1. Dr Yasmeen Memon Associate Professor Paediatric Unit 1 LUMHS
IYCF
Dr Yasmeen Memon
Associate Professor
Paediatric Unit 1
LUMHS

2. What do these letters stand for?I Y C F
= Infant (0—11 months)
= Young ( up to 2 years)
= Child
= Feeding

3. 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

4. Major Causes of Death Among Children under five in developing countries, 2008
Deaths associated
With malnutrition
54%
Source: The World Health Report 2008, WHO, Geneva.

5. 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), 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)

6. 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.

7. Nutrition and life course

8. 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
Stunting(low Ht/age) 43.7% ( Sind %) % (57% in sind )
Under weight ( low wt/age) %( Sind 39.8%) %
Wasting (low wt/Ht) %(Sind 17.5%) % (17.5% in sind )
Micronutrient deficiency----
Anemia % ( Sind 73%)
Vitamin A deficiency % (Sind 53%)
Vitamin D deficiency % (Sind 43%)
Zinc deficiency % (Sind 39.2%)

10. Trend of IYCF in Pakistan (preliminary results)
DHS
DHS
(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%

11. IYCF Component Nutrition of pregnant & Lactating women's
Breast feeding
Complementary feeding
Counselling & Key messages .

12. Appropriate diet during pregnancy & lactation
During Lactation
3 meals each day plus two extra small meals or snacks in between meals to sustain energy and better take care of child
Peas, lentils , beans, oil, green vegetables or fruit and meat
Never stay thirsty; use of juice, soups etc. should be increased
During Pregnancy
Women does not need more food during pregnancy
3 meals each day plus one extra small meal or snack in between meals

13. Advantages of breast feeding
Breast milk
• 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
Perfect nutrients
Easily digested; efficiently used
Protects against infection
It is free! Costs less than artificial feeding
Breastfed children get sick less often

14. TEN STEPS TO SUCCESSFUL BREASTFEEDING
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

15. During first 6 months = = + + +

16. ?

17. 28/2
Key Message 1
Breastfeeding for two years or longer helps a child to develop and grow strong and healthy

18. Good and poor attachment
3/8
Good and poor attachment
What differences do you see? 1 2

19. 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

20. Rider’s position

21. Energy required by age and the amount supplied from breast milk
28/4
Energy required by age and the amount supplied from breast milk
Energy (kcal/day)
1000
800
0-2 m
3-5 m
Age (months)
Energy Gap
Energy from breast milk
6-8 m
9-11 m
12-23 m
600
400
200

22. 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

24. Breast milk in second year of life
2/11
Breast milk in second year of life
100%
Gap
75%
Percentage of daily needs
50%
Provided by 550 ml breast milk
25% 0%
Energy
Protein
Iron
Vitamin A
Nutrient

25. Key Message 2
28/5
Starting other foods in addition to breast milk at 6 completed months helps a child to grow well

26. 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

27. Gap for iron Absorbed iron needed and amount provided
30/2
Gap for iron
Absorbed iron needed and amount provided
1.2
0.8
0.4
Iron gap
Iron from birth stores
Iron from breast milk
0-2 m
3-6 m
6-8 m
9-11 m
12-23 m
Age (months)
Absorbed iron (mg/day)

28. Animal-source foods are especially good for children, to help them grow strong and lively
30/3
Key Message 4
yoghurt
poultry
fish
meat
cheese
eggs
liver

29. 30/4
Key Message 5
Peas, beans, lentils, nuts and seeds are also good for children
lentils
beans
peas
nuts
seeds
Groundnut paste

30. Vitamin A needed and amount provided
30/5
Gap for vitamin A
Vitamin A needed and amount provided
400
Vitamin A gap
Vitamin A from birth stores
Vitamin A from breast milk
0-2 m
3-6 m
6-8 m
9-11 m
12-23 m
Age (months)
Vitamin A (µg RE/day)
300
200
100

31. 30/6
Key Message 6
Dark-green leaves and yellow-coloured fruits and vegetables help a child to have healthy eyes and fewer infections
pumpkin
spinach
papaya
mango
carrot
yellow sweet potato

32. Gaps to be filled by complementary foods for a 12-23 months old child
31/2
Gaps to be filled by complementary foods for a months old child

33. Three meals 31/3 Nutrients from meals Mid-day meal Gap Morning meal
Evening meal
Breast milk

34. Three meals and two snacks
31/5
Snacks
Mid-day meal
Gap
Morning meal
Nutrients from meals
Evening meal
Breast milk

35. Key Message 7 A growing child 6 – 8 months needs 2 – 3 meals a day
31/6
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

36. 31/9
Key Message 8
A growing child needs increasing amounts of food

37. 34/3
Key Message 9
A young child needs to learn to eat: encourage and give help … with lots of patience

38. 37/3
Key Message 10
Encourage children to drink and eat during illness and provide extra food after illness to help them recover quickly

39. From 6 up to 9 months ( FATVAH)x

40. From 9 up to 12 months ( FATVAH)x

41. From 12 up to 24 months ( FATVAH)x

43. 3 step counseling
Help you to counsel with mothers for infant & young child feeding
Step Assess ; Ask , Listen & observe--- Assess age appropriate feeding practices & health of child & mother
Step Analyze ; identify difficulties & prioritize the difficulties if more then than 1 difficulty, praise mother
Step 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

44. Benefit of IYCF teaching/training
Improvement in feeding practices ↓
Prevention of malnutrition & its consequences
↓ U5 mortality → Achieve MDG 4
Healthy children → Healthy adult
work hard
improve GDP
National benefit
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.

45. THANK YOU

46. Question ?
Thank You