Effects of an energy and micronutrient supplement on play behavior in undernourished children in Indonesia

Abstract

Objectives: This paper reports the effects of an energy and micronutrient supplementation on quantitative and qualitative aspects of play among poorly nourished children. At issue is whether the supplement led to a progression in complexity of play.

Design: two cohorts of children were randomly assigned to three treatments: E=1171 kJ+12 mg iron; M=12 mg iron+209 kJ; S=104 kJ. Supplementation was given for 6 months. Evaluations of play behavior were repeated four times.

Setting: The sites were six tea plantations in Pangalengan, West Java.

Subjects: The present study utilized a subsample of 55 children recruited for the larger Pangalengan project 6 months into the study. Thirty-eight children were recruited late enough to allow for longitudinal observations. The remaining cases were used for cross sectional observations only. Inclusion criteria were: no chronic disease; length-for-age ≤−1 standard deviation (s.d.) and weight-for-length between −1 and −2 s.d. of the median of the reference of the World Health Organization.

Methods: The children were videotaped during play. These tapes were coded for eight mutually exclusive categories of activities. Four activities coded represented manipulative, relational, functional and symbolic play.

Results: Treatment did not affect qualitative play. Girls that received E increased functional play but boys showed the opposite effect. Children in the S group were breastfed more during play as compared to the E group. Children in the E group waited less to begin play.

Sponsorship: Nestlé Foundation.

European Journal of Clinical Nutrition (2000) 54, Suppl 2, S91–S106