Infant and young child feeding

 

To enable mothers to establish and sustain exclusive breastfeeding for 6 months, WHO and UNICEF recommend:

·   initiation of breastfeeding within the first hour of life;

·   exclusive breastfeeding (i.e. only breast milk with no additional food or drink, not even water);

·   breastfeeding on demand, as often the child wants, day and night; and

·   no use of bottles, teats or pacifiers.

 

The recommendations for feeding infants and young children (6–23 months) include:

·   continued breastfeeding;

·   introduction of solid, semisolid or soft foods at 6 months;

·   appropriate food diversity (at least five food groups per day);

·   appropriate frequency of meals: two to three times a day between 6 and 8 months, increasing to three to four times a day between 9 and 23 months with nutritious snacks offered once or twice a day, as desired;

·   safe preparation of foods; and

·   feeding infants in response to their cues.

 

The caring practice indicators for infant and young child feeding available on the NLIS country profiles include:

• proportion of children aged 0–23 months who were put to the breast within 1 h of birth;
• proportion of infants under 6 months who are exclusively breastfed;
• proportion of infants aged 6–8 months who receive solid, semisolid or soft foods;
• proportion of children aged 6–23 months who receive a minimum dietary diversity; and
• proportion of children aged 6–23 months who receive a minimum acceptable diet.

  

Early initiation of breastfeeding

What does this indicator tell us?

This indicator is the percentage of infants who are put to the breast within 1 hour of birth.

 

How is it defined?

Early initiation of breastfeeding is defined as the proportion of children born in the past 24 months who were put to the breast within 1 hour of birth.

 

What are the consequences and implications?

Breastfeeding improves child health, and there is evidence that delayed initiation of breastfeeding increases their risk for mortality.

 

Infants under 6 months who are exclusively breastfed

What does this indicator tell us?

This indicator is the percentage of infants aged 0–5 months who are exclusively breastfed.

 

How is it defined?

It is the proportion of infants aged 0–5 months who are fed exclusively on breast milk and no other food or drink, including water. The infant is however, allowed to receive ORS and drops or syrups containing vitamins, minerals and medicine.

 

What are the consequences and implications?

Exclusive breastfeeding is an unequalled way of providing the ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process, with important health benefits for mothers. An expert review of evidence showed that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants.

Breast milk is the natural first food for infants. It provides all the energy and nutrients that the infant needs for the first months of life. It continues to provide up to one half or more of a child’s nutritional needs during the second half of the first year and up to one third during the second year of life.

Breast milk promotes sensory and cognitive development and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses, such as diarrhoea and pneumonia, and leads to quicker recovery from illness.

Breastfeeding contributes to the health and well-being of mothers, by helping to space children, reducing their risks for ovarian and breast cancers and saving family and national resources. It is a secure way of feeding and is safe for the environment.

 

Infants aged 6–8 months who receive solid, semisolid or soft foods

What does this indicator tell us?

The indicator is the percentage of infants between 6-8 months of age who start solid, semisolid or soft foods. WHO recommends starting complementary feeding at 6 months of age.

 

How is it defined?

It is defined as the proportion of infants aged 6–8 months who receive solid, semisolid or soft foods during the previous day.

 

What are the consequences and implications?

When breast milk alone no longer meets the nutritional needs of the infant, complementary foods should be added. The transition from exclusive breastfeeding to family foods, referred to as ‘complementary feeding’, typically occurs between 6 and 18–24 months of age. This is a very vulnerable period, and it is the time when malnutrition often starts, contributing significantly to the high prevalence of malnutrition among children under 5 worldwide.

 

Children aged 6–23 months who receive a minimum dietary diversity

What does this indicator tell us?

This indicator is the percentage of children aged 6–23 months who receive a minimum dietary diversity.

Proportion of children aged 6-23 months who receive a minimum dietary diversity is included as an interim process indicator in the core set of indicators for the Global Nutrition Monitoring Framework while the original indicator “Minimum Acceptable Diet” is being further developed and validated under the leadership of the WHO-UNICEF Technical Expert Advisory group on nutrition Monitoring (TEAM). In June 2017, TEAM also recommended to revise the MDD indicator as defined by WHO (2008) to make it feasible and meaningful for Member State reporting. The revision concerned adding “breast milk” as an 8th food group and shifting the criterion for MDD accordingly, from 4 of 7 groups to 5 of 8 groups.

 

How is it defined?

As recommended by the TEAM in June 2017, dietary diversity is present when the diet contained five or more of the following food groups:

·         breast milk;

·         grains, roots and tubers;

·         legumes and nuts;

·         dairy products (milk, yogurt, cheese);

·         flesh foods (meat, fish, poultry, liver or other organs);

·         eggs;

·         vitamin A-rich fruits and vegetables; and

·         other fruits and vegetables.

 

Children aged 6–23 months who receive a minimum acceptable diet

What does this indicator tell us?

This indicator is the percentage of children aged 6–23 months who receive a minimum acceptable diet.

Proportion of children aged 6-23 months who receive a minimum acceptable diet is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. 

 

How is it defined?

The composite indicator of a minimum acceptable diet is calculated from:

·    the proportion of breastfed children aged 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day and

• the proportion of non-breastfed children aged 6–23 months who received at least two milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day.

Dietary diversity is present when the diet contained five or more of the following food groups:

·         breast milk;

·         grains, roots and tubers;

·         legumes and nuts;

·         dairy products (milk, yogurt, cheese);

·         flesh foods (meat, fish, poultry, liver or other organs);

·         eggs;

·         vitamin A-rich fruits and vegetables; and

·         other fruits and vegetables.

The minimum daily meal frequency is defined as:

• twice for breastfed infants aged 6–8 months,
• three times for breastfed children aged 9–23 months and
• four times for non-breastfed children aged 6–23 months.

 

What are the consequences and implications?

A minimum acceptable diet is essential to ensure appropriate growth and development for feeding infants and children aged 6–23 months. Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality.

 

Source of all infant and young child feeding indicators

UNICEF. UNICEF Data: Monitoring the Situation of Children and Women. https://data.unicef.org.

 

Further reading

WHO. Infant and young child feeding list of publications. http://www.who.int/nutrition/publications/infantfeeding/en/index.html.

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/.

WHO. E-Library of Evidence for Nutrition Actions (eLENA):

·         Breastfeeding: early initiation. http://www.who.int/entity/elena/titles/early_breastfeeding/en/index.html.

·         Breastfeeding: exclusive breastfeeding. http://www.who.int/entity/elena/titles/exclusive_breastfeeding/en/index.html.

·         Breastfeeding: continued breastfeeding. http://www.who.int/entity/elena/titles/continued_breastfeeding/en/index.html.

·         Complementary feeding. http://www.who.int/entity/elena/titles/complementary_feeding/en/index.html.

WHO. WHO Global Data Bank on Infant and Young Child Feeding. http://www.who.int/nutrition/databases/infantfeeding/en/index.html.

WHO/UNICEF. Global Nutrition Monitoring Framework. Operational guidance for tracking progress in meeting targets for 2025. Geneva: World Health Organization; 2017. http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/.