The importance of infant and young child feeding and recommended practices 1.1 Growth.health and FIGURE 1 development Major causes of death in neonates and children under five in the world,2004 Adequate nutrition during infan- Deaths among children under five Neonatal deaths cy and early childhood is essen- Noncommunicablediseases tial to ensure the growth,health, (postnecnatal)4% and development of children to Other 1.3% their full potential.Poor nutrition HIV/AIDS 2%- Congenital anomalies 6.8% increases the risk of illness,and is Neonatal tetanus 3.4% Measles 4% Diarhoeal diseases 2.6% responsible,directly or indirectly, Malaria7% for one third of the estimated 6 Neonatal infections 26% 9.5 million deaths that occurred in 2006 in children less than 5 years of age(1,2)(Figure 1).Inap- Prematurity and Acute respiratory low birth weight 31% propriate nutrition can also lead 35%of under-five deaths are due to the presence of undernutrition to childhood obesity which is an increasing public health problem Sources:World Health Organization.The globalburden ofdisease:2004 update.Geneva,World Health Organization, in many countries. 2008;Black Ret al.Maternal and child undernutrition:global and regional exposures and health consequences. Lancet,,2008,371243-260. Early nutritional deficits are also linked to long-term impairment in growth and health. 1.2 The Global Strategy for infant and Malnutrition during the first 2 years of life causes young child feeding stunting,leading to the adult being several centime- In 2002,the World Health Assembly and UNICEF tres shorter than his or her potential height(3).There is evidence that adults who were malnourished in ear- adopted the Global Strategy for infant and young child ly childhood have impaired intellectual performance feeding(10).The strategy was developed to revitalise (4).They may also have reduced capacity for physical world attention to the impact that feeding practices have on the nutritional status,growth and devel- work(5,6).If women were malnourished as children, their reproductive capacity is affected,their infants opment,health,and survival of infants and young children(see also Session9).This Model Chapter sum- may have lower birth weight,and they have more complicated deliveries(7).When many children in a marizes essential knowledge that every health profes- population are malnourished,it has implications for sional should have in order to carry out the crucial national development.The overall functional conse- role of protecting,promoting and supporting appro- quences of malnutrition are thus immense. priate infant and young child feeding in accordance with the principles of the Global Strategy. The first two years of life provide a critical window of opportunity for ensuring children's appropri- 1.3 Recommended infant and young child feeding ate growth and development through optimal feed- practices ing(8).Based on evidence of the effectiveness of WHO and UNICEF's global recommendations for interventions,achievement of universal coverage of optimal infant feeding as set out in the Global Strat- optimal breastfeeding could prevent 13%of deaths egy are: occurring in children less than 5 years of age globally, while appropriate complementary feeding practices exclusive breastfeeding for 6 months (180 days) would result in an additional 6%reduction in under- (11): five mortality (9).The importance of infant and young child feeding and recommended practices 1.1 Growth, health and development Adequate nutrition during infan￾cy and early childhood is essen￾tial to ensure the growth, health, and development of children to their full potential. Poor nutrition increases the risk of illness, and is responsible, directly or indirectly, for one third of the estimated 9.5 million deaths that occurred in 2006 in children less than 5 years of age (1,2) (Figure 1). Inap￾propriate nutrition can also lead to childhood obesity which is an increasing public health problem in many countries. Early nutritional deficits are also linked to long-term impairment in growth and health. Malnutrition during the first 2 years of life causes stunting, leading to the adult being several centime￾tres shorter than his or her potential height (3). There is evidence that adults who were malnourished in ear￾ly childhood have impaired intellectual performance (4). They may also have reduced capacity for physical work (5,6). If women were malnourished as children, their reproductive capacity is affected, their infants may have lower birth weight, and they have more complicated deliveries (7). When many children in a population are malnourished, it has implications for national development. The overall functional conse￾quences of malnutrition are thus immense. The first two years of life provide a critical window of opportunity for ensuring children’s appropri￾ate growth and development through optimal feed￾ing (8). Based on evidence of the effectiveness of interventions, achievement of universal coverage of optimal breastfeeding could prevent 13% of deaths occurring in children less than 5 years of age globally, while appropriate complementary feeding practices would result in an additional 6% reduction in under￾five mortality (9). 1.2 The Global Strategy for infant and young child feeding In 2002, the World Health Assembly and UNICEF adopted the Global Strategy for infant and young child feeding (10). The strategy was developed to revitalise world attention to the impact that feeding practices have on the nutritional status, growth and devel￾opment, health, and survival of infants and young children (see also Session 9). This Model Chapter sum￾marizes essential knowledge that every health profes￾sional should have in order to carry out the crucial role of protecting, promoting and supporting appro￾priate infant and young child feeding in accordance with the principles of the Global Strategy. 1.3 Recommended infant and young child feeding practices WHO and UNICEF’s global recommendations for optimal infant feeding as set out in the Global Strat￾egy are: K exclusive breastfeeding for 6 months (180 days) (11); Sources: World Health Organization. The global burden of disease: 2004 update. Geneva, World Health Organization, 2008; Black R et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet, 2008, 371:243–260. Figure 1 Major causes of death in neonates and children under five in the world, 2004 Noncommunicable diseases (postneonatal) 4% Injuries (postneonatal) 4% Neonatal deaths 36% Other infectious and parasitic diseases 9% HIV/AIDS 2% Measles 4% Malaria 7% Diarrhoeal diseases (postneonatal) 16% Acute respiratory infections (postneonatal) 17% Other 1.3% Congenital anomalies 6.8% Neonatal tetanus 3.4% Diarrhoeal diseases 2.6% Other non-infectious perinatal causes 5.7% Neonatal infections 26% Birth asphyxia and birth trauma 23% Prematurity and low birth weight 31% Deaths among children under five Neonatal deaths 35% of under-five deaths are due to the presence of undernutrition Session 1