Infant and Young Child Feeding

1. Infant and Young Child Feeding Ms Mumtaz Khalid Ismail Consultant Nutritionist NRHM

2. Why Is Infant And Young Child Feeding So Important? • They are at the most vulnerable age • Poor Intake of food is common during first two years (Quantity And Quality) • Poor feeding practices result in malnutrition, contribute to impaired cognitive and social development, poor school performance • Cause of malnutrition which is responsible directly or indirectly for 60% death among under five.

3. Correct Norms for Infant andYoung Child Feeding • Initiation of breastfeeding immediately after birth, preferably within one hour. • Exclusive breastfeeding for the first six months • Receives only breast milk and nothing else, no other milk. Food, drink or water. • Appropriate and adequate complementary feeding from six months of age while continuing breastfeeding. • Continued breastfeeding up to the age of two years.

4. Infant and Young Child Feeding practices * Source: District Level Household Surveys

5. Nutritional Status of Children * Source: National Family Health Survey (NFHS-3)

6. The Tenth Plan -nutrition goals by 2007. 1. Intensify nutrition &health education to improve IYCF & caring practices to: • Bring down the prevalence of under-weight children <3yrs from the current level of 47% to 40%; • Reduce prevalence of severe Under nutrition in children in the 0-6 years age group by 50 per cent 2. Enhance early initiation of BF (colostrum feeding) from the current level of 15.8 % to 50 % 3. Enhance the exclusive BF rate for the first six months from the current rate of 55.2 % (for 0-3 months) to 80 % 4. Enhance the complementary feeding rate at six months from the current level of 33.5 per cent to 75 per cent.

7. The objectives of the national guidelines on IYCF • To advocate IYCN and its improvement through optimal feeding practices • To disseminate widely the correct norms of BF & complementary feeding from policy making level to the public at large in different parts of the country in regional languages • To help plan efforts for raising awareness and increasing commitment of the concerned sectors of the govt, NGOs and professional groups for achieving optimal feeding practices for infants and young children • To achieve the national goals for IYCF practices set by the planning commission for the 10th five year plan so as to achieve reduction in malnutrition levels in children.

8. 0 – 6 months • Energy 110 to 140 kcal / kg • Protein requirement is about 2 gm/kg • Calcium 500mg/day • Best food for the neonate is mother’s milk

9. Infant And Young Child Feeding Practices • Breastfeeding is the best way to satisfy the nutritional and psychological needs of the baby. • Mother’s milk is designed for easy digestion and assimilation. • Protein in mother’s milk is in a more soluble form which is easily digested and absorbed by the baby. • Fat and calcium in human milk which are also easily absorbable. • The amount of vitamins such as thiamine, vitamin A and vitamin C found in mother’s milk depends on the diet of the mother.

10. Advantages of breastfeeding • The best natural food for babies. • Is always clean. • Protects the baby from diseases. • Makes the child more intelligent. • Available 24 hours a day & requires no special preparation. • Nature’s gift to the infant and does not need to be purchased. • Makes a special relationship between mother and baby. • Helps parents to space their children. • Helps a mother to shed extra weight gained during pregnancy.

11. Summary of differences between milks

12. RDA 6 to 12 months • Energy 98 kcal/kg • Protein 1.65 gm/kg • Calcium 500mg/kg • Vitamin A 1550mcg/d • Vitamin B1 50mcg/kg, B2 65mcg/kg • Vitamin C 25mg/d

13. Importance of Complementary Feeding • To meet the growing needs of the growing baby. • An infant weighing around 3kg at birth doubles its weight by six months and by one year the weight triples and the body length increases to one and a half times than at birth. • Most of the growth in the nervous system and brain is complete in the first two years of life.

14. COMPLEMENTARY FEEDING • Complementary feeding at six months • First food for the baby- Porridge can be made with suji, broken wheat, ground rice, ragi, millet etc • Traditional foods for infants – mixed food like khichidi,dalia, suji kheer, upma, idli, dokhla. • Modified family food-rice or wheat preparation couldbe mixed with pulse and/or vegetable • Mashed potato, carrots, cauliflower, pumpkin, spinach • Weekly 3 – 4 cooked eggs • 9 -10 months fish, chicken, and meat

15. Ensuring safety of complementary foods • Hands should be washed with soap and water • Utensils used should be scrubbed, washed well, dried and kept covered. • Cooking kills most germs. • After cooking, handle the food as little as possible and keep it in a covered container • Cooked foods should not be kept for >2 hours. • The hands of both mother and child should be washed before feeding the child.

16. 1 to 6 years • Fuzzy eating starts at this time • Need 5 to 6 meals per day • Require high protein, high calorie, high calcium, iron rich diet • No restriction on fat but avoid fried food

17. RDA 1to 3 and 4 to 6 years • Energy 1240kcal/d, 1690 kcal/d • Protein 22gm/d, 30gm/d • Fat 25gm/d • Calcium 400mg/d • Iron 12mg/d, 18mg/d

18. Energy density of foods can be increased by • By adding a teaspoonful of oil or ghee in every feed. • By adding sugar or jaggery to the child’s food. • By giving malted foods. Malting reduces viscosity of the foods and hence child can eat more at a time. Malting is germinating whole grain cereal or pulse, drying it after germination and grinding. • By feeding thick mixtures.

19. FEEDING IN DIFFICULT CIRCUMSTANCES • Malnourished infants • Preterm or Low Birth Weight Infants • Feeding During Emergencies • Feeding in Maternal HIV – if AFASS AF, exclusive BF or exclusive artificial feeding

20. Feeding during and after illness • Malnourishment increases incidence & severity of infection • Sick child needs more nourishment • children with measles, diarrhoea and RTI must eat plenty of vitamin A rich foods • After the illness, a nutritious diet with sufficient • Energy, protein and other nutrients enable him to catch up growth &replacement of nutrient stores.

21. Take-home Messages • Malnutrition is a serious and prevalent problem • Malnutrition Increases Morbidity And Mortality and decreases Educational Achievement and lifetime earnings • Inadequate Infant And Young Child Feeding is the major cause of Malnutrition • Inadequate IYCF is not primarily due to lack of food (Quantity), But because of poor practices at the household level • Lack of Information about how feeding young children is a major reason for poor Breastfeeding and complementary feeding of Infants and young children

22. Thank You