A discourse the ideal feeding practices from pregnancy to infancy with a closer look into malnutrition, breastfeeding, complementary feeding and related interventions.

1. The 1000-day window
of opportunity:
Optimal infant and
young child feeding
(IYCF) practices
BY: DR NWANDO ONUIGBO-CHATTA
FOR: PRESTON HEALTHCARE CONSULTING LTD.
DATE: 22ND SEPTEMBER 2017

2. Outline
•Introduction
•Malnutrition
•IYCF
•Breast feeding
•Complementary feeding
•Interventions
•Discuss
•References

3. Introduction
•Nutrition of pregnant/lactating woman critical to development of child.
•Targeting the 1000 day period is one of the best investments to improve
health, nutrition and economic outcomes.
•Nutrition specific interventions will be most impactful when focusing on
this window of opportunity.
•A child’s, in fact nation’s future is determined
by the quality of nutrition in first 1,000 days.
•Optimal nutrition is critical for cognitive and
physical development at this stage.

4. Introduction cont’d
Why 1000 days?
•1000 days from pregnancy to 2nd birthday = 270+365+365 = 1000.
•Critical window when child’s brain and body are developing rapidly.
•Mothers and babies need good nutrition to lay the right foundation for the
child's future cognitive, motor and social skills.
•Good nutrition during pregnancy and infancy has profound impact on a child’s
ability to grow and learn.
•Poor nutrition during this window can lead to newborn and child morbidity,
mortality, poor fetal growth and stunting.

5. Introduction cont’d
Why 1000 days?
•Children with restricted development during this window are at risk
of neurological problems and poor school achievement.
•Consequently early school drop out, low-skilled employment and
poor care of their own children, thus intergenerational transmission
of poverty and malnutrition.
•Damage from poor nutrition during this period is often irreversible.
•Preventive efforts should focus on the 1,000 days; therapeutic
efforts target severe wasting.

6. Introduction cont’d
Key Facts
•Every infant and child has the right to good nutrition ("Convention on the
Rights of the Child“).
•Malnutrition is associated with 45% of children’s deaths.
•171 million (27%) of children stunted; 60 million children (10 %) wasted.
•Underweight and deficiencies linked with 19% and 10% of children’s deaths.
•About 40% of infants 0–6 months old are exclusively breastfed.
•In many countries less than 25% of infants 6–23 months meet criteria of
safety, diversity and frequency of diet appropriate for their age.

7. Malnutrition - Four types
1. Stunting:
•Child too short for age.
•Caused by chronic malnutrition
•Generally occurs before age 2.
•Largely irreversible.
•Delayed motor development, impaired cognitive function.

8. Malnutrition - Four types cont’d
2. Wasting:
•A child’s is too thin for their height.
•Caused by acute malnutrition.
3. Underweight:
•Child’s weight is too low for their
age.
•Due to stunting, wasting or both.
4. Micronutrient deficiency:
•A child lacks essential vitamins or
minerals
•namely; vitamin A, iron and zinc.
•Can be caused by lack of nutrients
or worms.

9. Malnutrition – Malnutrition crisis
•Yearly 7.6 million children die before they reach the
age of 5, mostly from preventable or treatable
illnesses and almost all in developing countries.
•Malnutrition is an underlying cause of about 35% of
these deaths.
•A malnourished child is up to 10 times as likely to
die from an easily preventable or treatable disease
as a well-nourished child.

10. Malnutrition - Malnutrition crisis cont’d
•One in four of the world’s (171 million)
children are chronically malnourished leaving
shorter children and cognitive impairment that
lasts a lifetime.
•Chronic malnutrition causes three times as
many child deaths as acute malnutrition
•However chronic malnutrition, unlike acute
malnutrition seldom grabs the headlines, yet
it is slowly destroying the potential of
millions of children.

11. IYCF - What is IYCF?
•Infant and Young Child Feeding (IYCF) is a global
strategy for feeding of children.
•Issued by World Health Organization (WHO)
and the United Nations Children's Fund
(UNICEF) in 2002, to reverse disturbing trends in
infant and young child feeding practices.
•Focus world attention on impact feeding
practices have on growth, development and
health; thus survival of infants and young
children.

13. IYCF - overview
Optimal breastfeeding is so critical that it could save
the lives of over 820 000 children under 5 per year.
WHO and UNICEF recommend:
•early initiation of breastfeeding within 1 hour of
birth.
•exclusive breastfeeding for the first 6 months of life.
•introduction of nutritional and safe complementary
(solid) foods at 6 months plus breastfeeding up to 2
years of age or beyond.

14. Breastfeeding
•Exclusive breastfeeding for 6 months
•Imptnt source of energy; less likely to develop
obesity.
•Benefits for the infant: Reduces GI
infections/diarrhea and confers immunity.
•Benefits to mother: reduces the risk of
ovarian and breast cancer and natural
contraception (not fail safe) due to lactation
amenorrhoea

15. Complementary feeding
•Breast milk no longer enough, therefore
complementary foods added.
•Transition from exclusive breast feeding to
family foods is ‘complementary feeding.’
•6 to 24 months and vulnerable period.
•Gradually increase consistency (liquid,
puree to mash).
•Feed variety of food; at least 3 types daily
including animal food (egg, fish, liver, meat).

16. Complementary Feeding cont’d

17. Intervention
•About 1/3 of stunting manifested as small for gestational age &
preterm babies
•This reflects the importance of targeting women during pregnancy
and the pre-pregnancy period.
• An integral part of 1,000 days nutrition programming is to integrate
maternal and newborn care as health outcomes for mothers and
their newborns/children are inextricably linked

18. Intervention overview
The six life saving intervention areas:
•Iron folate during pregnancy
•Breastfeeding
•Complementary feeding
•Vit. A supplementation
•Zinc for treatmnet of diarrhea
•WASH

19. Intervention

20. IYCF Strategies
1. Breastfeeding Support:
•Adoption of policies like ILO’s "Maternity Protection Convention’’
•Adoption of the "International Code of Marketing of Breast-milk Substitutes" and
subsequent relevant World Health Assembly resolutions.
•Implementation of the "Ten Steps to Successful Breastfeeding" specified in the
Baby-Friendly Hospital Initiative.
•Provision of supportive health services with IYCF counselling during contacts with
caregivers and young children.
•Community support i.e. mother support groups and community-based health
promotion and education activities.

21. IYCF Strategies
•Continue frequent, on-demand breastfeeding until at
least 2 years.
•Responsive feeding: Feed infants directly and assist
older children. Feed slowly and patiently, encourage
but don’t force, talk to child and maintain eye contact.
•Good hygiene and proper food handling.
•Start small amounts of food and increase gradually as
child gets older.
2.Complementary feeding: Developmentally ready at 6 months.

22. IYCF Strategies
2. Complementary feeding:
•Gradually increase consistency and variety.
•Increase feeding frequency: 2–3 meals to 3–4
meals per day with 1–2 additional snacks.
•Use fortified complementary foods or vitamin-
mineral supplements as needed.
•During illness, increase fluid intake including
more breastfeeding, and offer soft, favourite
foods.

23. IYCF Strategies
3. Feeding in exceptionally difficult
circumstances: Breastfeeding recommended
wherever possible.
•low-birth-weight or premature infants
•mothers living with HIV
•adolescent mothers
• Settings where diarrhoea, pneumonia and malnutrition are prevalent.
•infants and young children who are malnourished
•families suffering the consequences of complex emergencies.

24. IYCF Strategies
4. HIV and infant feeding
•Breastfeeding (especially early and
exclusive) is one of the most significant
ways to improve infant survival rates.
•While HIV can pass from a mother to her
child through breast-milk, evidence shows
antiretroviral treatment (ART) reduces the
risk of transmission through
breastfeeding.

25. Recommendations
1. Invest in proven, low-cost solutions to save children’s lives and
prevent stunting:
•Iron supplements prevents anaemia
•vit A prevents blindness and lowers risk of death from common dzs,
•zinc plus good hygiene can save a child from diarrhea,
•6 months of exclusive breastfeeding.
Although not expensive it’s a tragedy that millions of mothers and
children don’t have access.

26. Recommendations
2. Invest in health workers:
•to reach the most vulnerable mothers and children.
•CHWs are critical to save lives and prevent stunting
3. Help more girls go to school and stay in school:
•one of the most effective
•educated women tend to have fewer, healthier and better nourished
children.

27. Recommendations cont’d
•education gives girls knowledge, self confidence, skills and hope for
bright future.
•It can also delay marriage, child bearing and improve spacing.
4. Increase private sector partnerships to improve nutrition for
mothers and children.
5. Improve laws, policies and actions that support families and
encourage breastfeeding.

28. Recommendations cont’d
6. Increase government support for proven solutions:
•to meet SDG, lifesaving services must be increased for women and
children who need them most.
•Nigeria should commit to and fund national nutrition plans that are
integrated with plans for maternal and child health.
•Donors should support these goals by keeping their funding
commitments to achieving the SDGs.
•Countries should endorse and support the Scaling Up Nutrition
(SUN) movement.

29. Best Practices
1. Promote and support good maternal nutrition during pregnancy
and lactation
•Micronutrients iron, folic acid, calcium, iodine and vit. A via
supplementation, fortification and food consumption.
•Standards of nutritional care for pre natal and post natal care
developed and followed. e.g. optimum weight gain in pregnancy,
diagnosis and treatment of anemia, support dietary diversity, etc.

30. Best Practices cont’d
1. Promote and support good maternal nutrition during
pregnancy and lactation cont’d
•Education on optimum nutrition for exclusive breast feeding.
•Health provider/community worker continuing education on
nutrition.
•Education of fathers/family in providing of good nutrition for
pregnant/lactating women.

31. Best Practices cont’d
2. Promote and support optimal IYCF and care practices.
•Immediate initiation of breastfeeding (1 hour) and exclusive
breastfeeding for the 6 months.
•Engagement of fathers, family and community influencers on
supporting pregnant and lactating mothers.
•Starting at 6 months appropriate complementary feeding (e.g.,
dietary diversity) plus breastfeeding to 2 years or beyond.
•Adequate feeding of sick children to prevent wasting or stunting.

32. Best Practices cont’d
2. Promote and support optimal IYCF
and care practices:
•Integration of IYCF with WASH (safe
drinking water, hand-washing with
soap, safe disposal of excreta, and food
hygiene).
•National programs: supplementation,
fortification (ensure adequate intake of
essential micronutrients).

33. Best Practices cont’d
3. Focus on the 1,000-day period through
health, nutrition, agriculture, and
humanitarian assistance programs
•Scale up community management of acute
malnutrition in emergency settings.
•Proper IYCF guidance for HIV-infected mothers
and exposed infants

34. Best Practices cont’d
3. Focus on the 1,000-day period through
health, nutrition, agriculture, and
humanitarian assistance programs
•Make nutrition assessment, counseling, and
support a component of routine clinical health
care.
•Promote healthy timing and spacing of
pregnancies to reduce the risk and allow for
exclusive and continued breastfeeding until at
least 24 months.

35. Best Practices cont’d
3. Focus on the 1,000-day period through health, nutrition,
agriculture, and humanitarian assistance programs cont’d
•Promote dietary diversity for women and children through
integrated agriculture and nutrition programming.
•Strengthen evidence base for scale up of proven nutrition-sensitive
agriculture interventions.
•Increase professionals and frontline workers, especially women,
trained and employed in nutrition to meet country/local needs.

36. Best Practices cont’d
4. Social and behavior change communication:
Messaging reinforced by community
mobilization and mass media should include:
Interpersonal counseling
• Nutrition-specific services for
mothers/caregivers and their families.
• Home visits, peer support, “mothers groups,”
and counseling by health workers.

37. Best Practices cont’d
4. Social and behavior change:
Multiple media channels
• Informal means (community theater
and songs), videos, posters, and
leaflets.
• Targeted mass media (community
radio), mass media (television and
social media), cell phones, and other
technology.
Community mobilization and advocacy

38. Discuss
Adults who were malnourished as children can earn an estimated 20
percent less on average than those who weren’t. (SC, 2012)
•Can malnutrition cause/transmit poverty? Explain.

39. References
https://www.usaid.gov/what-we-do/global-health/nutrition/1000-day-window-opportunity
Nutrition in the First 1,000 Days State of the World’s Mothers 2012
http://www.who.int/mediacentre/factsheets/fs342/en/