Although children are not the face of the pandemic, it is not sparing them either. The COVID-19 pandemic will have a lifelong impact on children through indirect effects, including poor diet, impact on mental health, social isolation, closure of schools and healthcare. COVID-19 has diverse impact on nutrition with disrupted food supply and gaps in health and nutrition services. It has led to a double whammy of undernutrition and overnutrition in children.
This universal crisis has pushed additional 140 million children living in developing countries below the poverty line. Of the 132 million going hungry in 2020, 44 million were children. Additional 370 million have missed on nutritious meals due to closure of schools. On the other hand, there is rise in obesity with less physical activity, poor diets and disturbed schedules. A review on obesity in children and adolescents during COVID-19 pandemic notes increase in weight due to changes in dietary behaviours, increased food intake and unhealthy food choices.
WHO IS AT RISK?
COVID surge has led to a calamitous impact on children and a greater risk of violence cutting off the vital support. They are at a loss of access to essential health services, routine immunization and treatment for other diseases. For India, the crisis is even worse with high rates of malnutrition causing further impact on child nutrition and service delivery. COVID will have irrevocable impact on undernutrition, with rise in severe and moderately wasted children due to loss of income and inadequate access to nutrient-rich foods as a result of disruption of supply chain.
The Global Burden of Disease study estimates 11 million (1 in 5 deaths) deaths are globally associated with poor diet and dietary habits. Those below 18 years of age comprise about 8.5 per cent of coronavirus cases and fewer deaths globally. It is rare for children to get affected by COVID-19, with 1 in 1000 case probability. Research indicates less likelihood of children being affected due to presence of distinct immune system capable of producing many different antibodies specific to the virus. Children are the main reservoir for seasonal coronavirus causing common cold/flu, which likely renders immunity against SARS-CoV-2. Review indicates the role of maternal-derived immunity in lower infection and severity of COVID-19 among children.
Although lesser children are getting infected with the virus, some with underlying conditions—immunocompromised (malnourished children), diabetes, genetic disorders and obesity—can have severe illness. With the pandemic causing poor access to nutritious food, malnutrition and infection tend to co-exist. Even though children are not super-spreaders, but with emerging variants and adults vaccinated, children getting vaccinated could be beneficial to achieving herd immunity. With the onset of vaccine trials for under-12, it is important to focus on good nutrition for improved vaccine efficacy.
HOW TO BE FOOD-WISE
A balanced and healthy diet can ensure a robust immune system and lower incidence of chronic diseases and infections. It is important to ensure children receive a nutritious diet during the crisis. Infants up to 6 months should be exclusively breastfed. For children above 6 months, provide food from at least four food groups, including grains, pulses, fruits & vegetables, milk products, and nuts.
Evidence indicates the role of diets rich in Vitamins and trace elements (zinc, copper, selenium and iron) in strongly supporting the immune system and reducing the risk of infections. Avoids foods that contain high amounts of sugar, salt and fats that can increase the risk of overweight/obesity.
Physical activity and nutrition are known to boost the immune system. Foods rich in Vitamins C, D, and E improve the immune system by increasing the infection-fighting cells. The antioxidant in Vitamins C and E plays an important role in controlling infections and functioning of the immune system. Diets poor in micronutrients (iron, zinc, selenium, Vitamin A) can have negative effect on the immune system; whereas a diet rich in these can have a synergistic role in reducing infection risk. Inclusion of citrus fruits, yellow fruits and vegetables, green leafy vegetables (spinach), garlic, ginger, yogurt, almond, turmeric in child’s diet can help strengthen immunity to fight infections. Also keeping the body hydrated and getting adequate sleep (which helps increase muscle protein synthesis rates) can also help in curtailing the infection.
As rightly said by a Turkish scholar, “Your immune system is (the) best weapon against coronavirus.” Strengthening the immune system with adequate nutrition can help overcome the long-term effects of COVID-19 in children.