Making It to Five: A Nutritionist’s Perspective on a Significant Milestone

March 30th, 2016 | Viewpoint


It’s my turn. As a nutritionist who works internationally to improve global health, I knew my son turning five would be a big deal. Last week, when he reached his birthday, I had to reflect on the factors that contributed to this milestone.

Despite the current push to improve nutrition in the first “1,000 days” of life, the 24-month milestone just doesn’t seem as dramatic as “surviving to five.” I do remember, however, barely controlling myself at my son’s two-year check-up when the nurse measured his length instead of his height. Just for fun, I tricked her into measuring standing, so I could get the correct number.

For all the focus on preventing stunting before age two, “under five mortality” is always going to be an important indicator. Last year, nearly 5.9 million children didn’t make it to the five-year mark.  An average of 16,000 children died every day, largely of preventable causes. Forty-five percent of those children (3.1 million) died due to malnutrition-related causes. This includes fetal growth restriction, stunting, wasting, deficiencies of vitamin A and zinc, and suboptimal breastfeeding.

My work in nutrition helps me realize how fortunate my family has been when it comes to raising our child. I had my son later in life, so my body was certainly ready, and he was a big baby. While I was pregnant, I had access to the necessary macro and micronutrients. For the most part, I perform my job in an office; it doesn’t require the backbreaking, calorie-burning farm work that many women undertake around the world. He is certainly not wasted, though the pediatrician did give my husband and me the lecture many new parents seem to receive: “How can he have dropped so much weight so soon in his first three days? You need to do a better job!” My son is also lucky in that regard—I’ve heard hospital staff pressure other women, even mothers confident in their nutrition knowledge, to allow at least some formula feeding. But my husband fought them off and continued that support for as long as our son wanted to breastfeed.

Making it to five years old is very very big deal.
Making it to five years old is very very big deal.

As my son began complementary feeding (just shy of the recommended six-month mark), we worked with his grandmother to combine the best of her experience feeding 11 kids and the best of my learning from graduate school (don’t give them watery soup until after they’ve finished their “solid food”). We can afford to buy nutritious foods, and his grandparents grow an amazing array of micronutrient-rich foods for him to eat. Even better, there are minimal animal and insect pests in his environment. He also has toilets inside his home, clean water for drinking and handwashing, and four adults to remind him about good hygiene practices. He also benefits from a village of school staff, neighbors, and other friends and relatives who help keep him safe. Luckily, we bought my son an extra-long bed, because he’s going to need it, despite the fact that most of his father’s kin are stunted.

Most kids around the world are not so lucky. Most mothers don’t have access to nutritious food, the rest they need, nor support to breastfeed their children at home, much less at work. The JSI office where I sit has a lactation room on every floor! Most children do not live in homes with indoor plumbing, window screens, bednets, and good sanitation. Most are not exclusively breastfed, nor do they get enough nutritious complementary food starting at the recommended six months.

When we celebrated my son’s birthday with friends and family last weekend, we also remembered the millions of children who never reach this milestone. They make me want to speak out, like my friend Loria Kulathungam, a nutrition knowledge management guru, who encouraged me when she wrote a “made it to five” blog for her youngest son. So here’s a birthday wish for an end to child mortality linked to malnutrition and so many other causes—let’s hope that children everywhere get the chance to be healthy, well-nourished, and enjoy their fifth birthdays. There are many organizations and projects—including those operated by your own government—working hard to make this wish a reality.

How will you help children survive to five?

Written by Carrie Melgarejo

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