Key facts
·
Every infant
and child has the right to good nutrition according to the Convention on the
Rights of the Child.
·
Undernutrition
is associated with 45% of child deaths.
· Globally in
2013, 161.5 million children under 5 were estimated to be stunted, 50.8 million
were estimated to have low weight-for-height, and 41.7 million were overweight
or obese.
·
About 36% of
infants 0 to 6 months old are exclusively breastfed.
·
Few children
receive nutritionally adequate and safe complementary foods; in many countries
less than a fourth of infants 6–23 months of age meet the criteria of dietary
diversity and feeding frequency that are appropriate for their age.
·
Over 800 000
children's lives could be saved every year among children under 5, if all
children 0–23 months were optimally breastfed . Breastfeeding improves IQ,
school attendance, and is associated with higher income in adult life. 1
· Improving
child development and reducing health costs through breastfeeding results in
economic gains for individual families as well as at the national level.
Overview
Undernutrition is estimated to cause 3.1 million child
deaths annually or 45% of all child deaths. Infant and young child feeding is a
key area to improve child survival and promote healthy growth and development.
The first 2 years of a child’s life are particularly important, as optimal
nutrition during this period lowers morbidity and mortality, reduces the risk
of chronic disease, and fosters better development overall.
Optimal breastfeeding is so critical that it could
save over 800 000 under 5 child lives every year.
WHO and UNICEF recommend :
·
early
initiation of breastfeeding within 1 hour of birth;
·
exclusive
breastfeeding for the first 6 months of life; and
·
introduction
of nutritionally-adequate and safe complementary (solid) foods at 6 months
together with continued breastfeeding up to 2 years of age or beyond.
However, many infants and children do not receive
optimal feeding. For example, only about 36% of infants aged 0 to 6 months
worldwide are exclusively breastfed over the period of 2007-2014.
Recommendations have been refined to also address the
needs for infants born to HIV-infected mothers. Antiretroviral drugs now allow
these children to exclusively breastfeed until they are 6 months old and
continue breastfeeding until at least 12 months of age with a significantly
reduced risk of HIV transmission.
Breastfeeding
Exclusive breastfeeding for 6 months has many benefits
for the infant and mother. Chief among these is protection against
gastrointestinal infections which is observed not only in developing but also industrialized
countries. Early initiation of breastfeeding, within one hour of birth,
protects the newborn from acquiring infections and reduces newborn mortality.
The risk of mortality due to diarrhoea and other infections can increase in
infants who are either partially breastfed or not breastfed at all.
Breast milk is also an important source of energy and
nutrients in children aged 6 to 23 months. It can provide half or more of a
child’s energy needs between the ages of 6 and 12 months, and one third of
energy needs between 12 and 24 months. Breast milk is also a critical source of
energy and nutrients during illness, and reduces mortality among children who
are malnourished.
Children and adolescents who were breastfed as babies
are less likely to be overweight/obese. Additionally, they perform better on
intelligence tests and have higher school attendance. Breastfeeding is
associated with higher income in adult life. Improving child development and
reducing health costs result in economic gains for individual families as well
as at the national level.1
Longer durations of breastfeeding also contribute to
the health and well-being of mothers; it reduces the risk of ovarian and breast
cancer and helps space pregnancies–exclusive breastfeeding of babies under 6
months has a hormonal effect which often induces a lack of menstruation. This
is a natural (though not fail-safe) method of birth control known as the
Lactation Amenorrhoea Method.
Mothers and families need to be supported for their
children to be optimally breastfed. Actions that help protect, promote and
support breastfeeding include:
· adoption of
policies such as the International Labour Organization’s Maternity Protection
Convention 183 and Recommendation No. 191, which complements Convention No. 183
by suggesting a longer duration of leave and higher benefits;
· 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, including:
o skin-to-skin
contact between mother and baby immediately after birth and initiation of
breastfeeding within the first hour of life;
o
breastfeeding
on demand (that is, as often as the child wants, day and night);
o
rooming-in
(allowing mothers and infants to remain together 24 hours a day);
o
not giving
babies additional food or drink, even water, unless medically necessary;
·
provision of
supportive health services with infant and young child feeding counselling
during all contacts with caregivers and young children, such as during
antenatal and postnatal care, well-child and sick child visits, and
immunization; and
·
community
support, including mother support groups and community-based health promotion
and education activities.
Breastfeeding practices are highly responsive to
supportive interventions, and the prevalence of exclusive and continued
breastfeeding can be improved over the course of a few years.
Complementary feeding
Around the age of 6 months, an infant’s need for
energy and nutrients starts to exceed what is provided by breast milk, and
complementary foods are necessary to meet those needs. An infant of this age is
also developmentally ready for other foods. If complementary foods are not
introduced around the age of 6 months, or if they are given inappropriately, an
infant’s growth may falter. Guiding principles for appropriate complementary
feeding are:
·
continue
frequent, on-demand breastfeeding until 2 years of age or beyond;
·
practise
responsive feeding (e.g. feed infants directly and assist older children. Feed
slowly and patiently, encourage them to eat but do not force them, talk to the
child and maintain eye contact);
·
practise
good hygiene and proper food handling;
·
start at 6
months with small amounts of food and increase gradually as the child gets
older;
·
gradually
increase food consistency and variety;
·
increase the
number of times that the child is fed: 2-3 meals per day for infants 6-8 months
of age and 3-4 meals per day for infants 9-23 months of age, with 1-2
additional snacks as required;
·
use
fortified complementary foods or vitamin-mineral supplements as needed; and
·
during
illness, increase fluid intake including more breastfeeding, and offer soft,
favourite foods.
Feeding in exceptionally difficult circumstances
Families and children in difficult circumstances
require special attention and practical support. Wherever possible, mothers and
babies should remain together and get the support they need to exercise the
most appropriate feeding option available. Breastfeeding remains the preferred
mode of infant feeding in almost all difficult situations, for instance:
·
low-birth-weight
or premature infants;
·
HIV-infected
mothers;
·
adolescent
mothers;
·
infants and
young children who are malnourished; and
·
families
suffering the consequences of complex emergencies.
HIV and infant feeding
Breastfeeding, and especially early and exclusive
breastfeeding, is one of the most significant ways to improve infant survival
rates. However, HIV can pass from mother to child during pregnancy, labour or
delivery, and also through breast milk. In the past, the challenge was to
balance the risk of infants acquiring HIV through breastfeeding versus the
higher risk of death from causes other than HIV, in particular malnutrition and
serious illnesses such as diarrhoea and pneumonia, among HIV-exposed but still
uninfected infants who were not breastfed.
The evidence on HIV and infant feeding shows that
giving antiretroviral drugs (ARVs) to HIV-infected mothers can significantly
reduce the risk of transmission through breastfeeding and also improve her
health. This enables infants of HIV-infected mothers to be breastfed with a low
risk of transmission (1-2%). HIV-infected mothers and their infants living in
countries where diarrhoea, pneumonia and malnutrition are still common causes
of infant and child deaths can therefore gain the benefits of breastfeeding
with minimal risk of HIV transmission.
Since 2010, WHO has recommended that mothers who are
HIV-infected take ARVs and exclusively breastfeed their babies for 6 months,
then introduce appropriate complementary foods and continue breastfeeding up to
the child’s first birthday. Breastfeeding should only stop once a nutritionally
adequate and safe diet without breast milk can be provided.
Even when ARVs are not available, mothers should be
counselled to exclusively breastfeed for 6 months and continue breastfeeding
thereafter unless environmental and social circumstances are safe for, and
supportive of, feeding with infant formula.
WHO's response
WHO is committed to supporting countries with
implementation and monitoring of the "Comprehensive implementation plan on
maternal, infant and young child nutrition", endorsed by Member States in
May 2012. The plan includes 6 targets, one of which is to increase, by 2025,
the rate of exclusive breastfeeding for the first 6 months up to at least 50%.
Activities that will help to achieve this include those outlined in the
"Global Strategy for Infant and Young Child Feeding", which aims to
protect, promote and support appropriate infant and young child feeding.
WHO has formed a Network for Global Monitoring and
Support for Implementation of the International Code of Marketing of
Breast-milk Substitutes and subsequent relevant WHA resolutions called NetCode.
The goal of NetCode is to protect and promote breastfeeding by ensuring that
breastmilk substitutes are not marketed inappropriately. Specifically, NetCode
is building the capacity of Member States and civil society to strengthen
national Code legislation, continuously monitor adherence to the Code, and take
action to stop all violations. In addition, WHO and UNICEF have developed
courses for training health workers to provide skilled support to breastfeeding
mothers, help them overcome problems, and monitor the growth of children, so
they can identify early the risk of undernutrition or overweight/obesity.
In addition, WHO and UNICEF have developed courses for
training health workers to provide skilled support to breastfeeding mothers,
help them overcome problems, and monitor the growth of children, so they can
identify early the risk of undernutrition or overweight/obesity.
WHO provides simple, coherent and feasible guidance to
countries for promoting and supporting improved infant feeding by HIV-infected
mothers to prevent mother-to-child transmission, good nutrition of the baby,
and protect the health of the mother.
