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8/7/2019 malik IYCF
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Dr. Malik Shahnawaz Ahmed
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` Child is the chief victim of interplay of nutrition, socio-
economic and health factors that cause malnutrition.
` The steep rise in malnutrition in children during the first two
years of life is indicative of poor infant feeding practices
` WHO: 2/3rd of all under five deaths are related to POOR
FEEDING.
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Malnutrition strikes the most in infancy beginning in 3Malnutrition strikes the most in infancy beginning in 3--44thth month , 29month , 29--30 % at 6 months, goes up and peaks30 % at 6 months, goes up and peaksabout 46% by 18 months, flat curve after that (NFHSabout 46% by 18 months, flat curve after that (NFHS3).3).
Years of life
Brain development
Underweight (-2sd) NFHS-3
Over 60 million
10 lakh children
die during
first month,
14 lakhs by
1 year, and 20 lakhs
by 5 yrs. 2/3rd are related to poor feeding.
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Diarrhoea
Neonatal
disordersUnknown
Pneumonia
Measles
Malaria
OtherAIDS Neonatal disorders
Diarrhoea
Pneumonia
Breastfeeding is the No. 1 preventive intervention compared to any other intervention
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1
2
3
4
6
15
4
6
15
0 2 4 6 8 10 12 14 16
Measles vaccine
Vitamin A
Water, sanitation, hygiene
Clean delivery
Complementary Feeding
Breastfeeding
Newborn resuscitation
Antibiotics for pneumonia
Oral rehydration therapy
Percentages
U-5 child deaths (%) saved by universalising
key interventions in India
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� WHO introduced InternationalCode for Protection &
Promotion of Breastfeeding in 1981.
� Indian govt. adopted a National Code for Protection
& Promotion of Breastfeeding in 1983.
� IMS act was passed in 1992.
� Major drawback in these was to promote exclusive
breastfeeding for 4-6 months,
� This was used as a lacunae by MNCs which started
promoting infant milk substitutes from 3rd month
onwards.
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� Landmark decision was taken in WHA May, 2001 (54.2) to
promote exclusive breastfeeding for first 6 months.
� IMS act was also ammended along the same line to extend
exclusive breastfeeding to 6 months and bringing infant foodsat par with infant milk substitutes in so far as advertising,
promotion and other regulation are concerned.
�
Ammended in 2003 and implemented from 1
st
Jan 2004
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` A new resolution on Infant & Young Child Nutrition(55.2
WHA) was adopted in May 2002 by 55th WHA.
` ³ Breastfeeding is an unequalled way of providing ideal
food for healthy growth & development of infants; it is also
an integral part of reproductive process with important
implications for health of mothers. As a global publichealth recommendation, infants should be exclusively
breastfed for first six month of life to achieve optimal
growth, development and health. Thereafter, to meet their
evolving nutritional requirements, infants should receive
nutritionally adequate & safe complimentary foods whilebreastfeeding continues for upto two years of age or
beyond´- WHO, 2002.
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` National guidelines on IYCF launched 6 August, 2004
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` Intensify nutrition and health education to improve infant and
child feeding and caring practices so as to:
a. bring down the prevalence of under-weight children under
three years from the current level of 47 per cent to 40 per
cent;
b. reduce prevalence of severe Undernutrition in children in
the 0-6 years age group by 50 per cent;
10th Five year Plan
GOALS
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50.0%
80.0%75.0%
15.8%41.2% 33.5%
40%60%
80%
Exclusive
breastfeeding
(0-6 months)
Complementary
feeding (6-9 months)
100%
80%
NFHS-2NFHS-2 N H N
Initiation of
Breastfeeding
within 1 hr
xclusive
breastfeedingComplimentary feeding
60%
40%
20%
0%
1 th Five year lan
S
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` to advocate the cause of infant and young child nutrition
and its improvement through optimal feeding practicesnationwide
` to disseminate widely the correct norms of breastfeedingand complementary feeding from policy making level to the
public at large in different parts of the country in regionallanguages
` to help plan efforts for raising awareness and increasingcommitment of the concerned sectors of the Government,national organisations and professional groups
` to achieve the national goals for Infant and Young ChildFeeding practices set by the Planning Commission for theTenth Five Year Plan so as to achieve reduction in malnutritionlevels in children.
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A. Technical Guidelines
` 1. Breastfeeding
` 2. Complementary feeding
` 3. Feeding in the context of HIV infection
` 4. Feeding in other specific situations
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B . Operational Guidelines
` 1. Recommendations for Governmental andInternational Agencies
` 2. Role of NGOs
` 3. Recommendations for the media.
` 4. Training recommendations
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Nutritional superiority of breast milk
` best natural food for babies.
` always clean.
` protects the baby from diseases.
` makes the child more intelligent.
` available 24 hours a day and re uires no special preparation.
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` Breast milk is nature¶s gift to the infant and does not need to
be purchased.
` Breastfeeding makes a special relationship between mother
and baby.
` Breastfeeding helps parents to space their children.
` Breastfeeding helps a mother to shed extra weight gained
during pregnancy.
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` the baby should receive the first breastfeed as soon aspossible and preferably within half an hour of birth.
` To establish successful lactation as well as for providing
µColostrum¶.
` New born baby is very active during the first half anhour and if the baby is kept with the mother and effort ismade to breastfeed, the infant learns sucking very fast.
` Skin to skin contact between the mother and new bornshould be encouraged by µbedding in the mother andbaby pair¶.
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` No prelacteals should be given.
` The new born should be kept warm by promoting K angarooMother Care and promoting local practices to keep the room
warm.
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` more protein (upto10%) ; less fat and carbohydrate
` the f irst immunisation a child receives.
` Some mothers consider this first milk as something
dirty and indigestible.
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` babies are given only breast milk and nothing else ± no other
milk, food, drinks and not ever water for first 6 months.
` must be remembered that benefits of breastfeeding are
reduced if it is not exclusive breastfeeding.
` saves babies from diarrhoea and pneumonia. It also helps in
reducing specially the ear infections and risk of attacks of
asthma and allergies.
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` Addition of even a single feed of the animal or powder
milk, any other food or even water has two
disadvantages;
1) reduces lactation
2) inc. chances of infection
` No Bottles, Artificial
Teats or Pacifiers for
Breastfeeding Infants
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4.62
2.49
3.04
2.48
2.8
0
1
2
3
4
iarr eartality
Pne niartality
Diarr eainci ence
Pne niainci ence
ll ca sertality
Ex, r
. f
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` Baby should be fed ³on cues´.
` Working mothers should be encouraged to continue
exclusive breastfeeding for 6 months by expressing milk for
feeding the baby while they are out at work.
` The concept of ³Hirkani¶s rooms´ may be considered at
work places.
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` Ever y t er, s ecially t e first ti e t er s l receive
bre stfee i s rt fr t e ct rs and t e nursing
staff, r community ealt or ers regar ding c rrect
siti i , l tc i and treatment of r oblems, such as
breast engor gement, ni le fissures, etc.
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` Mouth wide open
` Lower lip is turned outside
` Chin touching the breast
`
areola not visible below thelower lip
` areola and nipple includingmilk collecting ducts areinside baby¶s mouth
` Tongue under the teat
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` Expectant mothers, particularly primiparas, and those who
have experienced difficulties with lactation
management, should be motivated and prepared for early
initiation of breastfeeding and exclusive breastfeeding.
` In the last trimester of pregnancy, breasts and nipples should
be examined and relevant advice given.
` Antenatal checkups and maternal tetanus toxoid immunisationcontact points should be utilised.
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`
The purpose of complementary feeding is to complement the breast milk and make certain that the young child continues to
have enough energy, protein and other nutrients to grow
normally.
` Roasted flour of any cereal can be mixed with boiled
water, sugar and a little fat to make the first complementary
food for the baby.
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` Complementary food should be :
1. Culturally acceptable
2. Ade uate to provide all nutritional re uirement
3. Locally available & inexpensive
4. Easily prepared at home
5. Physiologically suitable, easily digestable & nourishing
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Energy Density of Infant Foods
` can be increased in four different ways:
1. By adding a teaspoonful of oil or ghee in every feed.
2. By adding sugar or jaggery
3. By giving malted foods(Amylase Rich Flour)
4. By feeding thick mixtures.
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Instant Infant Foods
three parts of any cereal (rice/wheat) or millet (ragi, bajra jowar )
+
one part of any pulse (moong/channa/arhar )
+
half part of groundnuts or white til , if available
` Roast each of these seperately, mix & store in airtight
containers.
` For feeding, take two tablespoons of this infant food mix, add
boiled hot water or milk, sugar or jaggery and oil/ghee and
mix well.
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Fre e c f fee i
AGE TEXTURE FREQUENCY
AVERAGE
AMOUNT OF EACH MEAL
6-8 months Start with thick
porridge, well
mashed foods
2-3 meals per day
plus fre uent
breastfeeding
Start with 2-3
tablespoonfuls
9-11 months Finely chopped or
mashed foods, and
foods that baby
can pick up
3-4 meals plus
breastfeed,
Depending on
appetite offer 1-2
snacks
½ of a 250 ml
cup/bowl
12-23 months Family foods,chopped or mashed
if necessary
3-4 meals plus breastfeed,
Depending on
appetite offer 1-2
snacks
3/4 to one 250 mlcup/bowl
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Acti e fee i
` Adopting caring attitude hile feeding the ba by li e tal ing to the child, playing ith the child stimulates a ppetite and
development.
` ne-t o year old child should be given f ood on a
se parate plate and encouraged to eat on its own.
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` Hands should be washed with soap and water before handling
the food
` 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 protected from dust and flies.
` Cooked foods should not be kept for more than one to two
hours in hot climate unless there is a facility to store them at
refrigeration temperature.
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Gr t it ri r ti (GMP)
`
Infants and young children should bewe
ied
eve
r tin the presence of their mothers and the gr owth status of the
child should be explained to the mother.
` If the child is having mal triti , the mothers should be
advised to r vide additi al f d to the child ever y day.
` Malnourished children should be f ll wed at me and
mothers encouraged to come and as questions regar ding the
feeding and care of the child.
` Utilising the availa ble nutriti n and ealt services
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15.8
41.2
35
24.5
46.4
56.7
40.246.4
23.9
0
20
40
60
Initiation of
Breastfeeding within 1hour of birth
Exclusive breastfeeding
(0-6 months)
Complementary Feeding
(6-9 months)
NFHS-2 (98-99) NFHS-3 (2005-06) DLHS-3 (2007-08)
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Initiation of BF within
1 hour
Exclusive breastfeeding
RED 138(0-29%) 112 (0-11%)
YELLOW 197(30-50%) 373(11-49%)
BLUE 194(50-90%) 49(50-89%)
GREEN 5(90% or above) 0( 90% and above)
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0 1 0
2 0
3 0
4 0
5 0
6 0
7 0
Mizoram
Goa
MeghalayaManipur
Kerala
Tamil Nadu
Arunachal
Orissa
Maharashtra
Nagaland
Assam
Himachal
Sikkim
Karnataka
Tripura
UttaranchalJ&K
Gujarat
Chattisgarh
West Bengal
INDIA
Andhra
Haryana
Delhi
MP
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0 1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
1 0 0
Kerala
Sikkim
Mizoram
Manipur
Tamil Nadu
Arunachal
Meghalaya
Karnataka
Nagaland
Goa
Orissa
Himachal
Jharkhand
Andhra
Delhi
Tripura Assam
J&K
Bihar
Gujarat
West Bengal
INDIA
Chattisgarh
MP
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INDICATOR %
INITIATION OF BREASTFEEDING WITHIN 1
HOUR
8.9%
EXCLUSIVE BREASTFEEDING 5. %
COMPLIMENTARY FEEDING 4.4%
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5145
4340
2023
0
10
20
30
40
50
60
Stunted Underweight Wasted
NFHS-2 NFHS-3
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Child n und g y s who und w ight
6 6
6
6
66
S K
M Z
M N
K E
P J A
N A
J K
D L
T N
A P
A R
A S
H P
M H
K A
U T B
H R
T R
R J
O R
U P I N G
J C H
M G
B H
J H
M P
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7479
45
0
10
20
30
40
5060
70
80
90
Any anaemia Severe anaemia
NFHS-2 NFHS-3
Anaemia among Children Age 6Anaemia among Children Age 6--35 Months35 Months
Percent
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Anaemia revalenceAnaemia revalence tatetate
Anaemia prevalenceAnaemia prevalence
more than 70 percentmore than 70 percent
Bihar Bihar adhya rade hMadhya rade h
Uttar rade hUttar rade h
Har yanaHar yana
Chhattisgar hChhattisgar hAndhra radeshAndhra radesh
KarnatakaKarnataka
harkhandharkhand
Anaemia prevalenceAnaemia prevalence
Less than 50 percentLess than 50 percent
GoaGoaManipur Manipur
MizoramMizoram
KeralaKerala
Anaemia Is WidespreadAnaemia Is Widespread
throughout Indiathroughout IndiaChildren age 6-59 months
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79
85
56
6873
47
5762
42
Ur R r l T al
NFHS-1 NFHS-2 NFHS-3
NFHS-3, India, 2005-06
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62
54
52
42
35
72
63
55
51
42
78
78
55
59
44
BCG
Polio3
DPT3
M le
All V ine
NFHS-1 NFHS-2 NFHS-3 NFHS-3, India, 2005-06
Percent of children age 12-23 months vaccinated
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` 2006 guidelines suggested that health workers should
individually counsel all HIV positive mothers and help themeach determine the most appropriate infant feeding strategy for
their circum-stances.
` National health authorities have to decide whether they willrecommend that all HIV infected mothers will breast f eed and
receive ARV interventions OR will avoid all breast f eeding.
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` WHO recommendations advocate that all mothers known to be
HIV-infected should be provided with antiretroviral therapy
or antiretroviral prophylaxis to reduce mother to child
transmission and in particular to reduce postnatal transmission
through breastfeeding.
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mothers who are known to be HIV negative
OR
HIV status is unknownOR
infants of HIV +ve mothers known to be HIV-infected
exclusively breastfeed their infants for the first six months of
life and then introduce complementary foods while continuing
breastfeeding for 24 months or beyond.
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HIV+ve mothers on ARV therapy or prophylaxis
(whose infants are HIV-ve or of unknown HIV status)
exclusively breastfeed for the first 6 months of life, introducing
appropriate complementary foods thereafter, and continue breastfeeding for the first 12 months of life.
Mother on zidovudine prophylaxis«.. baby should receive
daily Nevirapine from birth until one week after all exposureto breast milk has ended
Mother on tripple ARV prophylaxis..... Nevirapine from birth to
6 weeks
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` Whenever I -infected mothers decide to stop
breastfeeding, it should be done gradually within one month.
` If a I positive mother chooses not to breastfeed in s pite of
receiving ARV pr ophylaxis
` Zidovudine or evira pine is indicated f or wee s f or the ba by
fr om birth.
R e placement feeding
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` the process of feeding a child who is not receiving any breast
milk, with a diet that provides all the nutrients until the child is
fully fed on family foods.
` AFASS criteria must be completely fulfilled
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` Cup feeding should be the method of choice
`
If any of the AFASS criteria is not met
` exclusive breastfeeding till 6 months along with early
treatment of breast and nipple problems of HIV+ve mother.
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` For infants less than 6 months of age
(i) Expressed, heat-treated breast milk
(ii) Unmodified animal milk
(iii) Commercial infant formula milk.
` For children over 6 months of age
(iv) All children can be given complementary
food from six months of age
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` Other options for all ages
(v) Breastfeeding by another woman who is HIV
negative (wet-nursing)
(vi) Human milk from breast milk banks
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Feeding during sickness
` continue to breastfeed
` encourage to eat small uantities of nutrient rich food but
more fre uently.
` After the illness the nutrient intake of child can be easilyincreased by increasing one or two meals in the daily diet for a
period of about a month.
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Infant feeding in maternal illnesses
` breast abscess and mastitis and psychiatric illnesses which pose a danger to the child¶s life
` Treatment of primary condition
` breastfeeding started as soon as possible.
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` Chronic infections like tuberculosis, leprosy, or medical
conditions like hypothyroidism
` Continue breastfeeding
` treatment of the primary condition
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` Breastfeeding is contraindicated when the mother is receiving
certain drugs like antineoplastic agents, immuno-suppressants & antithyroid drugs
` Breastfeeding may be avoided when the mother is receiving
following drugs - atropine, reserpine, psychotropic drugs.
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Infant feeding in various conditions related to the infant
` very LBW, sick, or depressed babies
` expressed breastmilk through intra-gastric tube or with the use
of cup and spoon
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` Gastro-Esophageal Reflux Disease (GERD)
` fre uent small, thickened feeds and upright positioning for 30
minutes after feeds.
` Galactosemia
` absolute contraindication to breastfeeding
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Feeding During Emergencies
` Infants and young children are among the most vulnerable
victims of natural or human induced emergencies.
` Emphasis should be on protecting, promoting and supporting
breastfeeding and ensuring timely, safe and appropriate
complementary feeding.
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1) Recommendations f or Governmental and International
Agencies
` Global legislation, binding to all states and private
organizations including labor benefits.
` regular advertisements in state, public or private owned
audiovisual and print media
` implementation of the provisions of Infant Milk Substitute
(IMS) Act
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` Lactation counsellor at least at Block level
` Government along with International agencies shouldformulate National policy on Fortification of food with
micronutrients.
` The experts, academicians and government shallformulate/develop guidelines for management of Severe Acute
Malnutrition
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2 ) ROLE OF NGOS
3 ) RECOMMENDATIONS FOR MEDIA
4 ) RECOMMENDATIONS FOR TRAINING
` all the community health workers, PPTCT counsellors, and
other personnel caring for children including doctors should
undergo three days skill training on IYCF (including IMS
Act).
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` IYCF should also be included in the curriculum of
undergraduate and postgraduate medical education, nursing
education, home science, child nutrition courses etc.
` Anganwadi workers, ASHA, Daiµs and other grass root levelworkers should be empowered by basic, scientific information
related to IYCF.
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Thank you!