From before a child is born to about 5 years of age, their brains develop rapidly — much more rapidly than at any other time in life. Like little sponges, they soak up information about the world around them, cognitively creating the building blocks they need for healthy emotional, physical and social development. Proper nutrition is critical to ensure the brain has all it needs to develop, unimpeded by roadblocks. If children do not receive proper nutrition in this most critical stage of growth, the effects can be grave — and in many cases, irreversible. Children may become stunted or underdeveloped for life — affecting their ability to perform well in school, reach key developmental milestones or bond relationally with others. They are unable to reach their full, thriving potential. Malnutrition affects nearly 250 million children worldwide and malnutrition and hunger-related diseases are the biggest killer of children under age 5 in the developing world (UNICEF, 2016).
The children Holt serves globally are among those most at risk for malnutrition and hunger-related diseases, in particular orphaned or abandoned children living in care centers, many of whom have significant special needs.
Holt’s feeding specialists have traveled the world training caregivers in nutrition and feeding best practices — and sometimes, something as simple as a spoon can make all the difference.
Born with cerebral palsy and placed in an orphanage at 10 months old, Analyn had a small world — mostly consisting of the ceiling tiles above her crib in the Philippines. But then, an unexpected intervention changed everything.
When Holt’s child nutrition program team did a training at Vathsalya Charitable Trust (VCT), one of Holt’s longest-standing partner agencies in India, *Saleem’s life and health dramatically changed for the better.
When Holt's nutrition program team traveled to India in spring 2015, they came back with reports of children whose lives and health had been transformed due to nutritional intervention. These three boys may not have survived without the critical nutritional intervention they received from the program.
Before Holt's child nutrition program team came to his care center in China, Jin could not walk or support himself, and he had constant upper respiratory infections. But after his caregivers learned safe feeding techniques, everything changed for Jin.
Holt leads multiple-day, in-person training sessions with on-the-ground staff and caregivers at our overseas programs. Holt equips our partners with nutrition and feeding manuals, translated into their local language by Holt, and furnishes all necessary equipment to ensure our partners are prepared to accurately assess, monitor and create action plans for children in their care or programs.
Once trained, the first action of our partner staff is to assess the baseline nutrition, health, height and weight of each child in their programs. To track and monitor individual child progress over time, they then record these findings utilizing the same methodologies from care center to care center and country to country.
Often, care centers lack some basic tools needed to accurately track a child's growth and overall health. Holt provides a package of child measurement and growth monitoring tools and a hemoglobin testing machine to monitor children for iron-deficiency anemia — a condition that is detrimental to healthy brain development.
Many children require supplements to ensure they receive adequate amounts of vitamins and minerals such as iron. Holt's child nutrition program shows our partner staff how to properly prescribe supplements and make nutritional interventions. Some children simply need more nutrition-rich formulas or snacks, and care centers may need to introduce a more diverse array of meal options or adjust menus. Even minor changes like these are critical to meeting children's individual nutrition needs.
Once caregivers are trained on proper nutrition and feeding methods, and on-the-ground staff have recorded a baseline nutrition screening for every child, medical staff begin to regularly monitor and track different aspects of children's growth and development — usually every one-to-three months depending on the child's age, needs and overall health status. Holt provides the materials required and a standardized database to ensure children's health results are being properly recorded and analyzed over time.
When children enter Holt's child nutrition program, they start with child growth assessments and anemia screenings to evaluate their health and nutritional status. Utilizing nutrition screening system tools, we are able to quickly identify children who are malnourished or at risk for malnutrition. More than 18,500 baseline and follow-up screenings have now been conducted among more than 2,576 children at sites across China, Ethiopia, India, Mongolia, the Philippines and Vietnam.
Children who are stunted are not as tall for their age as they should be due to delayed growth — an indicator of chronic malnutrition. Stunting is associated with increased mortality rates, reduced cognitive ability, and poor school and job performance.
Wasting, or extreme thinness, evaluates weight relative to height and is the most accurate indicator of malnutrition because it's less likely to be affected by any disabilities a child may have. Wasting reflects severe weight loss due to acute malnutrition or severe illness.
A child who is underweight has a low body mass for their age, which is influenced by both the height of the child (height-for-age) and his or her weight (weight-for-height).
Although commonly caused by micronutrient deficiencies of iron, folate and B12, iron deficiency is the most common cause of anemia in children, which can significantly impact their cognitive development and ability to fight infection while causing other developmental delays and behavioral disturbances, such as decreased motor activity and problems with social interaction and attention to tasks.
At our partner care centers in India, China, Vietnam, Ethiopia, Mongolia and the Philippines, Holt's child nutrition program team has worked extensively with caregivers and staff — providing nutrition and feeding education to ensure every child receives the vital nutrients they need to thrive.
“The child nutrition program met a great need; weight and height changed dramatically after implementation.” — Caregiver in India
“The trainings are so eye-opening.” — Caregiver in India
"The children looked healthy, so we did not realize that many had iron deficiencies. Child nutrition program gave us the tools to understand. The children are healthier, so we have to give them medication less often. When there is less sickness, our jobs are easier.” – Mr. Chui, Director of Childcare at Changchun
“When the children would get sick, we would treat them with medication and antibiotics. Through the training, we learned that they need Vitamin C. Now we have the knowledge and confidence to prevent illnesses.” – Mrs. Li, Director of Childcare at Nanning
“The caregivers know which food should and should not go together in the child’s menu to promote the most nutrition absorption. They also know how to feed a child when he or she gets sick. “ – Nguyen Thi Huong, healthcare worker at Binh Duong Social Welfare Center
“The workplace is equipped with proper equipment to monitor child development and do health screenings. I also apply the knowledge that I used in my daily work, as the result, the children are given better care in both nutrition and health aspect.” — Nguyen Thanh Tuan, healthcare worker at Bien Hoa Center for Sponsorship and Vocational Training for Orphans
“I now have the skills to review a child’s malnutrition issue from different angles. After training I no longer feel equivocal when assessing and giving treatment for malnourished children.” — Nguyen Thanh Tuan, healthcare worker at Bien Hoa Center for Sponsorship and Vocational Training for Orphans
“We all feel blessed for being trained and equipped with the invaluable knowledge in best child care practice and the precious donation for this child nutrition program project. The needs of children living in out-of-home care are still huge in Vietnam. Holt Vietnam plans to step-by-step expand the given knowledge and skills to serve more children and to improve the quality of care for children in new orphanages or child care centers in the country. Our strategy is to include child nutrition program as one of our long-term service components in Vietnam. We are in need of support in the aspect fundraising to make this enthusiastic plan happen." — Hang Dam, Country Director, Holt Vietnam
Since 2013, Holt's child nutrition program has grown to serve hundreds of children at multiple sites, and continues to expand to more countries where Holt works.
The Holt International Child Nutrition Program was established in 2013. The program was initially launched in two locations in India. Within a year and a half, the program expanded to five new locations in China and Vietnam. As of 2019, with 49 sites and 35 care centers, over 11,000 children in China, Vietnam, Ethiopia, the Philippines, Mongolia and India are benefitting from Holt’s child nutrition program. Children in Uganda and Haiti also receive nutrition programming – even though these countries have not fully implemented the child nutrition program yet. With an increasing number of sites around the world, over 800 caregivers have been trained on health screening, nutrition, hygiene and feeding practices.
In 2015, Holt conducted a full analysis of all the child health data collected from these sites. The results showed dramatic improvements in all key indicators — including malnutrition risk, stunting, wasting, anemia and feeding issues — at every implementing site. Holt also hired an independent evaluator to do an outside review of program implementation, as well as its impact on children. The results were overwhelmingly positive. Children at all sites were reported to be noticeably less sick, less often; Holt considers this a qualitative success.
In 2017, Holt China scaled the child nutrition program to two additional sites and one partner in India conducted a program implementation training at two new locations. The CNP team conducted trainings at two sites in the Philippines and one site in Ethiopia. Caregivers and staff in both countries took the knowledge they gained during the training to educate additional caregivers and expand the program to new locations. Vietnam also expanded CNP to three new locations. Multiple sites in Haiti were also assessed. In India, staff at one of the trained sites adapted the curriculum and developed a new program to serve children and their parents — marking the CNP’s first expansion into family strengthening.
In 2018, caregivers at a new site in Mongolia were trained, and CNP started serving children in foster care in the Philippines. Nutrition interventions and resources were shared in all the countries where Holt works. A new manual focused on community nutrition and health was developed, and further exploration into adapting CNP for parent trainings was completed. Research on CNP implementation was presented at the Food and Nutrition Conference and Expo in Washington D.C.
In 2019, along with our team of feeding specialists, the Nutrition Program completed Holt’s Feeding and Positioning Manual: Guidelines for Working with Babies and Children. This manual was developed to support caregivers of infants and children by providing a comprehensive set of resources regarding safe feeding practices for all children, especially children with special needs. As the first of its kind, the feeding and positioning manual will be translated into multiple languages to reach a wider audience globally and to ensure caregivers have access to safe feeding resources.
In 2019, six countries will be implementing and replicating Holt’s child nutrition program through our robust network of partners, helping thousands of children develop the healthy roots they need for a lifetime of success.
In 2020, the CNP program will continue expanding its work in the six countries where we already have a presence, as well as expand to additional countries where Holt works.
The Holt International Feeding and Positioning manual is intended to support the caregivers of infants and children by providing information regarding safe feeding practices. Additionally, this manual provides:
Strong child development is the foundation of prosperous communities. When a caregiver supports the development of a child, he or she is contributing to the health of the entire community. Caregivers are vital to healthy, well-developed children. A well-developed child becomes a healthy, productive and independent adult. The work that caregivers do — the love and care that they provide — is powerful and essential for a child to thrive.
This manual is intended to be used by all caregivers within a child’s life. Some of the information in this manual may be of interest to other health care workers, family members of children and community members. Depending on the needs of the individual, some may benefit from reading an entire chapter or section, or some may find it useful to refer to only certain handouts, illustrations, charts or activities.