1. An Overview of Infant and Young Child Feeding, 6-24 Months Jean Baker, AED/LINKAGES

2. Outline I. The “Big Picture” and How to Impact It II. A Better Understanding of the Issues III. The Role for Processed Complementary Foods

3. Complementary Feeding is… Then: Weaning foods…complementary foods Period when other foods or liquids are provided along with breastmilk Now: Period when child receives both breastmilk (or a breastmilk substitute) and solid or semi-solid food.

4. The ‘Big Picture’ and How to Impact It

5. 150 Million Children are Underweight Prevalence of underweight in children 0 - 4 years old de Onis and Blossner, 2001

6. Malnutrition Happens Early Weight for age by region

7. “Virtually all growth faltering occurs in the first 2 years, most of it during infancy” Length for Age by Region

8. Malnutrition has a Lasting Impact Worldwide 182 Million Children are Stunted Both girls are 3 ½ years old

9. Anemia Prevalence by Global Region Ages 0-4 years

10. 5 million Children Die Annually from the Underlying Causes of Malnutrition Estimated contribution of undernutrition to under-five mortality by cause Sources: For cause-specific mortality: EIP/WHO. For deaths associated with malnutrition: Caulfield LE, Black RE. Malnutrition and the global burden of disease: underweight and cause-specific mortality.

11. Top Three Prevention Interventions Prevention Intervention Number Deaths prevented (% of all <5 deaths) (thousands) 1. Breastfeeding 1,301 13% 2. Insecticide-treated materials 691 7% 3. Complementary feeding 587 6% Source: Lancet, 2003

12. Further Evidence Efficacy Trials & Programs in 14 Countries Child growth improved with increased dietary intake (as measured by anthropometry) Nutritional improvements support Lancet estimates of reductions in undernutrition and mortality Studies verified importance of feeding practices, not just food Source: Caulfied, Huffman, Piwoz, 1999

13. A Better Understanding of the Issues

14. Causes of Poor Growth in Infants and Young Children Poor maternal nutritional status at conception and undernutrition in utero Suboptimal feeding practices Impaired absorption of nutrients due to intestinal infections or parasites Combination of above

15. Issue One: Suboptimal Feeding Practices (Birth – 24 months)

16. Non-Exclusive Breastfeeding Currently only about 39% of infants worldwide are exclusively breastfed during the first 6 months of life

17. Poorly Timed Complementary Feeding Prevalence of Timely Complementary Feeding, 1995 and 2002

18. Infrequent Feeding Because of small stomach size, children need to be fed frequently throughout the day Labor, time, and resource constraints are often obstacles to frequent feedings

19. Inadequate Food Quality & Quantity Inadequate energy density Too much bulk or too diluted Too little variety Too few micronutrients, especially iron

20. Poor Feeding Methods, Hygiene, and Child Care Practices Unsupervised feedings Lack of interaction and encouragement Contaminated foods and utensils Poor food hygiene

21. Issue Two: Nutrient Gaps During Complementary Feeding Period (6-24 months)

22. Nutrient Gaps Breastmilk important source of energy, fat, and other nutrients and continues to protect against illness and death But complementary foods needed to meet increasing nutrient needs of the growing child

23. Energy Gap - Contribution of Breastmilk during Complementary Feeding Period

24. The Iron Gap

25. Issue Three: Measuring Complementary Feeding

26. Measurement Issues Timely Complementary Feeding (TCF) indicator is problematic, time-bound, and gives no information regarding: - Quality - Frequency - Food diversity - Caregiver practices

27. Issue Four: What Effect Does HIV and AIDS Have on Complementary Feeding?

28. Special Challenge: HIV and Infant Feeding

29. The Role for Processed Complementary Foods

30. History of Processed Complementary Foods 1950s - Concern about protein intake 1960s - Failure of processed foods to reach low income kids 1977 - Review showed little impact on nutrition (beginning of Nestle boycott) 1980 - Code of Marketing Breastmilk Substitutes Late 1980s - Shift from commercial to community-based focus

31. Why now? What’s changed? Lancet endorsement of CF Improved technology More palatable formulations Improved marketing, transport, logistics Increased “demand” for products and “buying power” Greater experience in building private/ public sector partnerships Urbanization

32. Source: United Nations, World Urbanization Prospects: The 2003 Revision (medium scenario), 2004. Trends in Urbanization by Region

33. Summary - Challenges Show impact on child growth/health Increase geographic coverage & scale Ensure safeguards for breastfeeding Focus on behaviors and food quality

34. Global Framework for IYCF Recognizes CF has received less attention Embraces feeding continuum Recommends viewing CF in broader framework Updates calorie & nutrient needs Provides impetus for new ‘guiding’ principles for CF

35. Guiding Principles for Complementary Feeding (PAHO, WHO, 2001) Excl BF duration and age of intro of CF Maintenance of BF Responsive feeding Safe preparation and storage of CF Amount of CF needed Food consistency Meal frequency and energy density Nutrient content of CF Use of vitamin mineral supplements or fortified products for infant and mother Feeding during/after illness

36. Thank You!