapter also examine Weaning practice, identifying various approaches adopted by
caregivers. These includes baby led weaning,where infant self feed and regulate their food
intake. Spoon feeding which involves adult direct feeding. Combination weaning,which blend
self feeding and care giver feeding and vegetarian or vegan weaning which emphasizes plant
based complementary foods. While each method has its advantage ,the review emphasized that

26
the success of any approach depends on proper implementation, caregivers knowledge and the
provision of age appropriate, nutrients dense complementary foods.

Furthermore,the chapter discussed harmful weaning practice,which significantly undermine

children's nutritional [Link] include the early introduction of solid food,which may
disrupt breastfeeding and expose infant to digestive complications, sudden or abrupt cessation of
breastfeeding,which deprive the child of essential nutrients and immunogical protection,the
provision of unsafe foods such as honey to infant under 12 month,which poses a risk of infant
botulism; adding salt or sugar to infant food, which increase susceptibility to future diet related
disorders;and delayed introduction of complementary foods, which lead can lead to nutrients
deficiencies during critical growth [Link] inappropriate practice contribute to poor dietary
adequacy and increase vulnerability to illness.

Severe malnutrition among children was also reviewed,with particular attention to the two major
clinical forms : kwashiorkor, characterized by oedema,fatty liver,skin lesion,and hyper
albuminemia and marasmus , a severe wasting condition marked by significant loss of muscle
and fat due to prolonged inadequate energy intake . Both conditions have devastating
consequences on child growth, immunity and survival especially in low resource settings.

The chapter explore the health complications associates with harmful Weaning practice, nothing
that inadequate or inappropriate weaning can lead to Stunted growth, Impaired cognitive
development, increase the risk of susceptibility of infectious diseases, Micronutrient deficiencies
such as iron , vitamin A and zinc deficiency and weakening of the immune [Link] outcomes
have a long term implications on physical health,mental development, academic
performance,and overall quality of life.

Finally,the chapter incorporated empirical studies that support the theoretical discussion
presented. This studies provided evidence on the prevalence of of harmful weaning practice in
various populations,the socio-cultural factors influencing infant feeding behaviours ,and the
relationship between weaning methods, nutritional outcomes, and child health indicators. The
empirical review also highlighted gaps in care givers knowledge , health education and access to
nutritional resources, reinforcing the need for targeted interventions and improved health policies
to promote safe and appropriate infant feeding practice.

27
Overall the chapter established a story theoretical and empirical foundation of the study by
demonstrating the significance of appropriate weaning practice and Adequate child nutrition in
promoting healthy growth and development.

28
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