An Overview of Infant and Young Child Feeding, 6-24 Months

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An Overview of Infant and Young Child Feeding,
6-24 Months

• Jean Baker, AED/LINKAGES

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Outline

• I. The Big Picture and How to Impact It
• II. A Better Understanding of the Issues
• III. The Role for Processed Complementary Foods

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Complementary Feeding is

• Then Weaning foodscomplementary foods
• Period when other foods or liquids are provided
  along with breastmilk
• Now Period when child receives both breastmilk
  (or a breastmilk substitute) and solid or
  semi-solid food.

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The Big Picture and How to Impact It
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150 Million Children are Underweight Prevalence
of underweight in children 0 - 4 years old
de Onis and Blossner, 2001
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Malnutrition Happens Early
Weight for age by region
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Virtually all growth faltering occurs in the
first 2 years, most of it during infancy
Length for Age by Region
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Malnutrition has a Lasting ImpactWorldwide 182
Million Children are Stunted

• Both girls are 3 ½ years old

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Anemia Prevalence by Global RegionAges 0-4 years
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5 million Children Die Annually from the
Underlying Causes of MalnutritionEstimated
contribution of undernutrition to under-five
mortality by cause
Sources For cause-specific mortality
EIP/WHO. For deaths associated with
malnutrition Caulfield LE, Black RE.
Malnutrition and the global burden of disease
underweight and cause-specific mortality.
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Top Three Prevention Interventions

• Prevention Intervention Number
  Deaths prevented ( of
  all lt5 deaths)
• (thousands)
• 1. Breastfeeding
  1,301 13
• 2. Insecticide-treated materials 691 7
• 3. Complementary feeding 587
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• Source Lancet, 2003

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Further EvidenceEfficacy Trials Programs in 14
Countries

• Child growth improved with increased dietary
  intake (as measured by anthropometry)
• Nutritional improvements support Lancet estimates
  of reductions in undernutrition and mortality
• Studies verified importance of feeding practices,
  not just food
• Source Caulfied, Huffman, Piwoz, 1999

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A Better Understanding of the Issues
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Causes of Poor Growth in Infants and Young
Children

• Poor maternal nutritional status at conception
  and undernutrition in utero
• Suboptimal feeding practices
• Impaired absorption of nutrients due to
  intestinal infections or parasites
• Combination of above

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• Issue One Suboptimal Feeding Practices (Birth
  24 months)

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Non-Exclusive Breastfeeding

• Currently only about 39 of infants worldwide
  are exclusively breastfed during the first 6
  months of life

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Poorly Timed Complementary FeedingPrevalence of
Timely Complementary Feeding, 1995 and 2002
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Infrequent Feeding

• Because of small stomach size, children need to
  be fed frequently throughout the day
• Labor, time, and resource constraints are often
  obstacles to frequent feedings

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Inadequate Food Quality Quantity

• Inadequate energy density
• Too much bulk or too diluted
• Too little variety
• Too few micronutrients, especially iron

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Poor Feeding Methods, Hygiene, and Child Care
Practices

• Unsupervised feedings
• Lack of interaction and encouragement
• Contaminated foods and utensils
• Poor food hygiene

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• Issue Two Nutrient Gaps During Complementary
  Feeding Period
• (6-24 months)

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Nutrient Gaps

• Breastmilk important source of energy, fat, and
  other nutrients and continues to protect against
  illness and death
• But complementary foods needed to meet increasing
  nutrient needs of the growing child

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Energy Gap - Contribution of Breastmilk during
Complementary Feeding Period
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The Iron Gap
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• Issue Three Measuring Complementary Feeding

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Measurement Issues

• Timely Complementary Feeding (TCF) indicator
  is problematic, time-bound, and gives no
  information regarding
• - Quality
• - Frequency
• - Food diversity
• - Caregiver practices

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• Issue Four What Effect Does HIV and AIDS Have
  on Complementary Feeding?

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Special Challenge HIV and Infant Feeding
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• The Role for Processed Complementary Foods

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History of Processed Complementary Foods

• 1950s - Concern about protein intake
• 1960s - Failure of processed foods to reach low
  income kids
• 1977 - Review showed little impact on nutrition
• (beginning of Nestle boycott)
• 1980 - Code of Marketing Breastmilk Substitutes
• Late 1980s - Shift from commercial to
  community-based focus

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Why now? Whats changed?

• Lancet endorsement of CF
• Improved technology
• More palatable formulations
• Improved marketing, transport, logistics
• Increased demand for products and buying
  power
• Greater experience in building private/ public
  sector partnerships
• Urbanization

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Trends in Urbanizationby Region
Source United Nations, World Urbanization
Prospects The 2003 Revision (medium scenario),
2004.
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Summary - Challenges

• Show impact on child growth/health
• Increase geographic coverage scale
• Ensure safeguards for breastfeeding
• Focus on behaviors and food quality

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Global Framework for IYCF

• Recognizes CF has received less attention
• Embraces feeding continuum
• Recommends viewing CF in broader framework
• Updates calorie nutrient needs
• Provides impetus for new guiding principles
  for CF

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Guiding Principles for Complementary
Feeding(PAHO, WHO, 2001)

• Excl BF duration and age of intro of CF
• Maintenance of BF
• Responsive feeding
• Safe preparation and storage of CF
• Amount of CF needed
• Food consistency
• Meal frequency and energy density
• Nutrient content of CF
• Use of vitamin mineral supplements or fortified
  products for infant and mother
• Feeding during/after illness

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Thank You!