Introduction to Global Strategy of IYCF By Amal El-Taweel MD-IBCLC
Introduction to infant and young child feeding After completing this session participants will be able to:
describe The Global Strategy for Infant and Young Child Feeding
list the operational targets of The Global Strategy
state the current recommendations for feeding children from 0-24 months of age
The Global Strategy for Infant and Young Child Feeding
Developed by WHO and UNICEF to revitalize world attention on the impact that feeding practices have on infants and young children
Malnutrition has been responsible, directly or indirectly, for over 50% of the 10.6 million deaths annually among children <5 years
Over two-thirds of these deaths occur in the first year of life
Facts on infant and young child feeding It has been estimated that about 2 million child deaths could be averted every year through effective breastfeeding. Exclusively breastfed infants have at least 2½ times fewer illness episodes than infants fed breast-milk substitutes. Infants are as much as 25 times more likely to die from diarrhoea in the first 6 months of life if not exclusively breastfed. Among children under one year, those who are not breastfed are 3 times more likely to die of respiratory infection than those who are exclusively breastfed. From: Jones, 2003; Chandra, 1979; Feachem, 1984; and Victora, 1987.
Facts on infant and young child feeding Infants exclusively breastfed for 4 or more months have half the mean number of acute otitis media episodes of those not breastfed at all. In low-income communities, the cost of cow’s milk or powdered milk, plus bottles, teats, and fuel for boiling water, can consume 25 to 50% of a family’s income. Breastfeeding contributes to natural birth spacing, providing 30% more protection against pregnancy than all the organized family planning programmes in the developing world. From: Duncan et al, 1993; UNICEF/WHO/UNESCO/UNFPAA, 1993; and Kleinman, 1987.
Facts on infant and young child feeding The peak period of malnutrition is between 6 and 28 months of age. Malnutrition contributes to about half of under-five mortality & a third of this is due to faulty feeding practices. Counselling on breastfeeding and complementary feeding leads to improved feeding practices, improved intakes and growth. Counselling on breastfeeding and complementary feeding contributes to lowering the incidence of diarrhoea.
Optimal Infant feeding practice reduces Under-five mortalitySource: Lancet Child Survival Series 2003
WHO’s infant and young child feeding recommendations Initiate breastfeeding within one hour of birth. Breastfeed exclusively for the first six months of age (180 days). Thereafter give nutritionally adequate and safe complementary foods to all children. Continue breastfeeding for up to two years of age or beyond. Adapted from the Global Strategy.
Early initiation of breastfeeding for the normal newbornWhy? Increases duration of breastfeeding Allows skin-to-skin contact for warmth and colonization of baby with maternal organisms Provides colostrum as the baby’s first immunization Takes advantage of the first hour of alertness Babies learn to suckle more effectively Improved developmental outcomes Slide 4.4.3
Early initiation of breastfeeding for the normal newbornHow? Keep mother and baby together Place baby on mother’s chest Let baby start suckling when ready Do not hurry or interrupt the process Delay non-urgent medical routines for at least one hour Slide 4.4.4
Breastfeeding and complementary feeding terms and definitions EXCLUSIVE BREASTFEEDING: the infant takes only breast milk and no additional food, water, or other fluids with the exception of medicines and vitamin or mineral drops. PARTIAL BREASTFEEDING or MIXED FEEDING: the infant is given some breast feeds and some artificial feeds, either milk or cereal, or other food or water. BOTTLE-FEEDING: the infant is feeding from a bottle, regardless of its contents, including expressed breast milk.
Breastfeeding and complementary feeding terms and definitions ARTIFICIAL FEEDING: the infant is given breast-milk substitutes and not breastfeeding at all. REPLACEMENT FEEDING: the process of feeding a child of an HIV-positive mother who is not receiving any breast milk with a diet that provides all the nutrients the child needs. COMPLEMENTARY FEEDING: the process of giving an infant food in addition to breast milk or infant formula, when either becomes insufficient to satisfy the infant's nutritional requirements.
Benefits of breastfeeding for the infant Provides superior nutrition for optimum growth. Provides adequate water for hydration. Protects against infection and allergies. Promotes bonding and development. Slide 2.1
Summary of differences between milks Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6). Slide 2.2
No water necessary Adapted from: Breastfeeding and the use of water and teas. Geneva, World Health Organization, 1997. Slide 2.3
Breast milk composition differences (dynamic) Gestational age at birth(preterm and full term) Stage of lactation(colostrum and mature milk) During a feed(foremilk and hindmilk) Slide 2.4
Colostrum Importance protects against infection and allergy protects against infection clears meconium; helps prevent jaundice helps intestine mature; prevents allergy, intolerance reduces severity of some infection (such as measles and diarrhoea); prevents vitamin A-related eye diseases Property Antibody-rich Many white cells Purgative Growth factors Vitamin-A rich Slide 2.5
The perfect match:quantity of colostrum per feed and the newborn stomach capacity Adapted from: Pipes PL.Nutrition in Infancy and Childhood, Fourth Edition. St. Louis, Times Mirror/Mosby College Publishing, 1989. Slide 4.6.3
Impact of routine formula supplementation Decreased frequency or effectiveness of suckling Decreased amount of milk removed from breasts Delayed milk production or reduced milk supply Some infants have difficulty attaching to breast if formula given by bottle Slide 4.6.4
Medically indicated There are rare exceptions during which the infant may require other fluids or food in addition to, or in place of, breast milk. The feeding programme of these babies should be determined by qualified health professionals on an individual basis. Slide 4.6.7
Acceptable medical reasons for use of breast-milk substitutes (WHO 2009) Infant conditions: Infants who should not receive breast milk or any other milk except specialized formula Infants with classic galactosemia: a special galactose-free formula is needed. Infants with maple syrup urine disease: a special formula free of leucine, isoleucine and valine is needed. Infants with phenylketonuria: a special phenylalanine-free formula is needed (some breastfeeding is possible, under careful monitoring).
Acceptable medical reasons for use of breast-milk substitutes (WHO 2009)cont. Infant conditions (cont.): Infants for whom breast milk remains the best feeding option but may need other food in addition to breast milk for a limited period Infants born weighing less than 1500 g (very low birth weight). Infants born at less than 32 weeks of gestation (very preterm). Newborn infants who are at risk of hypoglycaemia due to impaired metabolic adaptation or increased glucose demand (like those who are preterm, small for gestational age or who have experienced significant intrapartum hypoxic/ ischaemic stress, those who are ill and those whose mothers are diabetic if their blood sugar fails to respond to optimal breastfeeding or breast-milk feeding.
Acceptable medical reasons for use of breast-milk substitutes (WHO 2009)cont. MATERNAL CONDITIONS Mothers who are affected by any of the conditions mentioned below should receive treatment according to standard guidelines. Maternal conditions that may justify permanent avoidance of breastfeeding HIV infection: if replacement feeding is Acceptable, Feasible, Affordable, Sustainable and Safe (AFASS). Otherwise, exclusive breastfeeding for the first six months is recommended. Mixed feeding is not recommended.
Acceptable medical reasons for use of breast-milk substitutes (WHO 2009)cont. MATERNAL CONDITIONS (cont.) Maternal conditions that may justify temporary avoidance of breastfeeding Severe illness that prevents a mother from caring for her infant, for example sepsis. Herpes simplex virus type 1 (HSV-1): direct contact between lesions on the mother's breasts and the infant's mouth should be avoided until all active lesions have resolved.
Acceptable medical reasons for use of breast-milk substitutes (WHO 2009)cont. MATERNAL CONDITIONS (cont.) Maternal conditions that may justify temporary avoidance of breastfeeding (cont.) Maternal medication: - sedating psychotherapeutic drugs, anti-epileptic drugs and opioids and their combinations may cause side effects such as drowsiness and respiratory depression and are better avoided if a safer alternative is available; - radioactive iodine-131 is better avoided given that safer alternatives are available – a mother can resume breastfeeding about two months after receiving this substance; - excessive use of topical iodine or iodophors (e.g., povidone-iodine), especially on open wounds or mucous membranes, can result in thyroid suppression or electrolyte abnormalities in the breastfed infant and should be avoided; - cytotoxic chemotherapy requires that a mother stops breastfeeding during therapy.
Acceptable medical reasons for use of breast-milk substitutes (WHO 2009)cont. MATERNAL CONDITIONS (cont.) Maternal conditions during which breastfeeding can still continue, although health problems may be of concern Breast abscess: breastfeeding should continue on the unaffected breast; feeding from the affected breast can resume once treatment has started. Hepatitis B: infants should be given hepatitis B vaccine, within the first 48 hours or as soon as possible thereafter. Hepatitis C. Mastitis: if breastfeeding is very painful, milk must be removed by expression to prevent progression of the condition. Tuberculosis: mother and baby should be managed according to national tuberculosis guidelines. Substance use: - maternal use of nicotine, alcohol, ecstasy, amphetamines, cocaine and related stimulants has been demonstrated to have harmful effects on breastfed babies;
alcohol, opioids, benzodiazepines and cannabis can cause sedation in both the mother and the baby. Mothers should be encouraged not to use these substances, and given opportunities and support to abstain.
1000 Energy Gap 800 600 Energy (kcal/day) Energy from breast milk 400 200 0 0-2 m 3-5 m 6-8 m 9-11 m 12-23 m Age (months) 29/1 Energy required by age and the amount supplied from breast milk
Gap for iron 1.2 Iron gap 0.8 Iron from birth stores Absorbed iron (mg/day) Iron from breast milk 0.4 0 0-2 m 3-5 m 6-8 m 9-11 m 12-23 m Age (months) 30/2 Absorbed iron needed and amount provided
Gap for vitamin A 400 Vitamin A gap 300 Vitamin A from birth stores 200 Vitamin A (µg RE/day) Vitamin A from breast milk 100 0 0-2 m 3-5 m 6-8 m 9-11 m 12-23 m Age (months) 30/5 Vitamin A needed and amount provided
Breast milk in second year of life % daily needs provided by 500 ml breast milk From: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6). Slide 2.6