Childhood nutrition is only one facet of child development, yet it is crucial as nourishment affects all other forms of childhood development.  Development practitioners who strive to see holistic childhood development must take into consideration the best practices of community nutrition.  In the case of Alajuelita, Costa Rica, community nutrition programs are largely in the hands of local NGOs.

Myers and Bourdillon (2012) recognized that there are two major developmental approaches: universalization (a top-down approach) and contextualization (individualizing development for its unique setting).  Both are valid and necessary; universalization is critical for implementing laws and policies, while contextualization is important for determining best practices that will most benefit a specific community or context.  In working with childhood nutrition at the community level, contextualization is the optimal approach for development, as each program must fit the specific needs of the children in the community. 

Local NGOs that include childhood nutrition programs in Alajuelita have the advantage of the ability to implement change in their programs more quickly than government agencies or large, international NGOs.  Also, local NGOs have the capacity for closer relationship and monitoring, due to a constant presence in the community and connection to families.  Thus, it is these local NGOs which this paper addresses.  Childhood nutrition is critical to address in Alajuelita, and its potential is in the hands of NGOs to incorporate education, maternal health, and expansion of feeding programs.    

The Condition of Alajuelita, Costa Rica

            Alajuelita, a canton of the capital city San Jose in Costa Rica, is one of the poorest areas of the city.  Stigmatized by poverty and a high immigrant population, it is commonly said that “Nothing good can come from Alajuelita” (S. Gerhardt, personal communication, February 28, 2014).  Although Costa Rica provides healthcare to all citizens, poor households often slip through the system; furthermore, immigrant Nicaraguans also do not receive healthcare and are part of the poorest in Costa Rica (Foundation of International Medical Relief for Children [FIMRC], 2013).  Nutrition-related illnesses such as diarrhea, type 2 diabetes, and gastrointestinal microbe infections frequently plague residents of Alajuelita (FIMRC, 2013).

            Although nutrition data specifically from Alajuelita, or even San Jose, is not easily available, the state of child nourishment can still be gleaned from general country reports.  In 2008-2009, about 7.7% of children under the age of five were either underweight, stunted, or wasting, and 8.1% of children under five were overweight.  Vitamin A deficiency was present in 8.8% of preschool-aged children.  As far as food security, only 3.1% of the population was below the international poverty line (US$1 per day) and 6.5% of the total population did not have sufficient caloric intake (World Health Organization [WHO], n.d.).  Costa Rica is one of the most developed Latin American countries, but even with achievements in development, there are still children who suffer from malnourishment.   

            A study comparing adolescents to their parents or grandparents showed an alarming trend of poor dietary habits amongst the youth.  Although they tended to eat more tropical fruits than their older family members, they had overall decreased nutrient levels due to low intakes of vegetables and whole grains (Kabagambe et al., 2005). 

            Breakfast for children in Alajuelita is often a simple cup of coffee, possibly with some bread if available.  There are schools and other feeding programs that provide lunch for children, although they are usually underfunded and are basic meals like beans and rice, or sometimes include animal products like chicken (R. Castro, personal communication, February 28, 2014).

            In considering childhood nutrition in Alajuelita, children primarily fall under the first level of risk identified by Ray and Carter (2007).  Such children live in poverty, but live with their families.  As children in Alajuelita are largely in the first level of risk, primary methods of development should focus on prevention.     

Holistic Health of the Child

            Childhood development involves several components and requires that development practitioners consider a holistic approach to children.  Children must have development physically, socially, cognitively, emotionally, and spiritually (Copsey, 2003).  Physically, both health and nutrition are critical components of physical development and have a tremendous impact on other developmental areas (Tomkins, 2003).  Thus, the focus on physical development through nutrition, and the root causes of malnourishment are examined more carefully throughout this paper.

            Nutrition is crucial to brain development, which in turn affects cognitive and emotional development.  Children who are malnourished early on struggle to advance with their classes as they cannot make up for what was lost in their early years.  Tomkins (2003) pointed out that malnourishment leading to stunted brain development impacts IQ negatively, even when controlling for other contributions such as socioeconomic and environmental factors.

            Furthermore, development practitioners, community healthcare workers, and families may feel like they cannot make significant contributions to childhood health and nutrition (Tomkins, 2003).  Yet the contrary is true; child health starts at the family and community level, with healthcare professionals needed in more serious cases.  Health needs to be addressed through the closest relationships to the child for the greatest level of well-rounded development.   

            This leads to the critical recognition that the healthy, holistic development of a child starts even before birth.  Poverty is intergenerational and affects a child’s opportunity for development (Boyden & Feeny, 2003).  Maternal nutrition during the fetal stages of development can also impact a child’s growth and development; maternal malnourishment can set a child on a trajectory of stunting (Sabates-Wheeler, Devereux, & Hodges, 2009).  Thus, if development practitioners want to improve childhood nutrition, they must also consider the vulnerabilities of women of child-bearing age.

Root Causes of Child Malnourishment in Alajuelita

There are several key social factors at play with childhood nutrition in Alajuelita.  Some mothers have reported that their children do not want to eat traditional foods, which are associated with poverty (G. Barrett, personal communication, February 5, 2013).  Also, there are many latchkey children in Alajuelita who do not have basic cooking, food handling, and food preservation skills.  These children often seek out prepackaged food like chips and soda (R. Castro, personal communication, February 28, 2014).  As seen previously in the intake differences even within families, children—and adolescents in particular—are prone to a less varied diet that can further contribute to poor nutrition during critical years of growth.      

Poverty is deeply related to malnourishment.  Poverty affects children at a deeper level than adults, not only because they are acutely aware of and sensitive to the stigma of poverty, but also because it hits them harder as a more vulnerable sector of the population (Boyden & Feeny, 2003).  Malnourishment, which is often coupled with poverty, negatively impacts lifelong development, which further serves to place malnourished children at a greater vulnerability to perform poorly in school (Sabates-Wheeler, Devereux, & Hodges, 2009).  In the case of latchkey children, they are dependent upon parents for provision, yet are also dependent upon themselves for care.  Although health programs, including nutrition programs, cannot independently solve the complexities of poverty (Boyden & Feeny, 2003), nevertheless nutrition programs are critical for the development of children, and implementation in tandem with other development programs can significantly improve child well-being. 

Interventions for NGOs

Intervention 1: Childhood Nutrition and Cooking Education

            The primary focus of childhood nutrition should be investing in the skills and knowledge of children in Alajuelita, as the best nutrition programs incorporate learning and skill building (Tomkins, 2003).  Training in nutrition, as well as incorporating skills in cooking, food handling, and preservation would empower children to make better decisions when they have food purchasing power and would help children who must cook for themselves.  

            Cooking and nutrition classes would also be beneficial in building community assets, both external and internal.  Such classes might provide children with a constructive use of time at home, a commitment to learning, responsibility, planning and decision-making skills, and personal power.  Furthermore, the classes could build on assets already within the community, such as giving an opportunity for youth programs and religious organizations to expand opportunities for outreach (Search Institute, 2006).  Furthermore, if the program incorporated traditional foods and cooking methods, it could serve to shift the perception of traditional foods from association with poverty to that of empowerment. 

Intervention 2: Improving Maternal Health

            Pre-natal nutrition and care helps build a protective environment for children (Ray & Carter, 2007), and as discussed previously, maternal health is critical for well-child development.  Education on making balanced meals, the importance of breastfeeding, the importance of a high quality breakfast, and raising a healthy child are all important to address. 

            Because impoverished Costa Ricans and immigrants often do not have healthcare, it would be imperative for NGOs to help women get introduced to the system.  If women received free health care, they could benefit from pre-natal care, routine checkups, vaccinations for their children, and other critical healthcare services. 

Intervention 3: Expansion of Current Feeding Programs    

            Although feeding programs are in operation in Alajuelita, improvements could be made to better fulfill needs for children.  In fact, school feeding programs are one of the tools that can be used for social protection, as it contributes to development that helps form a bridge out of poverty and gives children dignity (Ray & Carter, 2007).  Tomkins (2003) stated that school-based feeding programs are a rather cost-effective way to ensure nutrition; it is practical, then, to build off of programs already in place. 

Incorporating breakfast into feeding programs is a priority to consider.  Not only will this add a meal that many children do not eat, but it begins to set a standard for breakfast consumption and what types of meals can be used for breakfast.  Even serving a simple meal of beans and rice would be a great improvement over coffee and bread.  Serving two meals per day is a starting point for helping children develop healthfully. 

Conclusion

            Children in Alajuelita would greatly benefit from NGOs that promote nutrition and cooking classes, maternal health, and expansion of feeding programs.  When nutritious foods are more readily accessed by children, they have much better odds at developing at an appropriate pace, which sets them up for development in other areas.  Thus, emphasizing nutrition in childhood contributes to the holistic care and development of children.

            However, in order for these interventions to be successful, more research is necessary regarding the specific needs of children in Alajuelita.  This is also a great opportunity for NGOs to incorporate child participation in their programs.  Child participation in program planning and feedback would further help children develop social competencies, community responsibility, identity, and membership, as well as give them an opportunity to be involved in interventions on issues that affect them (Hart, 1992; Reddy & Ratna, 2002). With new intervention strategies and giving voice to children, the community of Alajuelita will see improvements in the lives of their children—and ultimately their future. 

References

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Kabagambe, E.K., Baylin, A., Irwig, M.S., Furtado, J., Siles, X., Kim, M.K., & Campos, H. (2005).             Costa Rican adolescents have a deleterious nutritional profile as compared to adults in            terms of lower dietary and plasma concentrations of antioxidant micronutrients. The         Journal of the American College of Nutrition, 24, 122-128.

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Search Institute. (2006). The asset approach: 40 elements of healthy development. Minneapolis,   MN: Search Institute.

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World Health Organization [WHO]. (n.d.). Nutrition landscape information system: Costa Rica.      WHO. Retrieved from http://who.int