The first two years of life: a critical window of opportunity ensuring children’s appropriate growth and development through optimal feeding

1. Ezy Barnita

2. Introduction
Nutrition
Poor Adequate Inappropriate
Morbidity & mortality ↑
Directly or indirectly Obesity
Ensure growth, health
and development ~
2006: ⅓ of 9,5 potential
million deaths in
children <5 yo,

3. …introduction
The first two years of life: a critical window of
opportunity ensuring children’s appropriate
growth and development through optimal
feeding
Optimal breastfeeding prevent 13% of deaths
in children <5 years of age, appropriate
complementary feeding practices  an
additional 6% reduction in underfive mortality

4. Malnutrition during the 1 st 2 yrs of life
Short stature (stunting)
Impaired intellectual performance (adult)
Implication of national
development
Reduced capacity for physical work
Affected reproductive capacity in ♀(LBW)

5. Global strategy for infant and young
child feeding (2002)
1
Exclusive breastfeeding for 6 months (180 days)
2
Complementary feeding starting from the age of 6
months with continued breastfeeding up to 2 years of
age or beyond.

6. Definition
Exclusive
breastfeeding
Infant receives only breast milk or expressed breast milk, and
no other liquids or solids, not even water, with the exception of
oral rehydration solution, drops or syrups consisting of vitamins,
minerals supplements or medicines
Complementary
feeding
process starting when breast milk is no longer sufficient to meet
the nutritional requirements of infants, and therefore other
foods and liquids are needed, along with breast milk.

7. Evidence for recommended BF (1)
No breastfeeding
Mortality 6-10 times higher at 1st month of life
Diarrhea and pneumonia are more common
and more severe even with adequate
hygiene, as well as other acute infections
(otitis media, Haemophilus influenzae
meningitis, UTI)
↑ risk diseases with an immunological basis,
(asthma and other atopic conditions, type 1
diabetes, celiac disease, ulcerative colitis and
Crohn disease

8. Evidence for recommended BF(2)
Greater risk of childhood leukaemia
Obesity in later childhood and adolescence is
less common among breastfed children 
dose response effect
↑risks to cardiovascular health
(hypertension, cholesterol level, atheros-
clerosis in later adulthood)
A meta-analysis of 20 studies: cognitive
function on average 3.2 points higher among
children who were breastfed

9. Exclusive and partial BF
Diarrhea : 8,6 times higher
Mortality: 4,2 times higher

10. Exclusive and no BF
Diarrhea : 25 times higher
Mortality: 14,2 times higher

11. Complementary feeding

12. After 6 month old:
It becomes increasingly difficult for breastfed infants to
meet their nutrient needs from human milk alone
inadequate nutritional quality
Most infants are developmentally ready for other foods
given too early or too late
at about 6 months
in too small amounts or not frequently enough
premature cessation
low frequency of breastfeeding
In many countries, the period of complementary
Feeding (6–23 months) peak incidence of growth
faltering, micronutrient deficiencies and infectious
illnesses

13. Ten guiding principles for
complementary feeding of the
breastfed child

14. 1. Introduce complementary foods at 6 months of
age (180 days) while continuing to breastfeed.
Six months old doubled his or her birth’s
weight and more active exclusive BF is no
longer sufficient to meet baby’s energy and
nutrient needs
Digestive system is mature enough to digest
the starch, protein and fat in a non-milk diet.
Tongue thrust and rooting reflexes begin to
disappear infants can receive and hold
semi-solid food in their mouths

15. 2. Continue frequent on-demand breastfeeding until
2 years of age or beyond
higher quality
nutrients
protective factors
reduces the risk
of acute and
chronic diseases

16. 3. Responsive feeding
Feed infants directly & assist older children
feeding themselves. Feed slowly,patiently,
and encourage children to eat, but do not
force them
If children refuse experiment with different
food combinations, tastes, textures and
methods of encouragement.
Minimize distractions during meals
Feeding times are periods of learning &love

17. 4. Practise good hygiene and proper food handling

18. 5. Start with small amounts of food, increase the
quantity as the child gets older
Breastfeeding 0.7kcal/ml
Amount of
energy
0.6-1kcal/ml
Complementary
feeding
Dilute food
~0.3kcal/ml
Complementary foods should have a greater energy density
than breast milk, that is, at least 0.8 kcal per gram

19. Practical guidance of complementary food

20. 6. Increase food consistency and variety gradually
The most suitable consistency for an infant’s
or young child’s food depends on age and
neuromuscular development
6 months pureed, mashed or semi-solid foods
8 months finger foods
12 months family food
delayed beyond 10 months of age may ↑ the risk of feeding difficulties

21. 7. Frequency of complementary food
How much energy the child needs to cover
the energy gap
The amount that a child can eat at one meal
stomach capacity (~30ml/kg)
The energy density of the food offered at
least 0.8kcal/g (>BF) or need greater volume
need to be divided into more meals

22. 8. Feed a variety of nutrient-rich foods to ensure that
all nutrient needs are met

23. such as:
Vegetarian (plant-based)
complementary foods do not by
Animal themselves provide enough iron
source and zinc to meet child’s needs
Dairy Pulses
Fruit Fats &
and veg oil
There are no controlled studies that show that
restrictive diets have an allergy-preventing effect

24. 9. Fortified complementary foods or vitamin-mineral
supplements as needed
In settings where little or no animal-source
foods are available to many families, iron-
fortified complementary foods or foods
fortified at the point of consumption with a
multinutrient powder or lipid-based nutrient
supplement may be necessary

25. 10. Increase fluid intake during illness
During illness the need of fluid often ↑
child’s appetite for desire to breastfeed
food often decreases increases
breast milk may become the main source of
both fluid and nutrients
give more frequent, smaller meals

26. Take home message
Breastfeeding is the best
After 6 months yo start complementary feeding due to energy gap
along with maturity of digestive tract and
feeding skills development

27. Thank you