4.4. Causes of inadequate energy intakes in children

If the consequences discussed above are to be prevented, it is necessary to know why energy intakes fall below what is necessary or desirable. There are various possible causes:

1. Absolute lack of available food, e.g., during the hungry season. It is known that in such cases catch-up growth can occur when food supplies improve (Nepal). The question arises as to whether "stop-and-go" growth carries any handicap compared with more regular growth.

2. Even though food is available, the child may not be able to eat enough of it, because of low energy density, too widely spaced meals, etc.

3. Factors that influence the mother's activity may reduce the time available for cooking and child care.

4. Infections have a profound impact on appetite and energy intake.

The relative importance of different causes of low energy intakes of children will differ in different environments. A high priority should be given to in-depth case studies of families in different communities. The number of families studied need not be large. Where this approach has been used, it has proved extremely cost-effective.