Infant and young child feeding standard 2: Basic and skilled support
Mothers and caregivers of infants and young children have access to timely and appropriate feeding support that minimises risks and optimises nutrition, health and survival outcomes.
Key actions (to be read in conjunction with the guidance notes)
Undertake integrated multisector interventions to protect and support safe and appropriate IYCF (see guidance note 1).
Give priority to pregnant and breastfeeding women to access food, cash and/or voucher transfers and other supportive interventions (see guidance note 1).
Integrate skilled breastfeeding counselling in interventions that target pregnant and breastfeeding women and children aged 0–24 months (see guidance notes 2–7).
Target mothers of all newborns with support for early initiation of exclusive breastfeeding (see guidance note 3).
Support timely, safe, adequate and appropriate complementary feeding (see guidance note 5).
Enable access for mothers and caregivers whose infants require artificial feeding to an adequate amount of an appropriate BMS and associated support (see guidance note 6).
Give special consideration to feeding support of infants and young children in exceptionally difficult circumstances (orphans, acutely malnourished children, LBW infants and those affected by HIV) (see guidance notes 4–7).
Key indicators (to be read in conjunction with the guidance notes)
Measurement of standard WHO indicators for early initiation of breastfeeding, exclusive breastfeeding rate in children <6 months, and continued breastfeeding rate at 1 and 2 years (see guidance notes 2–3, 5–6).
Caregivers have access to timely, appropriate, nutritionally adequate and safe complementary foods for children 6 to <24 months (see guidance notes 5–6).
Breastfeeding mothers have access to skilled breastfeeding support (see guidance notes 1–3).
There is access to Code-compliant supplies of appropriate BMS and associated support for infants who require artificial feeding (see guidance note 5).
- Simple measures and basic interventions are needed to create a protective and supportive environment for IYCF. Be alert to and investigate reports of difficulties in breastfeeding, complementary feeding and/or practice of artificial feeding in children aged 0–24 months. Non-breastfed infants need urgent support. Support should to be prioritised for mothers, caregivers and pregnant and breastfeeding women to meet immediate essential needs. Households with children under 24 months and breastfeeding mothers of all newborns should be registered and linked to food security programmes to ensure access to adequate food. Designated shelters for mothers and caregivers enables access to peer-to-peer and basic IYCF support. Breastfeeding support should be integrated within key services such as reproductive health, primary healthcare, psychosocial services and selective feeding programmes from the outset.
- Pregnant and breastfeeding women: Inadequate nutrient intakes for pregnant and breastfeeding women risk pregnancy complications, maternal mortality, LBW infants and decline in maternal nutritional status associated with lower concentrations of certain nutrients in breastmilk. Low maternal body weight at conception is strongly associated with infant LBW and is a feature of adolescent pregnancy. Pregnant and breastfeeding women should receive daily supplements providing one daily requirement of multiple micronutrients to protect maternal stores and breastmilk content, whether they receive fortified rations or not. Iron and folic acid supplements when already provided should be continued. Women should also receive Vitamin A within six to eight weeks of delivery. Micronutrient supplementation should be in accordance with international recommendations on doses and timing. Referral to psychosocial services may be needed, especially in traumatised populations. Although nutrition support of the adolescent mother is important, programmes to prevent adolescent pregnancy are likely to have the most impact on LBW incidence.
- Early initiation of exclusive breastfeeding (within one hour of birth) is a priority intervention to safeguard the health of both the mother and the infant. LBW infants and their mothers will benefit especially from continued skin-to-skin contact at birth and early initiation of exclusive breastfeeding (see Essential health services - child health standard 2, guidance note 1).
- Breastfeeding: Exclusive breastfeeding requires an infant to receive only breastmilk and no water, other liquids or solids, with the exception of necessary micronutrient supplements or medicines. It guarantees food and fluid security in infants for the first six months and provides active immune protection. Breastfeeding also protects older infants and children, especially in contexts where water, sanitation and hygiene conditions are lacking, so is important to sustain to 24 months or beyond. Mothers, families, communities and health workers should be reassured of the resilience of breastfeeding; confidence can be undermined by acute emergency situations. Planning and resource allocation should allow for skilled breastfeeding support in managing more difficult situations including stressed populations and acutely malnourished infants under 6 months (see Management of acute malnutrition and micronutrient deficiencies standard 2), populations where mixed feeding is common, and infant feeding in the context of HIV (see guidance note 7).
- Complementary feeding is the process of giving other food in addition to breastmilk from the age of 6 months (or to an appropriate breastmilk substitute in non-breastfed infants). During the complementary feeding period (6–24 months), breastfeeding continues to significantly contribute to food and fluid security. Non-breastfed infants need support to make up the nutritional shortfall. Links with food security programmes are essential to support complementary feeding. Where a population is dependent on food aid, a suitable micronutrient-fortified food should be included in the general ration; blanket provision of complementary food may be needed. Clear criteria for the inclusion, use and duration of lipid-based nutrient supplements during the complementary feeding period are needed for different emergency contexts. Ready-to-use therapeutic foods are not a complementary food. Distribution of complementary food should be accompanied with practical guidance and demonstration on their preparation. The use of micronutrient supplementation, including Vitamin A, should be in accordance with the latest recommendations. LBW infants and young children may benefit from iron supplementation. If the population is in a malaria-endemic area, iron supplementation should be targeted to children who are anaemic and iron deficient with appropriate malaria control measures.
- Artificial feeding: Infants who are not breastfed require early identification and assessment by skilled personnel to explore feeding options. Where maternal breastfeeding is not available, donor breastmilk, particularly as wet nursing, has a valuable role, especially in feeding young and LBW infants. Where artificial feeding is indicated, mothers and caregivers need assured access to adequate amounts of an appropriate BMS for as long as is necessary (until infants are at least 6 months old) as well as to the associated essential supports (water, fuel, storage facilities, growth monitoring, medical care, time). Infants under 6 months who are mixed fed should be supported to move to exclusive breastfeeding. Feeding bottles should not be used due to difficulties in cleaning. Programmes that support artificial feeding should monitor the community’s IYCF practices using standard indicators to ensure that breastfeeding is not undermined. Morbidity surveillance should be conducted at individual and population levels, with a particular focus on diarrhoea. Low-dose supplemental Vitamin A should be considered for non-breastfed infants under 6 months.
- HIV and infant feeding: Maximising the survival of HIV-free children is a primary consideration in determining the best feeding option for infants born to HIV-infected mothers. Mothers of unknown or negative HIV status should be supported to breastfeed as per general IYCF recommendations for populations (see guidance notes 3–5). For HIV-infected mothers, combining anti-retroviral (ARV) interventions with breastfeeding can significantly reduce post-natal HIV transmission. Accelerated access to ARVs should be prioritised (see Essential health services – sexual and reproductive health standard 2). The risks to infants associated with replacement feeding are even greater under emergency conditions. This means that breastfeeding offers the greater likelihood of survival for infants born to HIV-infected mothers and for survival of HIV-infected infants, including where ARVs are not yet available. Urgent artificial feeding assistance is needed for infants already established on replacement feeding (see guidance note 6).