All parents feed their children the best they can but are the kids getting the right nutrition? It’s highly unlikely.Less than one in 10 children aged six months to 23 months in India gets an adequate diet, shows data from the National Family Health Survey 4 (NFHS4) released in March. The nutritional intake of children in cities is only marginally better than rural children – only 11.6% urban kids and 8.8% rural children have an adequate diet that includes four or more food groups, excluding milk.As a result, more than one in three under-5 children in India are underweight, including 29% urban children. India is also home to the largest number of stunted children in the world, with close to two in five (38.4%) children under-5 years being small for age because of unhealthy diets. The problem of undernutrition is not just a rural phenomenon -- 31% children in India’s cities are stunted. An additional 21% are wasted (low weight for age), and 7.5% are severely wasted, with the numbers being almost the same for children living in urban and rural areas.Of particular concern is the growing double burden of stunted and overweight children because of parents increasingly relying on calorie-dense foods that lack the nutrition children need to grow and develop. While there is no estimate for under-5 obesity in India, 42 million children under age 5 are overweight worldwide, up from 31 million in 2000.Ravi Choudhary/HT Photo Poor nutrition in the first 1,000 days of life causes irreversible damage to the child’s body and mind.Critical thousand daysPoor nutrition in the first 1,000 days of life causes irreversible damage to the child’s body and mind. In extreme cases, malnutrition kills and is responsible for nearly half of the world’s 5.9 million under-5 deaths – 16,000 each day, estimates the World Health Organisation. One in five of these deaths take place in India.Poor nutrition not only makes children smaller than average, but also lowers their immunity and puts them at risk of frequent infections and nutrition-related diseases, such as diabetes, hypertension and obesity as adults. Undernourished children have reduced muscle strength and lower learning abilities and IQ. Unicef estimates that stunted adults lose at least 10% decrease in future income over their lifetime.Unhealthy diets lead to a vicious cycle of malnourishment. Adolescent girls who are undernourished – whether from poverty, unhealthy food choices or dieting for weight loss–have several nutritional deficiencies, including anaemia. Close to three in four adolescent girls in India are anaemic and around 50% have low body weight, which affects health of their future pregnancies and children. Babies of undernourished young women are likely to have low birth weight (less than 2.5 kg at birth), which once again starts the cycle of undernourishment that stalks their health through lives.Sanitation woesWorldwide, stunting rates are higher among under-5 boys than girls in almost all countries except those in south Asia. Globally, initial review suggests that the higher risk for preterm birth among boys (which is inextricably linked with low birth weight) is a reason for this gender-based disparity in stunting.In India, however, the stunting across genders is almost uniform, most likely because low birthweight is common irrespective of the baby’s gender. Social bias in favour of sons is also likely to lead to the mother of a baby boy being provided better food, leading to baby girl’s being undernourished. A moderately malnourished mother produces enough milk to feed her baby, but if she is severely malnourished, the quantity of breast milk produced for each feeding may be diminished. A breastfeeding mother needs 500 additional calories each day than before she was pregnant, from a diet that includes adequate protein, vitamins and minerals, including iron, calcium, vitamin A and folic acid.Himanshu Vyas/HT PhotoAdding to the problem, especially in rural areas and urban slums, is the unavailability of safe drinking water and poor sanitation, which causes frequent childhood infections such as diarrhoea, which compound malnourishment. (For representational purposes)Adding to the problem, especially in rural areas and urban slums, is the unavailability of safe drinking water and poor sanitation, which causes frequent childhood infections such as diarrhoea, which compound malnourishment. Each episode of diarrhoea leads to vital nutrients being lost from the body, with repeated infections leading to chronic malnutrition and stunting. Diarrhoea continues to kill 1.2 lakh under-5 children in India each year, which makes it the second biggest cause of childhood death in India.With 565 million people in India still without toilets, the risk of frequent infections remains high. Newborns and children are handled by mothers, extended family and friends, so the potential of disease from contaminated hands and surroundings remains high. Hygiene lowers risk, as does giving children the nutrition they need to fight infection.Follow @htlifeandstyle for more.