INFANT AND YOUNG CHILD FEEDING GUIDELINES
WHO and UNICEF jointly developed a global strategy for infant and young child feeding (IYCF) in 2003, considering the impact of feeding practices and nutritional interventions during critical window period of first 1000 days of life (270 days in-utero and first two years after birth) on growth, development, health and survival in children.
First national IYCF guidelines were formulated by Government of India in 2004 and revised subsequently.IYCF guidelines are a set of recommendations for appropriate feeding of newborn and children up to two years of age. Important components of these guidelines, including those suggested by IAP in 2016 are as follows:
• Early initiation of breastfeeding as early as possible after birth, ideally within first hour, including in those born by cesarean section. Colostrum should not be discarded but to be fed to newborn and no pre-lacteal fluid should be given. Antenatal counseling, roomingin and breast-crawl are useful strategies to assist early initiation of breastfeeding.
• Exclusive breastfeeding for the first six months. No other foods or fluids, even the water, are permitted (except medicines). Useful strategies to promote exclusive breastfeeding include: demand feeding, early management of breast/nipple problems and workplace support, e.g. lactation leave/lactation rooms. Brestfeeding should be continued during maternal illnesses unless contraindicated.
• Timely introduction of complementary feeding from 6 months of age with introduction of solids and semisolids to complement breast milk, which should continue ad libitum till 2 years of age. Timely means introducing the complementary feeds when the need for energy and nutrients exceeds that provided through exclusive breastfeeding. The term quot;complementary feedingquot; and not quot;weaningquot; should be used.
• Age-appropriate complementary feeding for children 6-23 months, while continuing breastfeeding in terms of quality and quantity.
Children should receive food with:± Minimum food diversity including 4 or more of following seven food groups: (1) Grains, roots and tubers, (2) legumes and nuts, (3) dairy products, (4) flesh foods (meat fish, poultry). (5) eggs, (6) vitamin A rich fruits and vegetables, and (7) other fruits and vegetables.
± Minimum meal frequency, i.e. 2-3 times for breastfed infants 6-8 months; 3-4 times for breastfed children 9-23 months; 4-5 times for non-breastfed children aged 6-23 months, along with inter-meal snacks.
• Active feeding for children during and after illness should be encouraged except in medical contraindications. In sick or depressed babies, expressed breast milk may be fed via nasogastric tube or cup and spoon. Use of infant feeding formula, even on donation or subsidized supply, should not be encouraged. Even in HIV infected mothers, exclusive breastfeeding is the default option for infant feeding, with opt-out option.
• Responsive feeding, i.e.: (a) recognition of early hunger cues given by the baby before crying for feeds, e.g. sucking movements/sounds, lip smacking, restlessness, etc, (b) encouraging the baby to feed himself/herself, (c) avoidance of forced feeding, and (d) psychosocial stimulation during feeding, e.g. playing or caressing the baby while feeding. Feeding should be an enjoyable experience for baby as well as the mother.
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