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DECE-2: Child Health and Nutrition

DECE-2: Child Health and Nutrition

IGNOU Solved Assignment Solution for 2022-23

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Assignment Code: DECE-2 /TMA/2022

Course Code: DECE-2

Assignment Name: Child Health and Nutrition

Year: 2022

Verification Status: Verified by Professor


All Three Sections  A, B and C of this assignment are compulsory.

Total Mark:  100



Answer all questions. 60 marks


Q1. Briefly explain each of the below mentioned in 150 words each (2x4=8 marks)


Q1. (a) Health-sickness spectrum

Ans) It would be inadequate and unsatisfactory to define health as the absence of sickness. For the past 400 years or so, diseases have been categorised based on the presence of certain lesions or "abnormal" signals obtained through diagnostic tools. Disease is a noun; illness is a similar but distinct concept. It is mostly used to describe the feeling of being ill, taking into account our understanding of disease but truly conveying a person's subjective experience. Only a person can tell you they are sick to their stomach or are in pain. These phenomena won't be revealed by instruments. Similar to this, health should be viewed as a phenomena or experience in and of itself. Undoubtedly, having a condition or illness will affect how you feel about your state of health, but is this truly a simple matter? In my opinion, no. As we suffer an acute illness, we can quickly enter the danger zone in terms of our general health. Consider the phenomenon known as "winter vomiting," which, as of this morning, has impacted one in every five persons in Scotland this winter. You start to feel sick all of a sudden, and then you start to throw up or have diarrhoea. Essentially, all you can do is wait it out while resting and refilling any lost fluids. Despite the fact that this condition is virus-related, there is no antiviral medication that can swiftly and efficiently eradicate it (and even if we did, killing the virus is only one part of becoming well). What aids?


Q1. (b) Balanced Diet

Ans) We just eat on a diet during the day. And a balanced diet is one that has the right amount of each vitamin we need each day. Six essential nutrients—fats, protein, carbohydrates, fibre, vitamins, and minerals—make up a balanced diet. A healthy lifestyle can be maintained with a balanced diet. A diet consists of including several essential nutrients that have an impact on a body's growth and development. By balancing nutrients, a balanced nutrition diet helps to sustain good health. This kind defines optimal health and growth and is absolutely essential for receiving the proper nutrients. Foods that support the body's natural functioning and those that aid in body equilibrium must be on your balanced diet plate. The proportions of protein, carbs, fats, vitamins, and minerals in a balanced diet are all in the proper range. The influence of a diet lacking a balanced diet on the human body will be discussed in length in this article.


Q1. (c) Importance of Breast Feeding

Ans) You're probably buried in information if you've been thinking about not breastfeeding your new-born. You alone can decide for yourself, yet the advantages seem limitless. Let's go over all the advantages for both you and the baby before you make a decision (or if you simply need confirmation that breastfeeding is the best option for you). For new-borns, breast milk is the best source of nutrients. It is readily available, quickly digested, and has the correct amount of nutrients. Everything a new-born requires in the appropriate amounts for the first six months of life is present in breast milk. In fact, it's made up of different ingredients depending on the baby's changing needs, especially in the first month of life. In fact, breastfeeding burns more calories. Compared to non-lactating mothers, you'll probably notice an increase in fat burning after three months of nursing, according to a reliable source. Although there isn't much of a difference. A kind of depression known as postpartum depression may appear soon after giving birth. According to a 2012 study Trusted Source, women who breastfeed appear to be less likely to have postpartum depression than mothers who wean their children too soon or choose not to breastfeed.


Q1. (d) Growth Monitoring

Ans) A child's size is routinely measured to track growth through growth monitoring. After then, a growth chart must be used to plot the child's size measurements. This is very significant since it can spot early growth changes in a youngster. Growing too slowly or too quickly could both point to a dietary or other health issue. As a result, growth monitoring is a crucial component of children's basic healthcare. A child's size measurement is only really useful for tracking their growth. During the first year, take the infant for monthly growth evaluations. Every month, a healthy youngster that is developing normally should gain weight. There is an issue if your youngster is not gaining weight or is losing weight. He or she needs to be brought to the closest medical facility right away for treatment. As a result, growth monitoring is a crucial component of children's basic healthcare. A child's size measurement is only really useful for tracking their growth. In order to provide children with primary healthcare, growth tracking is crucial.


Q2. Explain how the concept of health has changed over the years and describe its various dimensions. (500 words: 5 marks)

Ans) Health has traditionally been defined as the "absence of sickness." In other words, a person was seen as healthy if she did not have any diseases. The "germ theory of disease," which predominated medical thought from the end of the 19th century onward, served as the foundation for this idea, also known as the biomedical notion. The medical community viewed sickness as the result of the human body's mechanical breakdown, which was mostly brought on by microorganisms. Due to its disregard for the importance of environmental, social, cultural, and psychological factors of health, the biological notion of health has been deemed inadequate. This idea of health was shown to be insufficient to explain some of the most significant issues facing humanity, including chronic disease, drug abuse, mental illness, and undernutrition. Other concepts of health, such the ecological and psychosocial models, emerged as a result of shortcomings in the biological notion. According to the ecological notion, disease is a situation in which a person's environment has been poorly adjusted by them, whereas health is a state in which a person's environment has been harmoniously balanced. The psychosocial perspective of health is a result of the development of social sciences. This idea is founded on the idea that health is a social as well as a biological reality. Health is also influenced by psychological, sociocultural, and economic factors. The influence of societal customs and practises on people's health is significant. such as those pertaining to a pregnant or nursing woman's diet, raising a child, and intermarriage amongst relatives. The comprehensive view of health is the most widely accepted.


Physical Dimension

Physical well-being denotes a condition in which every cell and organ in the body is operating at its peak potential and in unison with the other parts of the body. It is a crucial element of good health. In fact, when we state that a person is healthy, we typically speak to this dimension in concrete terms. Physical health is quite simple to recognise and define.


Mental Dimension

A crucial aspect of overall health is mental health. It is essential for successfully navigating reality, oneself, and others. Only a mentally healthy individual is able to deal with her life's challenges in a way that makes her feel personally satisfied and contributes adequately to society's well-being.


Social Dimension

Health is more than just being physically and mentally healthy. A healthy person ought to fit in well with the community to which she belongs and ought to be able to contribute to that group's advancement. The ability to see oneself as a part of a broader community, the number and quality of one's interpersonal interactions with others, and the degree of one's involvement in the community are all part of the social component of health. She needs to fulfil her societal duties. These include responsibilities to one's family and community. She should also be able to relate to others, which means that she should be able to assist others and get along with them.


Q3. (a) What is the role of childcare worker in infant feeding? (300 words; 3 marks)

Ans) When parents and other family members are not available, a childcare worker takes care of the kids. They are in charge of ensuring the security of babies, young children, and toddlers. Additionally, they are in charge of looking after their health, which involves providing food, overseeing playing, controlling tantrums, and scheduling sleep times. A day-care provider takes care of an infant or toddler's fundamental requirements by changing diapers and making meals for them. They also keep the kids' schedules, including those for play, naps, and meals.

  1. Supervise and monitor the safety of children in their care.

  2. Prepare meals and organize mealtimes and snacks for children.

  3. Help children keep good hygiene.

  4. Organize activities.

  5. Teach children about the world and explore interests.

  6. Develop schedules and routines.

  7. Ensure that children have enough physical activity, rest, and playtime.

  8. Watch for signs of emotional or developmental problems

  9. Bring any problems to the attention of parents.

  10. Keep records of children’s progress, routines, and interest


A childcare provider reads to and plays with new-borns and toddlers to introduce them to fundamental ideas. By playing games with other kids, they can show young kids how to share and take turns, for instance. They frequently aid pre-schoolers in getting ready for kindergarten. They employ children's play to hone children's social skills and language (for instance, through storytelling and acting games) (for example, through having them build something together in the sandbox). They might engage the kids in artistic, dance, or musical endeavours. Children in care are frequently watched before and after school. They assist these kids with their homework and make sure they participate in after-school activities like club meetings and sporting practises. When school is out for the summer, childcare providers may monitor both older and younger children all day while the parents are at work.


Q3. (b) Describe any two activities that you can plan for children to impart health and nutrition messages to them. (300 words: 2 4- 2 = 4 marks)


Snakes and Ladders Game

You must be accustomed to playing the classic game of snakes and ladders. A modified version of the classic game might encourage good hygiene practises like bathing, hand washing, sweeping, and trash burying while punishing bad ones like head lice, unclean nails, littering, and drinking polluted water. Similar messages can be used to convey the value of a healthy environment both within and outside the house. The safe disposal of garbage, upkeep of the environment, the necessity of balancing a green lifestyle in an urban environment, etc., are possible communication themes.


Writing a song for your community

Learn the musical preferences of the population, and adapt your creativity accordingly to compose songs bearing health and nutrition messages. In composing songs of your own, note the following points:

  1. Use simple words in the lyrics.

  2. Keep your message clear.

  3. Melody and lyrics should be rhythmic and repetitive, easily learnt and repeated.

  4. Traditional and/or well-known songs may be included, but only provided they do not take away from the message you are trying to convey. When film music is employed, kids occasionally start humming the song instead of paying attention to the new lyrics or the intended message.


Q4. List any two functions and any two food sources for each of the below mentioned nutrients. (1/2 mark per function/food source per nutrient---2x4=8 marks)


Q4 (a) Carbohydrates



  1. These are the main source of energy.

  2. it is a part of some connecting tissues.

  3. These also help in maintaining a healthy digestive system.

  4. The fibre in carbohydrates helps in lowering blood cholesterol.



Bread, Beans, Whole grains, Corn, Cereals, Potatoes, Dairy products are some of the best sources of the Carbohydrates.


Q4 (b) Proteins



Enzymes: Most of the countless chemical processes that occur within a cell are carried out by enzymes. Additionally, they perform intricate activities that aid in the regeneration and creation of DNA molecules.


Hormones: Different types of hormones that aid in balancing the body's constituent parts are produced by proteins. For instance, hormones like secretin and insulin, which control blood sugar. Additionally, it contributes to the production of digestive fluids and the process of digestion.



Some healthy protein sources, like a broiled steak, can also be heavy in fat and sodium. Other sources, such salmon, have lower levels of salt and saturated fat. In addition to being excellent sources of protein, beans, chickpeas, lentils, tofu, and low-fat dairy products are also high in antioxidants and fibre.


Q4 (c) Fats



It also serves as a container for the body's surplus calories to be stored in fat cells or adipose tissue, which aids in body insulation. They frequently serve as a significant energy source. Additionally, fats aid in the circulatory absorption and movement of the vitamins A, D, E, and K.



Avocados, cheese, cashew nuts, whole eggs, fatty fish, dark or milk chocolate, chia seeds, cream, etc. are the main sources of fats.


Q4 (d) Vitamins



Vitamin A helps in the development and maintenance of teeth and skeletal and soft tissues.

Vitamin B is required for healthy brain function.

Vitamin C is also an antioxidant, hence it aids in blocking some damage caused by free radicals.



The following are the numerous vitamin sources: carrots, cod liver oil, egg yolk, milk, butter, and green vegetables all contain vitamin A. Milk, kale, meat, eggs, yeast, cereals, almonds, etc. are all sources of vitamin B1. Green vegetables, milk, eggs, liver, and rice polishing all contain vitamin B2.


Q5. (a) Give any four symptoms of mild or moderate illness? (2+4=6 marks)

Ans) There are general features of a more serious illness that should prompt you to see a doctor urgently. These include:

  1. have severe pain that wakes them from sleep, is getting worse or is accompanied by other symptoms like a fever, vomiting or diarrhoea.

  2. they have a fever that makes them shiver.

  3. their crying changes pitch or volume or they are crying continuously.

  4. they have a rash that does not fade when you press on it.


Q5. (b) Discuss the rules for caring for a sick child.


Adjust the Temperature

Because of the weather, your child can find the temperature inside the room and outside a touch too chilly to be comfortable. Use heaters to balance it out, or give your youngster a warm blanket or sweater to recreate the cosy atmosphere. Instead, if your youngster is overheating, use a little fan to calm him down.


Maintain a Peaceful Setting

Your child may be desiring some inner calm while he is ill, so any exterior disturbances or distractions can be rather unsettling for him. Keep him away from any television or video game sounds, and let him to unwind in peace. If the noise from outside is too loud, shut the windows.


Provide Emotional Support

Make sure your child is aware of your support before choosing any form of medical care. Spend time with your infant and sing him his favourite tunes to keep him entertained. If your child is a bit older, talk to him, tell him stories, or just hold him close while you sleep.


Elevate His Head

Lying down on the bed while your child has a cough or cold might exacerbate the irritation, making it difficult for him to breathe. Your child can rest his head or upper body on a small platform or incline that you've made out of a few pillows. This may prompt him to take a comfortable nap or, if he so chooses, to curl up with a book.


Q6. As a caregiver, what first aid you would provide in case a child (150 words each ; 2x3=6 marks)


Q6 (a) gets an electric shock.

Ans) A plug, a device like an iron or toaster, or exposed electric wires that are laying on the ground can all shock a child. This can be quite dangerous, and if it's severe, the infant might pass away right away. If just modest, the affected limb will be uncomfortable and frail. Treatment: Avoid attempting to treat electric shocks inside a building or in one's home. The child could require a glucose drip to maintain blood pressure if the shock is severe.


Q6 (a) swallows poisonous substance.

Ans) Children are prone to ingesting dangerous or deadly chemicals. Since these are typically sitting around the house, kerosene, medications, and cleaning agents are the most common liquids that kids tend to swallow. As these fluids enter the stomach, the mucous membrane is corroded. As a result, the youngster will feel unwell and have painful mouth and oesophagus (gullet). Never attempt to induce vomiting in such circumstances as it will just cause more tissue injury. Send the kid right away to the hospital.


Q6 (a) falls down and fractures her hand.

Ans) A fracture of the bone will occur if the youngster falls or is struck directly on the bone by a hard object. The leg will hang limply and cannot be moved because to the severe pain. The fracture site begins to enlarge quickly, and the shattered bone may move. Avoid attempting to realign the bones. Avoid massaging the amputation limb. It's crucial to maintain the shattered bone's fixed, immobile position. Do not attempt to force the shattered bone in if it is sticking out through the skin. Without shifting the two parts of the bone, carry the infant to the hospital. The child may fall from a tree or other high area whether conscious or not. In either scenario, call a doctor or medical professional right away. If you need to relocate the child to a safe position in the interim, do so with extreme caution. People should grasp the child's hips, feet, heels, shoulders, arms, and head as she is moved "all together." This has major significance.


Q7.(a)What aspects should be kept in mind while planning meals for a pregnant woman? (300 words: 4 marks)


To ensure the health of the foetus, it is crucial that the expectant mother consumes the proper quantity and type of food. To guarantee that dietary protein is used for repairing existing tissues and not for energy needs, there should be a sufficient supply of food. Use only high-quality proteins, such as those found in milk, eggs, fish, and meat. Vegetable proteins and milk can be combined to produce high-quality protein. Leafy vegetables, other vegetables, and fruits should be consumed in large amounts to provide adequate vitamin and mineral intake.

  1. It should be planned to include carbohydrate items that are readily available in the morning during the period of nausea and vomiting.

  2. Meals must be planned with shorter intervals, such as 5–6 little meals, because pregnant women are unable to consume much at once. Some females might favour three substantial meals.

  3. Simple snacks between meals must also be provided, as well as liquids like buttermilk, milk, or lemonade. Pregnancy nausea can be reduced by drinking lemon or orange juice in the morning and before meals.

  4. Foods like whole grain cereals, whole pulses, some green vegetables like mustard leaves, bathua, etc., dried fruits, eggs, and organ meats should be incorporated into the diet to help fulfil the increased iron need.

  5. Particularly in the early stages of pregnancy, it is important to keep in mind the pregnant woman's preferences and tolerance levels.

  6. Foods that are rich, sugary, fried, or otherwise greasy should be avoided. These do more harm than good.

  7. Variety in terms of colour, texture, and flavour is essential, especially if the expectant mother does not feel hungry. Salt restriction may be necessary. Consumption of pickles, chutneys, etc. heavy in salt must be avoided.

  8. Constipation is prevalent during pregnancy because of the pressure from the foetus. The diet should therefore contain higher portions of foods high in dietary fibre such fresh fruits and vegetables, whole grain cereals, and husked legumes along with lots of water.


Q7. (b) Suggest a balanced lunch menu for a pregnant lady and state the nutrients she gets from each food item in the menu.(3marks)

Ans) The 32-year-old lady in this sample plan is 5 feet 4 inches tall, 130 pounds before becoming pregnant, in her second trimester, and only engages in less than 30 minutes of daily physical exercise.


Grains: 7 ounces a day

Typically, one slice of bread, one small corn or wheat tortilla, one cup of ready-to-eat cereal, or half a cup of cooked cereal, rice, or pasta equal one ounce of grains. Consume whole grains for at least half of your daily grain intake (like whole wheat bread or brown rice). The most fibre, vitamins, and minerals are found in whole grains.


Fruits: 2 cups a day

Vary the color of the fruit you eat and choose fresh over frozen or canned whenever possible. Many packaged varieties are preserved in sugary liquid, so choose products without added sugar.


Vegetables: 3 cups a day

In addition to tasting better than canned or frozen vegetables, fresh vegetables are a preferable option if you want to reduce sodium intake and stay away from preservatives. However, ordinary canned and frozen vegetables are just as nutrient-dense as fresh when it comes to fibre and vitamins. Vegetables should be a variety of colours for the best nutrition. For instance, broccoli is a great source of folate, calcium, and B vitamins. Sweet potatoes are a good source of fibre, vitamin C, and vitamin A.


Dairy: 3 cupss a day

One cup of dairy in the MyPlate diet equates to one cup of milk or yoghurt, one and a half ounces of natural cheese, and two ounces of processed cheese. Dairy products are a fantastic source of calcium and protein in general.


Meat and beans: 6 ounces a day

This is equivalent to two portions, each of which is about the size of a deck of cards. Pick lean meat and eat no more than 12 ounces of fish every week. (More than that could expose your infant to mercury levels that could be dangerous.)


Q8. (a) What is Protein Energy Malnutrition (PEM)? (200 words: 2 marks)

Ans) An energy deficit brought on by a lack of all macronutrients is known as protein-energy undernutrition (PEU), also known as protein-energy malnutrition. Numerous micronutrient deficits are frequently present. PEU can be gradual or abrupt (starvation). Subclinical deficits, evident wasting (with oedema, hair loss, and skin atrophy), and hunger are all different levels of severity. Frequently, many organ systems are compromised. Serum albumin testing is frequently used in the diagnosis. Treatment involves correcting fluid and electrolyte deficiencies with intravenous (IV) solutions, followed by a progressive replenishment of nutrients, preferably orally.


It is important to look at anthropometric measurements of lean body mass, fat distribution, and height and weight measurements. The severity of PEM is assessed using the Body Mass Index, or BMI. The severity of Protein Energy Malnutrition can be determined by laboratory procedures like the measurement of serum albumin, total lymphocyte count, transferrin, and reactivity to skin antigens. PEM can also be diagnosed using the lowered levels of hormones, lipids, fats, cholesterol, prealbumin, insulin-like growth factor, fibronectin, calcium, magnesium, and phosphate.


Q8. (b) Differentiate between the symptoms of Marasmus and Kwashiorkor? (300 words : 3 marks)

Ans) Marasmus, also known as the dry version of PEU, results in weight loss and muscle and fat depletion. Marasmus is the most prevalent type of PEU among kids in nations with high rates of hunger. Infants with marasmus experience hunger, weight loss, slowed growth, and subcutaneous fat and muscle atrophy. Face and rib bones are clearly visible. Folds of loose, thin skin are hanging.


Kwashiorkor, also known as the wet, swollen, or oedematous form, is a concern following premature breastfeeding cessation, which often takes place when a younger sibling is born and pushes the older kid away from the breast. As a result, kids with kwashiorkor are typically older than kids with marasmus. Kwashiorkor can also develop in a child who already has PEU as a result of an acute illness, frequently gastroenteritis or another infection (likely owing to cytokine release). Kwashiorkor may be more prone to develop in people who consume diets that are poor in protein than in energy. Kwashiorkor is less widespread than marasmus and is typically restricted to certain regions of the world, such as rural Africa, the Caribbean, and the Pacific islands. These regions' staple foods, such as yams, cassava, sweet potatoes, and green bananas, are high in carbs and low in protein. Cell membranes leak in kwashiorkor, resulting in extravasation of intravascular fluid and protein and peripheral oedema. Due to the drop in serum albumin, Kwashiorkor is characterised by peripheral and periorbital deem. Because to weak abdominal muscles, bloated intestines, enlarged livers, and ascites, the abdomen protrudes. The skin is thin, wrinkled, dry, and prone to hyperpigmentation and fissures, which can subsequently give way to hypopigmentation, friability, and atrophic changes. Skin in various bodily parts may be impacted at various times. The hair may thin, turn reddish brown, or turn grey. Eyelash hair may grow excessively, while scalp hair readily falls off and finally becomes scarce. The hair may appear dramatically "striped" like a flag when undernutrition and appropriate nutrition are experienced in quick succession. Children that are affected could seem lethargic, yet when held, they get agitated.


Q9. State the symptoms, management, and prevention for each of below mentioned childhood illnesses. (200 words per illness: 2 x 4 —8)


Q9. (a) whooping cough


Signs and Symptoms

This illness begins with a cough, runny nose, and fever. The child will start to holler after about ten days of breathing normally. In this condition, the bacteria in the windpipe thicken the mucus lining, which restricts airflow into the windpipe. A whooping sound is made as air enters the lungs, followed by a persistent cough. The child could become really upset, but as she coughs and the mucous comes out, she will feel better. Whooping cough is incredibly exhausting and terrible, but if left untreated, it usually goes away in three months or less.


Management and Prevention

Usually, by the time an infection has set in and been recognised, it is too late to treat it. Only the discomforts of the illness can be lessened after the first week of the illness, at which point antibiotics may be helpful.


Q9. (b)measles


Signs and symptoms

This widespread illness is brought on by a virus that affects the respiratory system and the skin. A fever, runny nose, sore mouth, and cough are the first symptoms to appear. The kid might get cranky and show signs of photophobia (avoidance of light). A rash will start to develop on the fourth day of the fever. first on the face and back of the neck, then the body, and lastly the limb? Typically, the temperature will drop as soon as the rash appears.


Management and Prevention

Measles is self-limiting (i.e., it goes away on its own after some time) and will eventually pass. It is not dangerous because it will heal on its own over time. If caution is not exercised, however, it might result in several issues that call for medical attention. While there is no known way to treat the measles virus, symptoms can be managed. Utilize cold compresses and medications to lower the fever. Eyes should be kept clean and free of secondary infections. Diarrhoea and coughing need to be treated properly. Antibiotics can effectively prevent secondary infections, especially in undernourished or malnourished youngsters, but they have little effect on the measles virus itself.


Q9. (c)typhoid


Signs and Symptoms

It begins with a fever, a headache, and overall malaise (i.e., listlessness and lack of energy). Sometimes these symptoms are accompanied by diarrhoea. The fever will progressively get worse and could linger for more than a week. Spleen size will increase.


Management and Prevention

Typhoid and cholera can both be avoided using the TABC vaccine. Six months of immunity are granted. Giving cholera vaccination during epidemics, however, is useless.


Q9. (d)scabies



The most typical skin infection in youngsters is this one. It is a very contagious illness. The tiny lesions in the area its defining feature. fingers, wrists, armpits, and the inside of the thighs and buttocks. They are individual, little, elevated lesions, and they itch a lot. In the evenings, the itching gets worse. Dry lesions can be seen. as the illness worsens. As a result of scratching, the lesions merge and spread infection. They are currently yellow and covered in pus. Except in extremely young kids, scabies rarely affects the face, palms, or soles of the feet.


Management and Prevention

By taking regular baths and washing their clothes as frequently as possible, the children must be taught how to maintain clean skin. The infection can be effectively controlled by a substance called Benzyl Benzoate. Most likely, the doctor will recommend this. After a thorough body scrub, the solution needs to be applied to the entire body, excluding the face. The next day, it is best not to wash it off. Apply more solution once more in its place. The child gets bathed on the fourth day after using this for three days in a row. Half-strength Benzyl Benzoate, which contains equal parts Benzyl Benzoate and oil, is indicated for young children.




20 Marks


In this Section you have to do either Exercise 2 or Exercise 3 given in the Practical Manual of this Course, i.e., DECE-2.


It would be useful for you to do both these Practical Exercises. You can then choose the exercise which you feel you have done the best and submit it for evaluation.


The details of these exercises have been described in the Practical Manual. Read each exercise carefully and do the exercise as indicated. The marks for the various components of each exercise have been mentioned in the Manual itself. In case the total marks for an Exercise are more than 20 in the practical manual, the evaluator will grade the exercise and convert the total marks from 20.


Exercise No: 2


The following figure shows you 20 food items represented as food squares.

1) Suggest two basic mixes as supplementary foods using the ingredients listed in the food squares (Fig.2.1). Make sure that at least one of the two mixes is suitable for serving to infants in a creche. Fill in the information in the following table. (3+3 marks)


Table 2.1 : Basic Mixes


Q2) Which of the basic mixes you have suggested is suitable for serving to infants in a créche? Why? (4 marks)

Ans)  The basic mixes suitable for serving infants in creche are:

  1. Rice Cereal

  2. Wheat and Green Gram Mix


Instant Infant Food from staple cereals and pulses. Instant food mixes can be roasted and powdered. The proportion of cereal and pulse can range from 2:1 to 3:1. Roasted groundnuts or gingerly seeds could also be added in the proportion 4:1 or 5:1. These mixes can be kept for more than one month in airtight containers and used whenever required. It is convenient and of much help to families where cooking is done once or twice a day only. Such instant foods help enable adequate feeding of infants, particularly for infants in Creche.


Q3) Suggest two multimixes using the food squares indicated in Fig. 2.1. Fill in the information in the following table. (4+4 marks)


Table 2.2 : Multimixes


Q4) Which of the food squares indicate foods which you would avoid serving to infants or which need special modification during preparation (e.g., removal of some parts)? Give any one example, stating the reason for avoiding the food or the special modification required while preparing the dish (as the case may be) for an infant. (2 marks)

Ans) Foods to avoid giving babies and young children:

  1. Salt: Babies should not eat much salt, as it's not good for their kidneys.

  2. Sugar: Your baby does not need sugar.

  3. Saturated fat.

  4. Honey.

  5. Whole nuts and peanuts.

  6. Some cheeses


Honey should be avoided for infants

Honey (or foods made with honey) is off-limits for the first year because it may contain the spores of the bacteria Clostridium botulinum. Although harmless to adults, these spores can cause infant botulism in babies under 1. This serious but rarely fatal illness can cause constipation, weakened sucking, poor appetite, lethargy and even potentially pneumonia and dehydration. So, wait until baby’s first birthday to serve your sweetie honey.




20 Marks


In this Section you are required to do any one Exercise out of Exercise 5, 6 or 7 given in the Practical Manual of this Course, i.e., DECE-2.

It would be useful for you to do both these practical exercises. You can then choose the exercise which you feel you have done the best and submit it for evaluation.

The details of these exercises have been described in the Practical Manual. Read each exercise carefully and do the exercise as indicated. The marks for the various components of each exercise have been mentioned in the Manual itself. incase the total marks for an Exercise are more than 20 in the practical manual, the evaluator will grade the exercise and convert the total marks from 20.

Ans) Exercise No: 7


1. Interview Schedule for the Parents

Background Information


1)      Name, age and sex of the child whose health status you are going to find out about:

Name: Rajesh

Age: 5

Sex: Male/Female : Male


2)     Age of the brothers and sisters of this child:

Brothers: 7

Sisters: 8


3)     Age of parents:

Father: 38Years

Mother: 36 Years


4)     Educational qualifications of the parents:

                                                                                          Father                                                                                             Mother

Not educated                                                                                           (*)

Education less than Class V

Education more than Class Vbut less than Class XII/High School                                         (*)

Passed Class XII/High School



(Tick the appropriate box in each case)


5)     Occupation and income of the parents:

(It is possible that the mother does notwork for an income)                                                             Father                                                                                           Mother



2. Interview Schedule for the Parents

Background Information


1)      Name, age and sex of the child whose health status you are going to find out about:

Name: Rajni

Age: 4

Sex: Male/Female : Female


2)     Age of the brothers and sisters of this child:

Brothers: 6

Sisters: Nil


3)     Age of parents:

Father: 33Years

Mother: 30 Years


4)     Educational qualifications of the parents:

                                                                                          Father                                                                                             Mother

Not educated                                                                                          

Education less than Class V

Education more than Class V                                                                     (*)

but less than Class XII/High School                                        

Passed Class XII/High School -                                                         (*)



(Tick the appropriate box in each case)


5)     Occupation and income of the parents:

(It is possible that the mother does notwork for an income)                                                            Father                                                                                           Mother



3. Interview Schedule for the Parents

Background Information


1)      Name, age and sex of the child whose health status you are going to find out about:

Name: Sunita

Age: 3

Sex: Male/Female : Female


2)     Age of the brothers and sisters of this child:

Brothers: 7

Sisters: 5


3)     Age of parents:

Father: 37Years

Mother: 34 Years


4)     Educational qualifications of the parents:

                                                                                          Father                                                                                             Mother

Not educated                                                                                          

Education less than Class V

Education more than Class Vbut less than Class XII/High School                                        

Passed Class XII/High School

Graduate                                                                                                 (*)

Post-graduate                                                                      (*)

(Tick the appropriate box in each case)


5)     Occupation and income of the parents:

(It is possible that the mother does notwork for an income)                                                            Father                                                                                           Mother

                                                                                          (*)                 (*)

4. Interview Schedule for the Parents

Background Information


1)      Name, age and sex of the child whose health status you are going to find out about:

Name: Pawan

Age: 4

Sex: Male/Female : Male


2)     Age of the brothers and sisters of this child:

Brothers: 2

Sisters: 6


3)     Age of parents:

Father: 30Years

Mother: 28 Years


4)     Educational qualifications of the parents:

                                                                                          Father                                                                                             Mother

Not educated                                                                                          

Education less than Class V

Education more than Class Vbut less than Class XII/High School                                        

Passed Class XII/High School

Graduate                                                                             (*)                     (*)


(Tick the appropriate box in each case)


5)     Occupation and income of the parents:

(It is possible that the mother does notwork for an income)                                                            Father                                                                                           Mother

                                                                                          (*)                 (*)


Questions pertaining to health status of the child:


Q1. What illness/illnesses has the child had in the last one year? What was the duration of each?

Ans) Some of the common illness that the young children have faced:

  1. Common Cold – lasted for a week.

  2. Gastroenteritis – lasted for around three to four days.

  3. Diarrhoea – generally around ten days

  4. Chickenpox – lasted for a little over two weeks.


Q2. What did you do to control the child’s illness?

·       Ask this question with respect to each illness of the child.

·       The intention behind this question is to find out whether the parents took the child to a PHC/medical centre/private doctor, or whether they relied on home remedies, or whether they let the illness get cured by itself: It is possible that the family gave the child medication as well as tried home remedies).


Ans) When asked regarding how the parents took care of the child the following are the responses received:


1. For Common Cold: Colds are common among infants and toddlers. If the child’s body feels hot, he could also be running a fever. 

This is what they did:

· Kept him hydrated with lots of fluids like water and low-sugar juices.

· Kept him away from crowded places, sick individuals and other children.

· Taught their child to use a tissue to blow his nose, or to cover his mouth when sneezing.


2. Gastroenteritis: He could be having the stomach flu, or an infection in his gut. Other symptoms include muscle aches, abdominal pain and a slight fever. 

This is what they did:

· To replace lost water and salts, kept their child hydrated with fluids like water or juices that do not contain milk. Encouraged child to take frequent, small sips of fluids.

· Suggested to Avoid other people — stomach flu is contagious.


3.  Diarrhoea - frequent, watery stools most often caused by a virus in babies and toddlers.

This is what they did:

· Give toddlers oral electrolyte solution, ice chips, or clear broth. If your child is vomiting, encourage them to take small, frequent sips instead of drinking too much at once.

·  Feed toddlers’ mild foods in their regular diet. Avoid spicy or fried foods.


4.     Chickenpox - In healthy children, chickenpox is usually a common and mild disease. It is very contagious and can easily spread through direct contact or droplets in the air from an infected person. 

This is what they did:

· They kept him home to prevent the illness from spreading to other children.

· To avoid scratching, trim your child’s fingernails and consider letting him wear gloves at night.

· Gave the child cool baths to help relieve itching.


Q3. Could you outline the care that was provided to the child during the period of sickness?

·       Ask this question with regard to each illness.

You may need to suggest some examples to the parents to help them understand what you mean by ‘care’, if they don’t seem to give appropriate answer to your question. For example, care with regard to the diet, intake of fluids and aspects like the room being well-ventilated, the child not left alone and symptoms constantly observed etc.

The answer to this question may have been partly given in response to Q.2.

This question is intended to find out about aspects that did not get covered in the answer to the earlier question. Even here, you may need to ask specific supplementary questions like, “In what ways was the diet given to the child during the period of illness different from the diet normally given to her/him?”


Ans) Given below are the dietary and care methods taken by parents regarding their child’s illness:


1. Common Cold  and Flu-


  1. Chicken soup: Chicken soup has been a go-to for sickness for generations — and for good reason.

  2. Broths: Like chicken soup, broths are excellent sources of fluid and electrolytes that can be helpful when you're sick.

  3. Garlic

  4. Coconut water

  5. Hot tea

  6. Honey

  7. Ginger


Care: It's important to blow your nose regularly when you have a cold rather than sniffling mucus back into your head. Resting when you first come down with a cold or the flu helps your body direct its energy toward the immune battle. Gargling can moisten a sore throat and bring temporary relief. Try a teaspoon of salt dissolved in warm water, four times daily.


2. Gastroenteritis –


  1. Foods containing ginger: Ginger is a plant that can reduce bloating and other digestive problems.

  2. Unsaturated fats. This type of fat helps the body absorb vitamins.

  3. Vegetables with skin.

  4. Fruits

  5. Whole-grain foods

  6. Yogurt

  7. Kefir

  8. Leafy green vegetables


Care: Though specific treatments vary depending on the diagnosis, general care of stomach or digestive trouble may include:


Resting and drinking plenty of fluids.


Following the BRAT diet – bananas, rice, applesauce and toast – all of which are easy on the stomach and beneficial in their own way. At the same time, avoid things like dairy, grease, and spices, as they can aggravate your digestive system.


Taking over-the-counter medications to ease symptoms (for example, laxatives for constipation).

Upon being examined by a medical provider, medications could be prescribed to control symptoms such as nausea to provide comfort and aid in the ability to rehydrate. When appropriate, anti-nausea medications and/or IV rehydration may be administered.



Diarrhoea is a bowel movement that is more liquid than solid or has a loose texture. It is a common problem and may occur a couple of times each year.

  1. Diet: People with diarrhoea should eat bland foods, as spicy or complex foods can irritate the bowels. Bland foods that may help with diarrhoea include  hot cereals, such as oatmeal, cream of wheat, or rice porridge bananas applesauce plain white rice bread or toast boiled potatoes unseasoned crackers.

  2. Care: People with diarrhoea should also ensure they get enough rest, as putting the body in stressful situations while dealing with diarrhoea may make matters worse.

  3. Limit physical activity while diarrhoea symptoms are presenting, as strenuous activity may put the body at a greater risk of dehydration. Drink plenty of water throughout the day.



  1. Diet : When you have chicken pox it is very important that you eat a nutritious diet. First of all, home-cooked meal is essential. Also eat foods like wheat, fresh fruits, green leafy vegetables, milk, plenty of water, buttermilk, sprouts some herbs like turmeric and garlic (as they boost the immunity).

  2. Care: These tips help: Tap or pat, don’t scratch your itch Take a cool oatmeal bath (you can buy it at your local drugstore). Dab or pat (don’t rub) your skin dry. Wear loose, cotton clothing so your skin can breathe Dab calamine lotion on your itchy spots Try an antihistamine, like Benadryl, to ease your symptoms.


Q4. Why do you think the child had the illness/illnesses?

·       Ask this question with respect to each illness.

If the parents do not give a satisfactory reply, for example, if they make a statement like “It happens” or “All children have such problems”, then rephrase your question, giving them hints like: “Do you think she/he got it from a friend who had this illness?” or “Could it be because of consuming unclean food or water?” However, you will have to be very careful when wording such probing questions, taking care that you do not offend the parents. Also, any question you ask should be related to the possible causes of that illness.


Ans) The following are the replies of Parents as to why illness affected their child:


Parents I – Unhygienic conditions and lack of proper water supply were the main causes of common cold and flu.

Parents 2 – Not having proper sanitary conditions is the common problem of Gastroenteritis.

Parents 3 – Lack of clean water supply is the main cause for Diarrhoea.

Parents 4 -  Since they did not give the vaccination that led to chickenpox illness.


Q5. Do you feel that these illnesses could have been prevented? (Find out with respect to each illness).


1. Common Cold and Flu

A cold is easy for children to spread. That's because they touch their nose, mouth, and eyes often and then touch other people or objects. This can spread the virus. It's important to know that viruses can be spread through objects, such as toys, that have been touched by someone with a cold.

Causes: The common cold, including chest cold and head cold, and seasonal flu are caused by viruses. Use over-the-counter cold medications to relieve symptoms including sore throat, runny nose, congestion, and cough. Flu symptoms are similar, but include fever, headache and muscle soreness.

Prevention : Flu can also have very serious complications. CDC recommends a yearly flu vaccination as the first and best way to prevent the flu. If you get the flu, antiviral drugs may be a treatment option.


2. Gastroenteritis

Causes: Gastroenteritis is a short-term illness triggered by the infection and inflammation of the digestive system. Symptoms can include abdominal cramps, diarrhoea and vomiting. Some of the causes of gastroenteritis include viruses, bacteria, bacterial toxins, parasites, particular chemicals and some drugs.

Prevention: The use of clean water and good sanitation practices are important for reducing rates of infectious gastroenteritis. Handwashing with soap has been shown to reduce the risk of gastroenteritis by up to 47%. Of course, avoiding contaminated foods that could harbour toxic bacteria and parasites is also important

3. Diarrhoea

Causes: Infection by bacteria. Infections by other organisms and pre-formed toxins. Eating foods that upset the digestive system. Allergies and intolerances to certain foods (Celiac disease or lactose intolerance).

Medications: Radiation therapy, Malabsorption of food (poor absorption).

Prevention : It is both preventable and treatable. Each year diarrhoea kills around 525 000 children under five. A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene.


4. Chickenpox

Chickenpox is a viral infection that causes fever and an itchy rash with spots all over the body.

Causes: Chickenpox is caused by the varicella-zoster virus (VZV). This virus also can cause a painful skin rash called shingles (herpes zoster) later in life. After someone has had chickenpox, the virus stays dormant (resting) in the nervous system for the rest of their life. The virus can reactivate ("wake up") later as shingles. Kids who are vaccinated against chickenpox are much less likely to develop shingles when they get older.


  1. Treatment for diarrhoea

  2. plenty of fluids to prevent dehydration.

  3. oral rehydration drinks to replace lost salts and minerals. ...

  4. intravenous replacement of fluids in severe cases.

  5. medications such as antibiotics and anti-nausea drugs.

  6. anti-diarrhoeal medications, but only on the advice of your doctor.

Prevention: The best way to prevent chickenpox is to get the chickenpox vaccine. Everyone—including children, adolescents, and adults—should get two doses of chickenpox vaccine if they have never had chickenpox or were never vaccinated. Chickenpox vaccine is very safe and effective at preventing the disease.


Q6. a) Has the child been immunized against  Yes   -  No


Ans) Parent 1 – No; Parent 2 – No; Parent 3 – Yes, Parent 4 – Yes;



Ans) Parent 1 – Yes; Parent 2 – Yes; Parent 3 – Yes, Parent 4 – Yes;



Ans) Parent 1 – No; Parent 2 – No; Parent 3 – Yes, Parent 4 – Yes;



Ans) Parent 1 – Yes; Parent 2 – Yes; Parent 3 – Yes, Parent 4 – Yes;



Ans) Parent 1 – Yes; Parent 2 – Yes; Parent 3 – Yes, Parent 4 – Yes;

Whooping cough

Ans) Parent 1 – No; Parent 2 – No; Parent 3 – No, Parent 4 – No;


(Tick in the appropriate boxes). (If possible, confirm this information by asking for and looking at the health card or immunization record, in case the parents have it.)


Q6. b) At what ages was the child immunized against the various diseases? (If the parents don’t remember, find out if they know at what ages should the various immunizations be done.)

Ans)  The following comments of parents indicate the age of their v=children who were immunized:

Parent 1 – Aged 2 years

Parent 2 – Aged 3 years

Parent 3 – Aged 1. 5 years

Parent 4 – Aged 2 years


Q6. c) When are you supposed to take the child next for immunization? (Also ask them how do they come to know that it is time for the child to be taken for immunization.)

Ans) Parents refer the file of the doctors to know when they have to take their child to the clinic.

Parents reply is that the doctors in their vicinity or family doctors tell them in writing the dates they have to come for the next inoculation.


Q6. d) Where do you take the child for immunization?

Ans) Generally the Parents 1 and 2 take their children to the local Government Municipal Hospital for getting the immunization for the children.

However, Parents No. 3 and 4 usually go to a private hospital for giving their children the needed vaccinations.


Q7. Do you think that the child is growing at a normal pace?

Ans) Parent 1 -  (Yes)

Parent 2 -  (No)

Parent 3 – (Yes)

Parent 4 – (Yes)



You would have found out this information with regard to four families. Though this does not constitute an extensive survey, it is adequate to enable you to make some common observations and draw inferences. Analyse your data with regard to the following aspects:

  • Where there some illnesses which most children had suffered from?

  • Were there some illnesses which were more common among children belonging

  • to a particular social class? If so, what do you think are the reasons for this?

  • Were most parents aware that the illnesses could have been prevented? Was

  • there a difference in the awareness level of parents belonging to different social

  • classes?

  • Were most of the children immunized? Was there a difference in terms of social class in this respect?

  • in general, what was the attitude of the parents with respect to the child’s illness? Did they treat it as a commonplace occurrence or class differences? Was there a need to explain to the parents how to manage and prevent the common childhood illnesses? Were you able to do so?

  • Comment upon each of the above aspects, while writing the analysis. You may, of course, think of some other relevant aspects and include those in your analysis as well. (6 marks)




There was a considerable variation in the parents' perception of illness threat. On the basis of a score, it was possible to group parents with a high, medium, and low perception of illness threat. Every fourth family reported a high perception of illness threat. A multivariate analysis, with a high perception of illness threat as dependent and selected psychosocial conditions and the diagnosis as independent variables, led to the following main results: 1) parents with a high perception of the general health threat ("worried" parents) most frequently reported a high perception of illness threat, 2) the diagnoses were decisive; in particular, inflammation in the middle ear, bronchitis, pneumonia, and accidents led to the parents' reporting a high perception of illness threat, 3) parents without experience of children and children's illnesses more frequently perceived an actual illness as a high illness threat than parents with this experience, 4) parents more frequently perceive an illness in girls as a high illness threat.



This should state in one or two paragraphs the major findings that have emerged from your brief survey. (4 marks)

Ans) Despite the best efforts of parent’s children struggle with various disorders or illness in their young childhood. Most parents, particularly in the lower education category today are ill equipped to evaluate and provide or refer for treatment.  Nevertheless, there is a silver lining for a nation that has a history of advocating for children who face barriers to learning and where there is a general consensus regarding the need to allocate more resources among the political and educational communities to aid in the health development of rural areas to avoid the increase of illness in young children.


In view of the above, the more the parents are literate about the various illness and the remedies available, the lesser will be the increase of infectious diseases and the greater will the overall health of the community be uplifted. But to do this, evidence-based practices must be adopted at a large scale, and partnerships between educators and mental health professionals from the policy level on down to the individual child must be encouraged.

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