title: Feeding difficulties in disabled children leads to malnutrition: experience in an Indian slum.
abstract: The aim of the present study was to explore the nature, extent and probable causes of nutritional deficiencies among children with disabilities living in Dharavi, a slum in Mumbai, India. A cross-sectional study was conducted to investigate whether the nutritional status of children with disabilities, aged 2-6 years (n 141), was worse than that of non-disabled sibling controls (n 122) and neighbour controls (n 162). Data on food patterns, anthropometry, micronutrient status and feeding difficulties reported by parents were collected. The mean weight for age of the children with disabilities (-2.44 (SD 1.39) Z scores; n 120) was significantly lower (P<0.05) compared with the sibling (-1.70 (SD 1.20) Z scores; n 109) and neighbour (-1.83 (SD 1.290) Z scores; n 162) control groups. The children with disabilities had significantly lower (P<0.05) mean haemoglobin levels (92 (SD 23) g/l; n 134) compared with siblings (102 (SD 18) g/l; n 103) and neighbours (99 (SD 18) g/l; n 153). Relative risk (RR) analysis indicated that the disabled children with feeding difficulties were significantly more likely (P<0.05) to be malnourished, by the indicator of weight for age (RR 1.1; 95 % CI 1.08, 1.20) compared with the disabled children without a feeding difficulty. They were also significantly more likely to be malnourished using the indicators of height for age (RR 1.3; 95 % CI 1.19, 1.43) and weight for height (RR 2.4; 95 % CI 1.78, 3.23) compared with the disabled children without a feeding difficulty. Feeding difficulties were identified as a risk factor for vulnerability to inadequate nutritional status among children with disabilities.
authors.affiliation: Centre for International Child Health, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK. A.Yousafzai@ich.ucl.ac.uk
authors.forename: Aisha K
authors.initials: AK
authors.lastname: Yousafzai
authors.forename: Suzanne
authors.initials: S
authors.lastname: Filteau
authors.forename: Sheila
authors.initials: S
authors.lastname: Wirz
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis; D000886:Anthropometry; D002648:Child; D015362:Child Nutrition Disorders / Q000209:etiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019988:Children with Disabilities; D005247:Feeding Behavior; D005248:Feeding Methods / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000097:blood; D009752:Nutritional Status; D018570:Risk Assessment; D012307:Risk Factors; D012923:Social Class
chemical_list: D000209:Acute-Phase Proteins; D018977:Micronutrients