toys and play therapy for malnourished children

IMPORTANCE OF INTEGRATION OF TOYS AND PLAY THERAPY ALONG WITH NUTRITION IN HOSPITALIZED SEVERE ACUTE MALNOURISHED CHILDREN:

IMPORTANCE OF INTEGRATION OF TOYS AND PLAY THERAPY ALONG WITH NUTRITION IN HOSPITALIZED SEVERE ACUTE MALNOURISHED CHILDREN Dr. Pooja Talikoti And Molshree Rathore

WHAT IS SEVERE ACUTE MALNUTRITION?:

WHAT IS SEVERE ACUTE MALNUTRITION? Severe Acute Malnutrition (SAM) is defined by the presence of bilateral pitting edema or severe wasting. A child with SAM is highly vulnerable and has a high mortality risk.

The 3 children have the same age:

The 3 children have the same age Same weight Same height ?

Undernutrition and Child Mortality:

4 Undernutrition and Child Mortality 54% of child mortality is associated with underweight Severe wasting is an important cause of these deaths (it is difficult to estimate) Proportion associated with acute malnutrition often grows dramatically in emergency contexts Malnutrition 54% Caulfied, LE, M de Onis, M Blossner, and R Black, 2004

WHAT IS MALNUTRITION TREATMENT CENTRE ?:

WHAT IS MALNUTRITION TREATMENT CENTRE ? Malnutrition treatment centre’s have been established in all district hospitals and medical colleges under National Rural Health Mission/Health and Family Welfare (Government of Rajasthan). These centres cater to the severely malnourished children to provide adequate treatment to them. Standard protocol/guidelines developed by WHO is being used in the management of SAM children at these centres .

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SAM is a life treating condition requiring urgent treatment. Until, recently, the recommendation was to refer these children to hospital to review therapeutic diets along with medical care. The United Nations Millennium Development Goals (MDGs) are eight goals, that all 191 UN members states have agreed to try to achieve by the year 2015. One of the 8 goals is Reduce Child Mortality. (Goal 4 : Reduce by two thirds, between 1990 and 2015, the under five mortality).

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National Status : Malnutrition in children is widely prevalent in India. There is a need for standardized protocol based management to improve the outcome of severely malnourished children. In 2006, Indian Academy of Paediatrics undertook the task of developing guidelines for the management of severely malnourished children based on adaptation from the WHO guidelines.

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Malnutrition alone accounts for nearly half of the deaths occurring in the paediatric age group. As a matter of fact, the malnourished children are brought to the health centre only at a time where their condition becomes worse.

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Origin of the Research Problem To improve the quality of inpatient care and reduce child deaths, WHO has developed case management guidelines for severe malnutrition. Management of severe acute malnutrition according to Who guidelines reduce the case fatality rate by 55%.

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Early childhood malnutrition is associated with poor mental development. Psycho-social stimulation (eg-play)can benefit the development of such children. The malnourished children who received stimulation are happier, friendlier, more co-operative and more vocal.

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Malnutrition on its own is a problem. Malnutrition without mental stimulation is an even bigger problem. As children become malnourished they become less active and stop developing mentally as well as physically, and that loving care and playful interactions should form part of caring for SAM children.

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Giving toys to play with, boosts their mental development even if they suffer from malnutrition. SAM produced upto a 9 point improvement in the IQs , just with play.

OBJECTIVES OF THE STUDY (Broad Objectives):

OBJECTIVES OF THE STUDY (Broad Objectives) To incorporate low cost psychosocial stimulation (toys and play therapy) into the routine treatment of severe acute malnourished children admitted at Malnutrition Treatment Centres, Jaipur and To assess the impact of stimulation (along with nutrition) on the physical growth of severe acute malnourished children.

OBJECTIVES OF THE STUDY (Specific Objectives):

OBJECTIVES OF THE STUDY (Specific Objectives) To assess the growth and gross motor milestones of S.A.M children admitted at M.T.C, Jaipur, using the WHO child growth standards. To assess the knowledge of mothers/caretaker of S.A.M children admitted at M.T.C, regarding infant and young child feeding practices. To observe the child and note clinical signs of Kwashiorkor and Marasmus. To develop and pre-test the curriculum for play therapy for S.A.M children. To add psychosocial stimulation (toys and play therapy) to the routine treatment of S.A.M children at M.T.C. To provide continued stimulation to malnourished children after discharge (at home) and nutrition education to the mothers, and To assess the impact of psychosocial stimulation (along with nutrition) on physical growth of S.A.M children.

RELEVANCE OF THE STUDY:

RELEVANCE OF THE STUDY A malnourished child has reduced psychomotor activity eg. The child is less likely to crawl and engage in creative play. Thus the combination of malnutrition and lack of psychosocial stimulation are harmful. Improving both nutritional status and stimulation has an added impact of child development and recovery. Therefore nutritional and psychosocial intervention should be integrated. During rehabilitation phase, nutrition alone is not enough, along with nutrition sensory stimulation is a must.

METHODOLOGY :

METHODOLOGY Locale of the study and selection of the subjects The study was carried out in Kawatia hospital, Shastri Nagar, Jaipur. The present study was conducted for 6 months which accounts to a total of 96 children. The impact of play therapy was studied on 25 children , as their stay in the hospital was for more than 15 days.

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Curriculum for play therapy Each play session had : Language activities (words, smile, laugh, local songs). Motor activities (to perform next motor activity). Activities with toys (combination of toys as per the age of the child)

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Preparation of Toys A set of a toys was prepared as per the WHO guidelines. These toys were prepared out of the waste material like, plastic bottles, wooden pieces, thread rolls etc.

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Pretesting Sensitization of para-medical staff and mothers regarding the importance of play therapy for SAM. Demonstration and orientation of para-medical staff and mothers regarding the curriculum for play therapy. During the entire process of pre-testing, personal observations were done and interviews were conducted with para-medical staff and mothers of children.

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Assessment of physical growth of SAM children. The following references are used: Physical growth of the children will be assessed by measuring the child’s growth, using WHO child growth standards (April 2006). A brief note on WHO growth standards (April 2006) Assessment of body weight and height. Gross motor milestones Plotting on growth charts. Interpretation of growth charts.

Developmental Milestones:

Developmental Milestones

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Observation of clinical signs of kwashiorkor and marasmus.

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Assessment of mother’s knowledge. Oral questionnaire was prepared to assess mother’s knowledge regarding: Breast-feeding practices Child feeding in relation to type of food, amount and frequency. Micronutrients (Vitamin A, Iron, Iodine). Hygiene and sanitation Immunization Psychological stimulation Feeding during illness Growth monitoring and promotion

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Implementation Training of para-medical staff Orientation to mothers Daily play therapy for 15-30 minutes to children while at MTC. Ensuring correct therapeutic feeding and nutrition counselling to mothers.

Results :

Results Recommended Practice Step 9: To provide stimulation, play and loving care. The IAP guidelines states that, the children while at MTC should be given sensory stimulation through play therapy (toys).

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Prior to the introduction of Play therapy There was no play activity or organized play sessions at MTC. Children were left to be in bed without any stimulation. Even the mothers/caretakers used to sit idle, as they had no other work to do at MTC. Further, it was also observed, that such malnourished children had reduced psycho-motor activity i.e. reduced engagement in creative play. In such circumstances, these children are less demanding and become more apathetic, therefore, even the parents do not interact with children.

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Barriers for play therapy as perceived by the Nursing staff at MTC The nursing staff had no knowledge about the importance of play therapy for severely malnourished children. They were not aware that sensory stimulation (play therapy) is one of the management steps for treatment & management of Severe Acute Malnourished children while at MTC. Both nursing staff & mothers perceived that such Severe Acute Malnourished children, are dull and no one would like to play with such a child. Further, the nursing staff also expressed the lack of resources & educational material for children.

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Introduction of play therapy (Toys) The nursing staff at MTC and the mothers were explained about the need of play therapy. Severe Acute Malnourished Children become less active and this impairs their physical & mental development. Stimulating environment loving care and playful interaction can help to develop the child's psycho-motor and language skills which would further enhance the cognitive development of children. The play sessions were given for 10-15 minutes in the morning & evening by involving the mothers. The toys were cleaned prior to & after use by the children. The mothers, were also asked encourage to continue to play with the child as much as possible at home, by using safe house hold utensils.

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Response to play therapy (Toys) The toys were accepted by the Nursing staff and mothers. The children also enjoyed to play with toys. The nursing staff agreed to prepare such toys & implement at MTC.

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Globally, it is estimated that there are nearly 20 million children who are severe acute malnourished and malnutrition alone accounts for nearly half of the deaths occurring in the pediatric age group. As we all know children are the future of our nation, and we can never see our future end this way; therefore this study is an effort to save the children for a brighter tomorrow.

Healthy Baby Healthy Nation.:

Healthy Baby Healthy Nation.

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Thank You