Action to improve infant and young child feeding in nutrition and child health programmes
A mother prepares porridge from
soy-fortified bulgur in Guatemala
Proceedings of meeting1
Over 50 researchers, programme implementers, infant feeding experts and representatives of WHO and UNICEF headquarters departments and regional offices gathered in Geneva in October 2008, to discuss how to fill the gap between the progress that has been made in defining principles for appropriate feeding for infants and young children from 6 to 23 months and translating these into specific policies and programmes.
Participants recognised that there are not enough examples of well-documented, largescale programmes that have successfully improved feeding practices in children 6-23 months of age and resulted in improved health outcomes. Therefore, there are important weaknesses in the evidence base for effective actions. Nevertheless, the evidence is strong to support the following conclusions:
- Recommendations for optimal infant and young child feeding include that infants should be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health, and thereafter, they should receive nutritionally adequate and safe complementary foods while breast feeding continues up to 2 years or beyond.
- The Global Strategy for Infant and Young Child Feeding, endorsed by WHO Member States and the UNICEF Executive Board in 2002, provides the overall framework for actions needed to protect, promote and support appropriate feeding practices in infants and young children 0-23 months of age.
- The Planning Guide that accompanies the Global Strategy is intended to assist country teams to develop national plans of action to improve child nutrition. The Guide outlines what needs to be done to protect, promote and support breastfeeding. However, it should be updated to give further clarity on what is needed to strengthen complemen tary foods and feeding practices in children 6-23 months of age.
- Acknowledging the critical contribution of continued breastfeeding to child nutrition, the meeting focused mostly on evidencebased and feasible options to improve the quality of complementary foods and on caregivers' practices to enhance their intake.
- Appropriate nutrition in children 6-23 months of age requires interventions across the life span, from pregnancy into the first 2 years of life. They include support for maternal nutrition2, early initiation of breastfeeding, exclusive breastfeeding for 6 months, and the introduction of adequate complementary foods at 6 months with continued breastfeeding for 2 years of age or beyond. Influencing appropriate feeding practices is as critical as influencing avail ability and use of adequate foods.
- Quality counselling of mothers and caregivers, and appropriate behavioural change communication to other family and community decisionmakers, are essential for improving infant and young child feeding practices. They should be at the centre of any strategy to improve infant and young child nutrition.
- Similarly, strategies should maximise the utilisation of locally produced foods in any given setting, and consider the promotion of additional products only if they can fill a critical gap in nutrients in an acceptable, feasible, affordable, sustainable and safe way, as a complement to continued breastfeeding and the local diet, not as a replacement.
- Where locally available foods alone will not satisfy nutritional requirements, various types of products offer promise. They may include centrally produced fortified foods, micronutrient powders, and lipid-based nutrient supplements. Further research and carefully monitored applications at scale are needed to generate more evidence on which product is best for which circumstance, how best to promote their correct utilisation, and their contribution to improving nutritional, developmental and health status in different circumstances.
Effective programme design and delivery
1Strengthening action to improve feeding of infants and young children 6-23 months of age in nutrition and child health programmes. Geneva, 6-9 October 2008. WHO, UNICEF. Report of Proceedings. Available from WHO website or direct link: http://whqlibdoc.who.int/publications/2008/9789241597890_eng.pdf
2Although not addressed at this meeting, other practices, such as delayed umbilical cord clamping to enhance newborn body iron stores and micronutrient supplementation and nutrition during pregnancy, are also very important for young child nutrition.
Taken from Field Exchange Issue 36, July 2009