IYCF
Dr Yasmeen Memon
Associate Professor
Paediatric Unit 1
LUMHS
What do these letters stand for?
• I
= Infant (0—11 months)
• Y
= Young ( up to 2 years)
• C
= Child
• F
= Feeding
The Global Strategy for Infant and Young Child
Feeding(IYCF)
• 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 10.9 million deaths annually
among children <5 years.
• Over two-thirds of these deaths
occur in the first year of life
Major Causes of Death Among Children under five
in developing countries, 2008
Acute Respiratory
Infections
Diarrhoea
18%
25%
Malaria
Deaths associated
With malnutrition
15%
54%
Measles
HIV/AIDS
Perinatal
23%
10%
4%
Other
5%
Source: The World Health Report 2008, WHO, Geneva.
Global situation (save the children-2012 report)
• 7.6 million children U5 yr die /year
• 2.6 million (35%) ---- malnutrition---1/3rd (10%) of
these deaths are due to micronutrient deficiencies
• 170 million (27% of all children globally )--stunted ( low Ht/age), 100 million of total in
Asia
• 100 million --- under weight (Low wt/age)---19%
of child death
• 60 million ---wasted (low wt/ht)
• 20 million/yr ---LBW (<2.5 kg)
The State of the World’s Children
2014
• More than 150 million children in
developing countries are malnourished.
• According to more recent estimates, IUGR,
stunting and severe wasting are responsible
for one third of under-5 mortality.
Nutrition and life course
Malnutrition in Pakistan (NNS 2011)
• In Pakistan, the nutritional status of children under five
years of age is extremely poor Child Malnutrition rates in
Pakistan is significantly high.
• Types of
•
•
•
•
•
•
•
•
Malnutrition
PDHS 2012-13
Stunting(low Ht/age) 43.7% ( Sind -49.8%)
45% (57% in sind )
Under weight ( low wt/age)-- 31.5%( Sind 39.8%)
30%
Wasting (low wt/Ht) - 15.1%(Sind 17.5%)
11% (17.5% in sind )
Micronutrient deficiency---Anemia --- 61.9%
( Sind 73%)
Vitamin A deficiency --- 54% (Sind 53%)
Vitamin D deficiency --- 40% (Sind 43%)
Zinc deficiency --37% (Sind 39.2%)
Trend of IYCF in Pakistan
DHS 2006-07
DHS 2012-13
(preliminary results)
Exclusive breastfeeding
37.1%
37.7%
Predominant breastfeeding
18.2%
17.1%
Bottle feeding
32.1%
41.0%
Complementary feeding
Recommended CF
practices
33.6%
56.6%
15%
IYCF Component
•
•
•
•
•
Nutrition of pregnant & Lactating women's
Breast feeding
Complementary feeding
Counselling & Key messages
.
Appropriate diet during pregnancy & lactation
• During Pregnancy
• During Lactation
• 3 meals each day plus two extra small
• Women does not need more
meals or snacks in between meals to
food during pregnancy
sustain energy and better take care of
child
• 3 meals each day plus one extra
small meal or snack in between • Peas, lentils , beans, oil, green
vegetables or fruit and meat
meals
• Never stay thirsty; use of juice, soups
etc. should be increased
Advantages of breast feeding
Breast milk
•
•
•
•
Perfect nutrients
Easily digested; efficiently used
Protects against infection
It is free! Costs less than artificial
feeding
• Breastfed children get sick less often
Breast feeding
• • Breastfeeding immediately after birth
•
•
•
•
•
helps: - Reduce bleeding after delivery
- Quicken the expulsion of placenta
Helps emotional bonding and
development
Helps delay a new pregnancy•
Exclusive breastfeeding –
contraception (98% effective)
Protects mothers’ health • Reduces
risks of breast and ovarian cancer.
Benefits of Breastfeeding for the
community ---Better brain
development - leads to intelligence and
better jobs
• Healthy children become healthy
adults that can work hard
The Baby-Friendly Way
TEN STEPS TO SUCCESSFUL BREASTFEEDING
Every facility providing maternity services and care for
newborn infants should:
1. Have a written breastfeeding policy that is routinely communicated to all health care
staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within an half hour of birth.
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be
separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically
indicated.
7. Practise rooming in – allow mothers and infants to remain together – 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding
infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them
on discharge from the hospital or clinic.
14
During first 6 months
=
=
+
+
+
?
28/2
Key Message 1
• Breastfeeding for two years or longer helps
a child to develop and grow strong and
healthy
3/8
Good and poor attachment
• What differences do you see?
1
2
Good position & Attachment
• Baby head & body in line
• Baby held close to mothers
body
• Baby whole body
supported
• Baby approaches breast
nose to nipple.
More areola visible above
baby’s mouth than below
Baby’s mouth wide open
Lower lip turned outwards
Chin close to breast
Rider’s position
Energy required by age and the
amount supplied from breast milk
Energy (kcal/day)
1000
28/4
Energy Gap
800
600
Energy from
breast milk
400
200
0
0-2 m
3-5 m
6-8 m
9-11 m 12-23 m
Age (months)
Complementary food
• Complementary feeding means giving other
foods in addition to breast milk. These other foods
are called complementary foods
• Complementary foods should be introduced from
6 months of age, when breast milk alone no longer
meets infant’s nutrient needs.
• According to age of the child food needs to have
the right amount, texture, variety, and should be
given in the right frequency and cleanly prepared.
• FATVAH ---frequency, amount, texture, variety,
active feeding, hygiene
Nutrition- food Groups
Staple foods:
wheat
corn
rice
Minerals and vitamins:
green leaves
fruit
vegetables
Protein:
Meat, fish
beans
Nuts
Egg
Calories:
fat
honey
sugar
2/11
Percentage of daily needs
Breast milk in second year of life
100%
Gap
75%
50%
Provided by
550 ml
breast milk
25%
0%
Energy
Protein
Nutrient
Iron
Vitamin A
28/5
Key Message 2
• Starting other foods in
addition to breast milk
at 6 completed months
helps a child to grow
well
29/5
Key Message 3
• Foods that are thick
enough to stay in
the spoon give
more energy to the
child
Just right
Too thin
30/2
Gap for iron
Absorbed iron
(mg/day)
Absorbed iron needed and amount provided
1.2
Iron gap
0.8
Iron from
birth
stores
Iron from
breast
milk
0.4
0
0-2 m
3-6 m
6-8 m
Age (months)
9-11 m
12-23 m
30/3
Key Message 4
•Animal-source foods are especially good for
children, to help them grow strong and lively
fish
poultry
meat
liver
cheese
eggs
yoghurt
30/4
Key Message 5
•Peas, beans, lentils, nuts and seeds are also
good for children
seeds
Groundnut
paste
lentils
beans
peas
nuts
30/5
Gap for vitamin A
Vitamin A needed and amount provided
Vitamin A (µg RE/day)
400
Vitamin A
gap
300
200
Vitamin A
from birth
stores
100
Vitamin A
from
breast milk
0
0-2 m
3-6 m
6-8 m
Age (months)
9-11 m
12-23 m
30/6
Key Message 6
•Dark-green leaves and yellow-coloured fruits
and vegetables help a child to have healthy eyes
and fewer infections
carrot
pumpkin
yellow sweet
potato
mango
papaya
spinach
31/2
Gaps to be filled by complementary
foods for a 12-23 months old child
Percentage of daily needs
% 100
75
Gap
50
Provided by
550 ml breast
milk
25
0
Energy
Protein
Iron
Vitamin A
31/3
Three meals
Percentage of daily needs
% 250
Gap
200
Evening meal
150
Mid-day meal
Morning meal
100
Breast milk
50
0
Mid-day meal
Gap
Morning meal
Evening meal
Breast milk
Energy
Protein
Iron
Vitamin A
Nutrients from meals
31/5
Three meals and two snacks
Percentage of daily meals with iron rich food and
snacks added
% 250
200
Gap
Snacks
150
Evening meal
Mid-day meal
100
Morning meal
Breast milk
50
Snacks
Mid-day meal
Gap
Morning meal
Evening meal
Breast milk
0
Energy
Protein
Iron
Vit A
Nutrients from meals
31/6
Key Message 7
• A growing child 6 – 8 months needs 2 – 3 meals a day
• A growing child 9 – 24 months needs three to four meals a day
• Plus additional 1 – 2 snacks if the child is hungry:
• Give a variety of foods
31/9
Key Message 8
• A growing child needs increasing amounts
of food
34/3
Key Message 9
• A young child needs to learn to eat:
encourage and give help
… with lots of patience
37/3
Key Message 10
• Encourage children to drink and eat during
illness and provide extra food after illness to
help them recover quickly
From 6 up to 9 months ( FATVAH)
: Recommended complementary feeding practices
Age
6 –8 month
frequency
2 –3 time
Amount of food
an average
child will
us ually eat at
each s erving in
addition to
breas t milk
Te xture
Var iety
2— 3 table
s poons Tastes
upto 1/2cup
(250ml)
Thick por ridge
Breas t feeding
Mas hed /pureed
fa mily food
+
Staple
(porridge, other
local e xa mples
Legu mes
vegetables /
Fruits
Anima l foods
thicknes s/
cons is tency
x
From 9 up to 12 months ( FATVAH)
x
From 12 up to 24 months ( FATVAH)
x
: Recommended complementary feeding practices
Res pons ive
feeding
Be patient & act ively encourage your baby to eat
Hygiene
Feed your baby us ing a clean cup & s poon
is difficult to c lean & may caus e your baby
W ash your hands with s oap & water before
food,before eating & before feed ing young
,never a bottle as this
to get diarrhea.
preparing
children
use iodiz ed salt in preparing food
3 step counseling
• Help you to counsel with mothers for infant & young child
feeding
• Step 1 ---- Assess ; Ask , Listen & observe--- Assess age
appropriate feeding practices & health of child & mother
• Step 2 ---- Analyze ; identify difficulties & prioritize the
difficulties if more then than 1 difficulty, praise mother
• Step 3 ---- Act ; discuss , suggest small amount of relevant
information, give option regarding feeding difficulty & help
mother to select one option .
• Additional Support --- Refer to health facility, IYCF
support group in community, Health worker
• Thank the mother ,Set next meeting for F/up
Benefit of IYCF teaching/training
• Improvement in feeding practices
• Benefit to community
Helpful for onward
counseling and support
to mothers to carry out
recommended feeding
practices for their
infants and young
children from birth up
to 24 months of age at
any opportunity.
•
↓
• Prevention of malnutrition & its
consequences
•
↓
• ↓ U5 mortality → Achieve MDG 4
•
↓
Healthy children → Healthy adult
work hard
↓
improve GDP
↓
National benefit
Question ?
Thank You