1. Child Protection Cluster
IYCF ORIENTATION
Child Protection Cluster
Date:
Location: Sana’a, Yemen
Photo: Save the Children, Yemen

2. Session Objectives
By the end of this session, you will be able to:
Understand why IYCF(E) is important.
Know the recommended IYCF practices.
Know how to report untargeted distributions of breastmilk substitutes.
Understand that integration of IYCF in different sectors is crucial due to multi- sectoral causes of malnutrition.
Understand how you can support IYCF.

3. What is IYCF? I = Infant Y = Young C = Child F = Feeding
Infant = completed months
Young child = completed months
SAY:
We know that today we have gathered to discuss about IYCF, and specifically the “IYCF Framework: A multi-sectoral Framework for Action” and how YOU fit into this as a ‘champion’. So, let us first cover some basics. What is IYCF?
DO:
Now show the slide and go over the acronyms one by one.
And now let us go over the age range of an infant and young child.
Now, show the age ranges and the picture.
Therefore, the focus of IYCF is always children under two, and the mother and/or any other caregiver of that child because a child this age is dependent on their caregiver. Pregnant women are also a target group, because they will become a mother of a baby and that baby’s health hinges on his mother’s health, as we will demonstrate later in this session. So, you cannot ignore the caregiver/mother if your focus is a child under two years.

4. EMEGENCIES INCREASE RISK
Why focus on IYCF?
Extremely Vulnerable to
Illness
Malnutrition
Death
Increased risk
Chronic diseases
Lower productivity
Long term Consequences
EMEGENCIES INCREASE RISK
SAY:
The first two years of life is a period of rapid growth and body demands are high. Which is why when those needs are not met, children get malnourished. Their body lacks nutrients and energy. Children under two are also vulnerable to illnesses and death. You may have seen malnutrition yourself. See if you recognize any of the signs in the pictures.
DO:
Show the pictures one by one, as you name the manifestations.
Children can become extremely thin or wasted (mouse click), have water-retention or edema (mouse click), become short for age or stunted (mouse click) (Both the girls are 3 and half years of age but we can clearly see that one of the girls is shorter than the other girl) and have micronutrient deficiencies such as anemia (mouse click), which is deficiency of a micronutrient called iron.
But it doesn’t end there (mouse click), children suffer long term consequences (mouse click). Children who fail to catch up on their growth suffer illness and death later in life. And if they gain weight, for example, in later years, it increases their likelihood of chronic diseases such as heart disease. Children who do not attain their full growth, also have lower productivity as adults and therefore have lower wages.
(mouse click)
Emergencies put children under increased risk of dying. In emergencies, children are 2-70 times more likely to die. Even in previously healthy populations, death rates can increase 20fold and malnutrition can set-in in just 2 weeks.
Save the Children, Yemen, 2017
Mayaclinic, 2014
FANTA, 2008
Rae Galloway, 2006
Source: Guiding principles for IYCF during emergencies, WHO , 2004.

5. Recommended IYCF Practices
ONLY breastmilk
Other solids, semi-solids, liquids at 6 months with continued breastfeeding up to 2 years
SAY:
This brings us to the question: what are the recommendations for optimal IYCF practices? We talked about breastfeeding and complementary feeding in the last slide. Lets take a closer look at them.
DO:
Now, show the slide.
Optimal IYCF recommendations are:
Early initiation of breastfeeding – this means breastfeeding within 1 hour of birth
Mouse Click to show definition of EBF.
Exclusive Breastfeeding for 6 months – exclusive breastfeeding means an infant receives only breastmilk, no other liquids or solids, not even water, with the exception of necessary vitamins, mineral supplements or medicines. It is recommended to not to use any artificial feeding which includes feeding breastmilk substitute or infant formula, unless it is medically necessary. Also, no use of feeding bottles, treats or pacifiers.
Continued breastfeeding to 2 years or beyond - Complementary feeding encompasses continued breastfeeding, the introduction of complementary foods at six months, and how that is done in the nutritional and developmental interests of the child.
Mouse Click to show definition of CF.
Source: GNC IFE training 2011

6. Recommended IYCF Practices
DO:
Show the first picture.
SAY:
This is how artificial feeding or feeding infant formula with a bottle is advertised and it actually may look like this in reality under normal circumstances.
Show the next picture.
But, this is how it actually is during emergencies. The risks of artificial feeding are heightened in emergencies, with constraints on water and sanitation, fuel, preparation, storage and supplies. Therefore, infant formula or breastmilk substitutes should not be given unless there is a medical reason to do so. Bottles, teats and pacifiers should not be used.
Priyanka.guru
The Guardian, 2010

7. Breastmilk Substitutes (BMS)
Breast Milk Substitute (BMS):
Any food being marketed or otherwise presented as a partial or total replacement for breast milk, whether or not suitable for that purpose.
Infant Formula Other milk products
Follow-on milks Baby Teas & Juices
Infant Cereals Vegetable Mixes
Artificial Feeding: where an infant or young child is fed with a BMS (partial or exclusive)

8. International Code on Marketing of BMS
NO untargeted distribution of BMS
Code Violations to:
SAY: In emergencies, targeting and use, procurement, management and distribution of BMS, milk products, bottles and teats should be strictly controlled based on technical advice.
Yemen Breastfeeding Legislation adapted from International Code
International Code: Advertising, Samples, Health Care, Facilities, Health Workers, Supplies,
Information, Labels, Products

9. Recommended IYCF Practices
Its TRUE!
Even malnourished mothers can breastfeed.
Stress does not prevent mothers from producing milk.
Infant Formula is NEVER as good as breast milk.
Donations and untargeted distribution of breast milk substitutes may undermine a mother’s confidence and motivation to breastfeed.
Cholera is NOT transmitted in breastmilk
SAY:
Even Malnourished mothers can breastfeed.
Stress does not prevent mothers from producing milk.
Infant Formula is NEVER as good as breast milk.
Donations and untargeted distribution of breast milk substitutes may undermine a mother’s confidence and motivation to breastfeed.

10. IYCF Framework: A Multi-Sectoral Framework for Action
Multi-Sectoral Approach
IYCF Framework: A Multi-Sectoral Framework for Action
SAY:
The “IYCF Framework: A Multi-Sectoral Framework for Action” is a tool for UNHCR and partners, which has been designed for national and international staff working in refugee operations to provide guidance to managers and technical staff across all sectors on what needs to be considered to create an ‘infant and young child friendly’ environment and facilitate optimal IYCF. This Framework enlists key and overarching activities that each sector can adopt to integrate IYCF in their respective sectors.

11. Important links between IYCF and CP
Many activities in child protection are designed for children above 2 or 3 years.
However, early childhood is a critical period in a child´s life due to it being the time for rapid cognitive, emotional and physical growth.
As outlined in the First 1000 Days approach, both adequate nutrition and psychosocial stimulation from conception until 2 years of age are important for the child´s development.
In building strong collaborations between IYCF and Child Protection colleagues, protecting children remains at the core of our work.
Why should ECD activities be combined with IYCF and other nutrition programmes?
In famines and food shortage situations, providing food alone is not enough
Child growth and brain development depend on good nutrition AND stimulation and caretaker emotional responsiveness
The brain is most responsive in the first three years of life. This is when it grows and develops fastest
There is strong evidence that combined programmes improve growth and developmental outcomes in short and long term
Early child development activities improve maternal mood if conducted using groups and home visits
Regular mother and baby groups to do ECD activities build resilience and increase networks of social support. They provide a non-stigmatizing way of supporting vulnerable women and children exposed to violence
Combined programmes are fun to do!

12. IDENTIFY
PROTECT
Train CP staff on how to identify and refer PLW and children 0-23 months between IYCF and CP programmes (safe and confidential)
Prevent separation - keep infants and young children with their parents/caregivers
Ensure cases that need urgent care are referred (separated/orphaned children, infant <6 months not breastfed, malnourished children, mothers with breastfeeding difficulties)
Prevention of child marriage – adolescent mothers are at high risk of delivering low birthweight babies
Ensure registration of newborns
Report uncontrolled BMS distributions (all sectors)
Prioritize appropriate shelter for the most vulnerable families (with PLW and children 0-23 months) to prevent negative effects of the environment on health and nutritional status i.e. cold weather leading to hypothermia, insect bites and to provide PLW with the support needed to feed and care for this vulnerable age group (i.e. location to services, privacy).
Protect PLW, infants and young children during mass distributions. Both Settlement and Shelter and IYCF teams should coordinate with camp management and the community to define ways to protect mothers and caregivers of young children during a general distribution: design rest areas, organise priority lines, reduce the number of people in each group etc.

13. PROMOTE
SUPPORT
Standardise relevant IYCF and CP messages for PLW and caregivers of children 0-23 months (availability of / access to services)
Recognize unique challenges in providing CFS services to 0-23 months old children (i.e. caregiver remaining on site)
IYCF staff to participate in CP sector to raise awareness and orientation on IYCF
CP programmes should consider needs and space for IYCF activities (i.e. safe space for breastfeeding)
Collect success stories to demonstrate positive impact on children’s well-being (weight gain, psychosocial indicators)
Identify psychosocial stimulation activities safe and engaging for 0-23 months old (PSS in therapeutic feeding programmes)
Organise training on IYCF for CP staff (and vice versa)
Locate Child Friendly Spaces near Baby Friendly Spaces
Consider standardizing relevant IYCF and food security messages considering the needs identified in the needs assessment e.g. related to availability, access and utilization of food for this target group. Jointly plan dissemination opportunities in one another’s programmes;
Consider cash/voucher programmes that promote good nutrition outcomes i.e. preventing malnutrition and consider unintentional impacts of programming on optimal IYCF practices. E.g. Ensure cash transfer/ voucher programmes include conditional vouchers for appropriate, nutritious foods for PLW and 6-23 months olds.
Provide hygiene promotion and related NFIs at IYCF sites to allow complementary nutrition education, particularly around IYCF and care practices;
Ensure caregivers of artificially fed infants have access to a safe water supply to safely prepare breastmilk substitutes (BMS);

14. THANK YOU QUESTIONS?