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

Objectives: This paper reports the effects of an energy and micronutrient s upplementation on quantitative and qualitative aspects of play among poorly nourished children. At issue is whether the supplement led to a progressio n 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. Supplementa tion was given for 6 months. Evaluations of play behavior were repeated fou r times. Setting: The sites were six tea plantations in Pangalengan, West Java. Subjects: The present study utilized a subsample of 55 children recruited f or the larger Pangalengan project 6 months into the study. Thirty-eight chi ldren were recruited late enough to allow for longitudinal observations. Th e remaining cases were used for cross sectional observations only. Inclusio n criteria were: no chronic disease; length-for-age less than or equal to - 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 f or 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 i ncreased functional play but boys showed the opposite effect. Children in t he S group were breastfed more during play as compared to the E group. Chil dren in the E group waited less to begin play.