IYCF UNICEF GUIDELINES 2016

1. JOURNAL CLUB BY : DR MAHESH YADAV

2. INFANT YOUNG AND CHILD FEEDING
GUIDELINES ,2016
• This guidelines published by SATISH TIWARI, KETAN
BHARADAVA, BALARAJ YADAV,SUSHMA MALIK, PRASHANT
GANGAL , CR BANAPURMATH,ZEEBA ZAKA-Ur-Ur, URMILA
DESHMUKH , VISHESHKUMAR AND RK AGRAWAL , FOR THE
CHAPTER OF IYCF , IAP IN VOLUME 53 ,AUGUST 15 2016 .
• JUSTIFICATION :- TO SHAPING UP THE POST 2015
DEVELOPMENT AGENDA AND TO ASSES OUR PROGRESS
,THE MILLENNIJM DEVELOPMENT GOALS AND THESE
GUIDELINESARE AN ATTEMPT IN THAT REGARD .
• OBJECTIVE :- TO FORMULATE ,ENDORSE,ADOPT AND
DISSEMINATE GUIDELINES RELATED TO INFANT AND YOUNG
CHILD FEEDING FROM AN INDIAN PERSPECTIVE .

3. • RECOMMENDATIONS:- EARLY INITIATION OF BREASTFEEDING
WITHIN FIRST HOUR OF BIRTH , EBF FOR THE 1ST
SIX MONTHS
FOLLOWED BY CONTINUED BREASTFEEDING FOR UP TO 2
YEARS AND BEYOND WITH APPROPRIATE COMPLEMENTARY
FOODS AFTER COMPLETION OF 6 MONTHS IS THE MOST
APPROPRIATE FEEDING STRATEGY . MICRO – NUTRIENTS
SUPPLIMENTATION IN INFANTS AND INADEQUATE NUTRITION
AND ANAEMIA CONTROL FOR ADOLESCENTS GIRLS
,PREGNANT ,LACTATING MOTHERS IS ADVOCATED
.CONCEPTS AND NEED FOR HUMAN MILK BANKS IN INDIA
HAS ALSO BEEN INCORPORATED .

4. INTRODUCTION
• Infant and Young Child Feeding (IYCF) is a set
of well-known and common recommendations
for appropriate feeding of new-born and children
under 5 years of age.

5. IYCF TECHNICAL GUIDELINES
1. Breastfeeding
2. Complementary feeding
3. HIV and Infant feeding
4. Special situations

6. BREAST FEEDING
•WHO/UNICEF emphsized the first 1000 days of life i.e. the
270 days in-utero
and the 1st
2 years after birth as the critical window
period for nutrional
intervention
•Breastfeeding should be promoted to mothers and other
caregivers as the gold standard feeding option for babies.
•Antenatal Counseling .

7. • Breastfeeding must be initiated as early as possible after
birth for all normal newborns (including those born by
caesarean section).
• In case of operative birth, the mother may need
motivation and support to initiate breastfeeding within the
first hour. Skin to skin contact between the mother and
newborn should be encouraged by ‘bedding in the
mother and baby pair’. The method of “Breast Crawl” can
be adopted for early initiation in case of normal
deliveries. Mothershould communicate, lookinto the
eyes, touch and caress the baby while feeding. The new
born should be kept warm by promoting Kangaroo
MotherCare and promoting local practices to keep the
roomwarm.

8. • Mothers who work outside should be encouraged to
continue exclusive breastfeeding for 6 months by
expressing milk for feeding the baby while they are out at
work, and initiating the infant on timely complementary
foods. They may be encouraged to carry the baby to a
work place crèche wherever such facility exists. The
concept of “Hirkani’s room” may be considered at work
places (Hirkani’s room is a specially allocated roomat
the workplace where working mothers can express milk
and store in a refrigeratorduring theirworkschedule).
Every such mother leaving the maternity facility should
be taught manual expression of her breast milk.

9. • At every health visit, the harms of artificial feeding and
bottle feeding should be explained to the mothers.
Inadvertent advertising of infant milk substitute in health
facility should be avoided. Artificial feeding is to be
practiced only when medically indicated.
• NURSING IN PUBLIC: All efforts should be taken to
provide appropriate facilities so that mothers can
breastfeed babies with ease even in public places.
• Adoption of latest WHO Growth Charts is recommended
for growth monitoring

10. • Colostrum, milk secreted in the first 2-3 days, must not
be discarded and no prelacteal fluid should be given to
the newborn.
• Baby should be fed “on cues”.
• Periodic feeding is practised in certain special situation
like ,very small infant and who dose not demand .

11. SUMMARY
• Exclusive breastfeeding should be practiced from birth till
six months requirements.
• After completion of six months of age, introduction of
optimal complementary feeding.
• Breastfeeding should be continued for a minimum for 2
years and beyond depending on the choice of mother
and the baby. Even during the second year of life, the
frequency of breastfeeding should be 4-6 times in 24
hours, including night feeds.

12. COMPLEMENTARY FEEDING
• Appropriately thick complementary foods of homogenous
consistency (not spilled from spoon)made from locally
available foods should be introduced at six completed
months to all babies while continuing breastfeeding
along with it.
• To address the issue of a small stomach size, aim to
provide more calories from smaller volumes,this can be
attain by making FERMENTED PORRIDGE and one or
two snacks between the three main meals .

13. • Parents must identify the staple homemade food
comprising of cereal-pulse mixture (as these are fresh,
clean and cheap) and make them calorie and nutrient
rich with locally available products.
• Iron-fortified foods, iodized salt, vitamin A enriched food
etc. are to be encouraged.
• As the babies start showing interest in complementary
feeds, the variety should be increased by adding new
foods in the staple food one by one. Easily available,
cost-effective seasonal uncooked fruits, green and other
dark coloured vegetables, milk and milk products
pulses/legumes, animal foods, oil/butter, sugar/jaggery
may be added in the staples gradually.

14. • Junk food and commercial food, ready-made, processed
food from the market, e.g. tinned foods/juices, cold-
drinks, chocolates, crisps, health drinks, bakery products
etc. should be avoided.
• Giving drinks with low nutritive value, such as tea, coffee
and sugary drinks should also be avoided.
• Hygienic practices are essential for food safety during all
the involved steps viz. preparation, storage and feeding.
• Practice of responsive feeding is to be promoted. Young
children should be encouraged to take feed by praising
themand theirfoods. Self-feeding should be
encouraged despite spillage. Each child should be fed
under supervision in a separate plate to develop an

15. • Consistency of foods should be appropriate to the
developmental readiness of the child in munching,
chewing and swallowing. Foods which can pose choking
hazard are to be avoided. Introduction of lumpy or
granularfoods and most tastes should be done by about
9 to 10 months. Missing this age may lead to feeding
fussiness later. So use of mixers/grinders to make food
semisolid/pasty should be strongly discouraged.

17. HIV ANDINFANT FEEDING
1. The best time for counselling is ANTENATAL
PERIOD ,counsel about the feeding ptions .
EXCLUSIVE BREAST FEEDING is better than
EXCLUSIVE REPLACEMENT FEEDING .
2. Prevention of parent to child transmission
interventions should begin in early pregnancy .
3. EBF is the recommended infant feeding choice
,irrespective of the fact that mother is on ART early
or infant is provided with anti – retroviral prophylaxsis
for 6 weeks .
4. No mixed feeding is to be done in initial 6 months .

19. INFANT EXPOSED TO HIV

20. DOSES OF NEVIRAPINE

21. 1. Mother who are HIVinfected and insist on not
breastfeeding and opt for exclusive
replacement feeding should be explained ther
are so at their own risk and this is contrary to
the WHO / NACO’s guidelines.
2. ADVANTAGES of exclusive replacement
feeding .
• No risk of HIV transmission
• ERF milk can be given by
DISADVANTAGES OF ERF
• Animal milk is not a complete food for baby .
• Formula milk may be complete but it is
expensive .
• Baby has more risk of infections

22. FEEDING IN OTHERSPECIFIC
SITUATIONS•Feeding during sickness
Feeding during sickness is important for recovery and
for prevention of under-nutrition. Even sick babies mostly
continue to breastfeed and the infant can be encouraged to
eat small quantities of nutrient rich foods, but more
frequently and by offering foods that a child likes to eat.
•Infant feeding in maternal illnesses
•Painful and/or infective breast conditions like breast
abscess and mastitis and psychiatric illnesses which pose
a danger to the child’s life e.g. postpartum psychosis,
schizophrenia may need a temporary cessation of
breastfeeding. Treatment of primary condition should be
done and breastfeeding should be started as soon as
possible after completion of treatment
•Chronic infections like tuberculosis, leprosy, or medical

23. 3. Breastfeeding is contraindicated when the mother is
receiving certain drugs like antineoplastic agents,
immuno-suppressants, antithyroid drugs like thiouracil,
amphetamines, gold salts, etc. Breastfeeding may be
avoided or continued with caution when the mother is
receiving following drugs atropine, reserpine,
psychotropic drugs. Other drugs like antibiotics,
anaesthetics, antiepileptics, antihistamines, digoxin,
diuretics, prednisone, propranolol etc. are considered
safe for breastfeeding.

24. Infant feeding in various conditions related
to the infant
• Breastfeeding on demand should be promoted in normal
active babies. However, in difficult situations like very low
birth weight, sick, or depressed babies, alternative
methods of feeding can be used based on
neurodevelopmental status. These include feeding
expressed breast milk through intra-gastric tube or with
the use of cup and spoon. For very sick babies, expert
guidance should be sought.
• Gastro-Oesophageal Reflux Disease (GERD): treated
conservatively through thickening the complementary
foods, frequent small feeds and upright positioning for 30
minutes after feeds.
• Primary lactose intolerance is congenital may require

25. • Various in born error of metabolism warrant restriction of
specific offending agent and certain dietary modifications
e.g. in galactosemia, dietary lactose and galactose
should be avoided . This is probably the only
contraindication to breast feeding.
• During emergencies, priority health and nutrition support
should be arranged for pregnant and lactating mothers.
Donated or subsidized supplies of breast milk substitutes
(e.g. infant formula) should be avoided. Donations of
bottles and teats should be refused, and theiruse
actively avoided.

27. THANK
YOU