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CASE REPORT
Year : 2013  |  Volume : 3  |  Issue : 3  |  Page : 320-322

Bottle fed child with severe stunting: A case report on practice in Jenukuruba tribe from Southern India


1 Department of Community Medicine, JSS Medical College and Hospital, Karnataka, India
2 Department of Paediatrics, JSS Medical College and Hospital, Karnataka, India
3 Department of Food Science and Nutrition, University of Mysore, Mysore, Karnataka, India
4 Department of Anthropology, University of Mysore, Mysore, Karnataka, India

Date of Submission29-Nov-2012
Date of Acceptance19-Jan-2013
Date of Web Publication10-Jul-2013

Correspondence Address:
K Jagadish Kumar
Department of Pediatrics, JSS Medical College, A Constituent College of JSS University, Mysore - 570 015, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0738.114884

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   Abstract 

Bottle feeding, in vogue, was evidenced by a Jenukuruba tribal daily-wage working mother of 2-year-old male child who was bottle fed the baby from 2 nd day onward with poor bottle hygiene and using a rat bitten nipple. On examination, the child was found to be stunted. This observation calls for strengthening the national programs to educate the tribal community about feeding infants and young children and its implication on their overall health and nutritional status.

Keywords: Bottle feeding, Jenukuruba tribe, stunting


How to cite this article:
Manjunath R, Kumar K J, Begum K, Gangadhar M R. Bottle fed child with severe stunting: A case report on practice in Jenukuruba tribe from Southern India. Int J Nutr Pharmacol Neurol Dis 2013;3:320-2

How to cite this URL:
Manjunath R, Kumar K J, Begum K, Gangadhar M R. Bottle fed child with severe stunting: A case report on practice in Jenukuruba tribe from Southern India. Int J Nutr Pharmacol Neurol Dis [serial online] 2013 [cited 2020 Aug 14];3:320-2. Available from: http://www.ijnpnd.com/text.asp?2013/3/3/320/114884


   Introduction Top


Breast feeding for first 6 months of life followed by safe and adequate complementary feeding together with continuous breast feeding is recommended by World Health Organization (WHO). [1] WHO has stipulated that the feeding bottle with a nipple should not be used at any age, in order to achieve optimal growth, development, and health of infants. Despite this, bottle feeding to infants is still practiced across our country due to various socio-cultural reasons. [2],[3] Tribal families having less access to the correct health messages that are propagated through different sources, together with the tendency to mimic their urban counterparts, encounter high childhood morbidity and mortality. This case report is unique in the context of a child been started with only bottle feeding right from birth through infancy resulting in failure to start breast feeding by mother and leading to an underweight and a stunted child.


   Case Report Top


An illiterate daily wage Jenukuruba tribal woman from Hunsur taluk of Mysore District, Karnataka state, Southern India was interviewed about the infant feeding practices. It was revealed that the woman had a total of five conceptions and four of them died in neonatal period and in infancy. The fifth child was a male and the only child alive. At the time of investigation the child was 2-years old.

The present child was delivered at home, delivery was conducted by an untrained dai (traditional midwife). Soon after the delivery, parents consulted a local fortune teller who suggested not to breast feed the baby since her breast milk was the cause for deaths of earlier births. Therefore, the mother was not allowed to breastfeed by the family members. Customarily, in the first 2 days the newborn was given castor oil drops followed by diluted cow's milk using feeding bottle (purchased over the counter) from the nearby town. Bottle feeding continued till the day of our visit.

On close observation of the feeding bottle, it was found that rats had nibbled the nipple and there was no cap to cover it [Figure 1] along with poor bottle hygiene. However, the mother stated that for the past 3 months the child was also given milk in a cup and also through the feeding bottle. Clinical examination revealed that the child was underweight (weight-0.9 kg), i.e., weight/age was between 2 SD and 3 SD and severely stunted (height-77 cm), i.e., height/age was below 3 SD of the reference median as per WHO child growth standards, 2006 data. The child was pale, had angular stomatitis, mild edema, dyspigmented hair and features of pyoderma [Figure 2]. On examination of the mother it is found that she was chronically energy deficient (CED) with body mass index (BMI) of 14.3. However, it was good to note that the child was completely immunized as per universal immunisation programme schedule (UIP). The mother informed that the child was not receiving the supplementary food from the Anganwadi center. Incidentally, the haadi/settlement where the family resides has Anganwadi center which a km away from her place but the route gets waterlogged during monsoons making it difficult to reach the center.
Figure 1: Poor bottle hygiene with rat nibbled nipple and there was no cap to cover it

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Figure 2: Child showing dyspigmented hair, angular stomatitis and mild edema

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   Discussion Top


Developing countries alone account for 98% of the world's undernourished, and the prevalence of undernourishment in school children of Mangalore city was found to be 5.03%, in a study done by Kamath et al. [4] Bottle feeding practice is in vogue in various parts of our country both in urban and rural areas due to various socio-cultural factors. A community-based study from West Bengal among 647 children aged less than 2 years revealed 10.2% children were bottle fed. [3] A hospital-based study from Karachi, Pakistan showed the prevalence of bottle use in infants belonging to low income peri-urban community to be 68%. [5] Though in modern era, the present case study clearly shows the strong influence of social factors-religious belief, low literacy level, working mother, free access to buy feeding bottle complemented by absence of Anganwadi center (under Integrated Child Development Service Scheme) activities has influenced the family to continue to bottle feed, unaware of its consequences on nutritional status. Similarly higher prevalence of anemia in underweight children [6] and association of women's poor nutritional status (Chronic Energy Deficiency) with high risk of severe thinness, underweight and wasting in their children [7] calls for multipronged/integrated approach for mother and Child health. However, there is still a ray of hope as studies have reported positive impact of lactation counseling of mothers about correct feeding practices of infants and young children. [8] This can form a basis for educating mothers and care takers about the correct feeding practices and hazards of bottle feeding on child health specially belonging to families living in remote and in poor environmental conditions which can be an effective means to promote better feeding practices. It also calls for sensitization of health personnel about this issue through in-service training and the local community through peer counselors. [9],[10] This case study is a live demonstration that reaching the inaccessible should be a prioritized activity of the national programs in the interest of the tribal/rural upliftment. Effective teaching aids for behavior change should be developed and made available to those responsible for educating the tribal/rural masses.

To conclude, the haadi/settlement having no Anganwadi center, and most of the tribal women being daily-wage workers with no care takers of children, calls for concentrated efforts from both health and social welfare departments to reach these unreached.

 
   References Top

1.WHO: World Health Organization (Published 2006 updated 2008): The International code of marketing of breast-milk substitutes: A booklet of frequently asked questions Department of Nutrition for Health and Development . WHO- Geneva-Switzerland. http://www.who.int/nutrition/  Back to cited text no. 1
    
2.Lal V, Rai SK. The culture of bottle-feeding. Indian J Community Med 2009;34:247-8.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Sinhababu A, Mukhopadhyay DK, Panja TK, Saren AB, Mandal NK, Biswas AB. Infant- and young child-feeding practices in Bankura district, West Bengal, India. J Health Popul Nutr 2010;28:294-9.  Back to cited text no. 3
[PUBMED]    
4.Kamath R, Kumar M, Pattanshetty S, Kamath A. Nutritional status assessment of school children in Mangalore city using the multicenter growth reference study WHO 2007 scores. Int J Nutr Phamacol Neurol Dis 2012;2:233-6.  Back to cited text no. 4
    
5.Shamim S, Jamalvi SW, Naz F. Determinants of bottle use amongst economically disadvantaged mothers. J Ayub Med Coll Abbottabad 2006;18:48-51.  Back to cited text no. 5
[PUBMED]    
6.Sudhagandhi B, Sundaresan S, William WE, Prema A. Prevalence of anaemia in school children of Kattankulathur Tamil Nadu, India. Int J Nutr Pharmacol Neurol Dis 2011;1:184-8.  Back to cited text no. 6
  Medknow Journal  
7.Kulasekaran RA. Influence of mothers' chronic energy deficiency on the nutritional status of preschool children in Empowered Action Group states in India. Int J Nutr Pharmacol Neurol Dis 2012;2:198-209.  Back to cited text no. 7
  Medknow Journal  
8.Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Sisk PM, Lovelady CA, Dillard RG, Gruber KJ. Lactation counseling for mothers of very low birth weight infants: Effect on maternal anxiety and infant intake of human milk. Pediatrics 2006;117:67-75.  Back to cited text no. 8
    
9.Nankunda J, Tumwine JK, Soltvedt A, Semiyaga N, Ndeezi G, Tylleskär T. Community based peer counsellors for support of exclusive breastfeeding: Experiences from rural Uganda. Int Breastfeed J 2006;1:19.  Back to cited text no. 9
    
10.Kronborg H, Vaeth M, Olsen J, Iversen L, Harder I. Effect of early postnatal breastfeeding support: A cluster-randomized community based trial. Acta Paediatr 2007;96:1064-70.  Back to cited text no. 10
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

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