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An Overview of Infant and Young Child Feeding, 6-24 Months
Jean Baker, AED/LINKAGES
Outline
I. The “Big Picture” and How to Impact It
II. A Better Understanding of the Issues
III. The Role for Processed Complementary Foods
Complementary Feeding is…
Then: Weaning foods…complementary 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.
The ‘Big Picture’ and How to Impact It
General_2000.shp2 - 1111 - 2020 - 2828 - 3737 - 46
150 Million Children are Underweight
Prevalence of underweight in children 0 - 4 years old
de Onis and Blossner, 2001
Malnutrition Happens Early
-2
-1.5
-1
-0.5
0
0.5
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
Age (months)
Z-s
core
(N
CH
S)
Africa Asia Latin America and Caribbean
Weight for age by region
-2.5
-2
-1.5
-1
-0.5
0
0.5
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60
Age (months)
Z-s
core
(N
CH
S)
Africa Asia Latin America and Caribbean
“Virtually all growth faltering occurs in the first 2 years, most of it during infancy”
Length for Age by Region
Malnutrition has a Lasting ImpactWorldwide 182 Million Children are Stunted
Both girls are 3 ½ years old
0
10
20
30
40
50
60
70
Africa Americas E. Medit E. Europe South Asia USA
Anemia Prevalence by Global RegionAges 0-4 years
5 million Children Die Annually from the Underlying Causes of Malnutrition
Estimated contribution of undernutrition to under-five mortality by cause
0%
20%
40%
60%
80%
100%
Diarrhoea Malaria Pneumonia Measles All-cause
Proportion of deaths associated with undernutrition All Deaths
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.
Top Three Prevention Interventions
Prevention Intervention Number Deaths prevented (% of all <5
deaths) (thousands)
1. Breastfeeding 1,301 13%
2. Insecticide-treated materials 691 7%
3. Complementary feeding 587 6%
Source: Lancet, 2003
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
A Better Understanding of the Issues
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
Issue One: Suboptimal Feeding Practices (Birth – 24 months)
Non-Exclusive Breastfeeding
Currently only about 39% of infants worldwide are exclusively breastfed during the first 6 months of life
Poorly Timed Complementary Feeding
Prevalence of Timely Complementary Feeding, 1995 and 2002
64
40 4046
6572
5660
0
10
20
30
40
50
60
70
80
Africa Region Region of theAmericas
South EastAsia Region
GlobalEstimates
19952002
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
Inadequate Food Quality & Quantity
• Inadequate energy density
• Too much bulk or too diluted
• Too little variety• Too few
micronutrients, especially iron
Poor Feeding Methods, Hygiene, and Child Care Practices
• Unsupervised feedings • Lack of interaction
and encouragement• Contaminated foods
and utensils• Poor food hygiene
Issue Two: Nutrient Gaps During Complementary Feeding Period
(6-24 months)
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
Energy Gap - Contribution of Breastmilk during Complementary
Feeding Period
The Iron Gap
Issue Three: Measuring Complementary Feeding
Measurement Issues Timely Complementary Feeding (TCF) indicator is
problematic, time-bound, and gives no information regarding:
- Quality
- Frequency
- Food diversity
- Caregiver practices
Issue Four: What Effect Does HIV and AIDS Have on
Complementary Feeding?
Special Challenge: HIV and Infant Feeding
The Role for Processed Complementary Foods
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
Why now? What’s 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
29
1517
5355
42
74
37 37
76
47
85
54
61
82
World Africa Asia Latin America/Caribbean
More DevelopedRegions
1950 2000 2030
Source: United Nations, World Urbanization Prospects: The 2003 Revision (medium scenario), 2004.
Trends in Urbanizationby Region
Summary - Challenges
• Show impact on child growth/health
• Increase geographic coverage & scale
• Ensure safeguards for breastfeeding
• Focus on behaviors and food quality
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
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
Thank You!