Effects of an energy and micronutrient supplement on mental development and behavior under natural conditions in undernourished children in Indonesia

Objectives: This paper reports the effects of an energy and micronutrient s upplement on mental development and on the social-cognitive and emotionally regulatory behaviors of nutritionally at risk infants and toddlers in Pang alengan, Indonesia. 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 kJoule. Supplem entation was given for 12 months. Setting: The sites were six tea plantations in Pangalengan, West Java. Subjects: A 12-month-old (N = 53) and an 18-month-old (N = 83) cohort were recruited from day-care-centers. Twenty children who received S belonged to the 12- and 18-month-old cohort. Inclusion criteria were: no chronic disea se; length-for-age less than or equal to -1 standard deviation (s.d.) and w eight-for-length between -1 and -2 s.d. of the median of the reference of t he World Health Organization. Methods: Evaluations of intake were made at baseline and every 2 months the reafter. Motor development was assessed with the Bayley Scale and with a cu stom-made scale to assess gross motor development leading to bipedal locomo tion. Four hours of continuous observations were made of the child's intera ction with the social and physical environment. Results: In the 12-month-old cohort, as compared with the M and S groups, t he children who received the E supplement walked at an earlier age, had hig her scores in the Bayley Scale and showed more mature social-cognitive and emotional regulatory behaviors. Similar intergroup differences were observe d in the 18-month-old cohort in social cognition and regulation of emotions .