Lecture No.

01 HND-SP21

Course: Infant and young child feeding

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Who I am?
Muhammad Tanveer Aslam (MS/ M. Phil in Food and Nutrition)
(Department of Pharmacy and AHS, IQRA University (Chak Shahzad
Campus Islamabad)
Email: tanveer.aslam@iqrauni.edu.pk
Previous Employment
Fatima Memorial Hospital Lahore (Trainee Nutritionist)
Vintage Institute of Health Sciences Faisalabad (Lecturer)
Johar Institute of Professional Studies Lahore (Lecturer)

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Course Detail
Course Name: Infant and young child feeding(T) (HND-
3631)
Contact Hours: Credit Hours:
Theory: 32 Theory: 2
Practical: 40 Practical: 1
Total: 72 Total: 3
Pre – Requisite: None

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Course Outlines
Course Description
 This course focuses on the feeding problems among Infant and Young children and
suggesting appropriate interventions
 Infant young child feeding: introduction, global strategy, importance of breastfeeding,
local and international scenario, breastfeeding working; Breastfeeding practices:
assessing a breastfeed, taking a feeding history, common breastfeeding difficulties,
expressed breast milk; Breastfeeding counselling: listening and learning, building
confidence and giving support, counselling for infant feeding decisions, counselling
cards tools; Complementary feeding practices: importance, cup-feeding and hygienic
preparation of food, replacement feeding in the first 6 months

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 Foods to fill energy and micronutrients gap, quantity and frequency of feeding,
feeding techniques, food demonstration; Breastfeeding related topics: growth
charts, maternal illnesses and breast feeding, breast conditions, health care
practices, International code of marketing of breast milk substitutes, checking
understanding and arranging follow-up, feeding during illness and low-birth-
weight babies; Feeding guidelines of various global agencies – WHO etc.;
Complex challenges to implementing the global strategy for infant and young
child feeding.

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Course Objectives
Course Objectives
 Understand importance and principles of meal planning
 Learn rules for good menu planning and family meal budgeting
 Study of different types of table settings, table manners and table etiquettes
 Develop knowledge about kitchen safety, food hygiene and sanitation
 Design menus for schools and other health care centers

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 Course Learning Outcomes (CLOs)
Sr. Taxonomy
Course Learning Outcomes (CLOs) Statement PLOs
No. Level

1 Discuss the importance of meal planning and its role in everyday life C2 2

2 Explain the principles of diet therapy and therapeutic nutrition C2 4

Identify the principles of meal planning in the planning of balanced and appropriate meals keeping
3 in mind the nutritional requirements, family budget and food requirements choices of different age C3 7
groups

4 Demonstrate conditions of a patient and make a meal plan accordingly P4 3

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 Taxonomy Levels

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Programme Learning Outcomes (PLOs)
1. HealthCare Knowledge
2. Problem analysis
3. Investigation and assessment
4. Health services
5. Individual and team work
6. Communication
7. Modern tools
8. Ethics
9. Management
10. Lifelong learning
11. Health and safety
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Course Weight Breakdown
Assessment Instruments with Weights
 Homework, Quizzes, Midterms, Final, performance, Assignments, etc.)
 Theory
o Quizzes 10
 Lab
o Lab Reports
o Assignment 10
o Lab Viva
o Midterm 30
o Lab Mid
o Presentation/Other Activities 10
o Lab Final
o Final 40
o Lab file

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Recommended books
Pediatric nutrition in practice edited by
B.Koletzko, 2nd edition

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The baby Food Bible – A Complete Guide to
Feeding Your Child from Infancy by Behan, E. 2008.

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Lecture Contents
Course introduction and basic concepts
 Introduction of IYCF
 Optimal IYCF practices
 Importance of IYCF
 Nutrition goals
 Objectives of national guidelines on IYCF
 Advantages of breast feeding
 Complementary feeding and its importance

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Infant and young child feeding

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Introduction
 Infant and young child feeding is set of well known and common
recommendations for appropriate feeding of new born and children under two
years of age.
 Pakistan has a strong culture of breastfeeding. According to the National Nutrition
Survey (NNS 2011), (based on past 24-hour dietary recall) 63.5% of mothers
predominantly breastfed children from 0–6 months of age and 77.3% of mothers
continued breastfeeding up to 12–15 months.
 The recommended exclusive breastfeeding children for the first six months of life
is met for only 38 percent of children

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Optimal IYCF practices
 Early initiation of breastfeeding; immediately after birth, preferably within one
hour.
 Exclusive breastfeeding for the first six months of life i.e. 180 days (no other foods
or fluids, not even water; but allows infant to receive ORS, drops, syrups of
vitamins, minerals and medicines when required)
 Timely introduction of complementary foods (solid, semisolid or soft foods) after
the age of six months i.e. 180 days.
 Continued breastfeeding for 2 years or beyond

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Age of appropriate complementary feeding for children 6-23 months, while
continuing breastfeeding. Children should receive food from 4 or more food groups:
 Grains, roots and tubers, legumes and nuts
 Dairy products
 Flesh foods (meat fish, poultry)
 Eggs
 Vitamin A rich fruits and vegetables
 Other fruits and vegetables and fed for a minimum number of times (2 times for
breastfed infants 6-8 months; 3 times for breastfed children 9-23 months;4 times for
non-breastfed children 6-23 months)
 Active feeding for Children during and after illness.
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Why is infant and young child feeding is
so important?
 They are at the most vulnerable age
 Poor Intake of food is common during first two years (Quantity And Quality)
 Poor feeding practices result in malnutrition, contribute to impaired cognitive and
social development, poor school performance
 Cause of malnutrition which is responsible directly or indirectly for 60% death
among under five.

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Correct norms for infant and young child
feeding
 Initiation of breastfeeding immediately after birth, preferably within one hour.
 Exclusive breastfeeding for the first six months
 Receives only breast milk and nothing else, no other milk. Food, drink or water
 Appropriate and adequate complementary feeding from six months of age while
continuing breastfeeding.
 Continued breastfeeding up to the age of two years

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Nutrition goals
Intensify nutrition & health education to improve IYCF & caring practices to:
 Bring down the prevalence of under-weight children <3yrs from the current level
of 47% to 40%;
 Reduce prevalence of severe Under nutrition in children in the 0-6 years age
group by 50 per cent
Enhance early initiation of Breast Feeding (colostrum feeding) from the current
level of 18%
Enhance the exclusive BF rate for the first six months from the current rate of
37.7 % (for 0-3 months)
Enhance the complementary feeding rate at six months from the current level of
33.5%
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Objectives of national guidelines on ICYF
 To advocate IYCF and its improvement through optimal feeding practices
 To disseminate widely the correct norms of BF & complementary feeding from
policy making level to the public at large in different parts of the country in
regional languages
 To help plan efforts for raising awareness and increasing commitment of the
concerned sectors of the govt, NGOs and professional groups for achieving
optimal feeding practices for infants and young children
 To achieve the national goals for IYCF practices set by the planning commission
for reduction in malnutrition levels in children.

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0-6 months
 Energy 110 to 140 kcal / kg
 Protein requirement is about 2 gm/kg
 Calcium 500 mg/day
 Best food for the neonate is mother’s milk

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RDA 6 to 12 months
 Energy 98 kcal/kg
 Protein 1.65 gm/kg
 Calcium 500mg/kg
 Vitamin A 1550mcg/d
 Vitamin B1 50mcg/kg,
 Vitamin B2 65mcg/kg
 Vitamin C 25mg/d

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Infant And Young Child Feeding Practices
 Breastfeeding is the best way to satisfy the nutritional and psychological needs of
the baby
 Mother’s milk is designed for easy digestion and assimilation
 Protein in mother’s milk is in a more soluble form which is easily digested and
absorbed by the baby
 Fat and calcium in human milk which are also easily absorbable
 The amount of vitamins such as thiamine, vitamin A and vitamin C found in
mother’s milk depends on the diet of the mother

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Advantages of Breast Feeding
The best natural food for babies.
 Is always clean
 Protects the baby from diseases
 Makes the child more intelligent
 Available 24 hours a day & requires no special preparation
 Nature’s gift to the infant and does not need to be purchased
 Makes a special relationship between mother and baby
 Helps parents to space their children
 Helps a mother to shed extra weight gained during pregnancy

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Importance of Complementary Feeding
 To meet the growing needs of the growing baby
 An infant weighing around 3kg at birth doubles its weight by six months and by
one year the weight triples and the body length increases to one and a half times
than at birth
 Most of the growth in the nervous system and brain is complete in the first two
years of life

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COMPLEMENTARY FEEDING
Complementary feeding at six months
 First food for the baby- Porridge can be made with suji, broken wheat, ground
rice, millet etc
 Traditional foods for infants – mixed food like khichidi, dalia, suji kheer
 Modified family food-rice or wheat preparation could be mixed with pulse and/or
vegetable
 Mashed potato, carrots, cauliflower, pumpkin, spinach
 Weekly 3 – 4 cooked eggs
9 -10 months fish, chicken, and meat

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Ensuring safety of complementary foods
 Hands should be washed with soap and water
 Utensils used should be scrubbed, washed well, dried and kept covered.
 Cooking kills most germs.
 After cooking, handle the food as little as possible and keep it in a covered
container
 Cooked foods should not be kept for >2 hours.
 The hands of both mother and child should be washed before feeding the child.

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1 to 6 years
 Fuzzy eating starts at this time
 Need 5 to 6 meals per day
 Require high protein, high calorie, high calcium, iron rich diet
 No restriction on fat but avoid fried food
RDA 1to 3 and 4 to 6 years
 Energy 1240kcal/d, 1690 kcal/d
 Protein 22gm/d, 30gm/d
 Fat 25gm/d • Calcium 400mg/d • Iron 12mg/d, 18mg/d

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Energy density of foods can be increased by:
 By adding a teaspoonful of oil or ghee in every feed
 By adding sugar or jaggery to the child’s food
 By feeding thick mixtures

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FEEDING IN DIFFICULT CIRCUMSTANCES
 Malnourished infants
 Preterm or Low Birth Weight Infants
 Feeding During Emergencies
 Feeding in Maternal HIV

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Feeding during and after illness
 Malnourishment increases incidence & severity of infection
 Sick child needs more nourishment
 Children with measles, diarrhea and Respiratory Tract Infection must eat plenty of
vitamin A rich foods
 After the illness, a nutritious diet with sufficient energy, protein and other
nutrients enable him to catch up growth & replacement of nutrient stores

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Breast feeding
 Breastfeeding must be initiated as early as possible after birth for all normal
newborns (including those born by caesarean section).
 In case of operative birth, the mother may need motivation and support to initiate
breastfeeding within the first hour.
 Skin to skin contact between the mother and newborn should be encouraged by
'bedding in the mother and baby pair'. The method of ''Breast Crawl'' can be
adopted for early initiation in case of normal deliveries.
 Mother should communicate, look into the eyes, touch and caress the baby while
feeding. The new born should be kept warm by promoting Kangaroo Mother Care
and promoting local practices to keep the room warm.

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 Colostrum milk secreted in the first 2-3 days, it must not be discarded and no
prelacteal fluid should be given to the newborn
 Baby should be fed ''on cues''- The early feeding cues includes; sucking
movements and sucking sounds, hand to mouth movements, rapid eye
movements, soft cooing or sighing sounds, lip smacking, restlessness etc. Crying
is a late cue and may interfere with successful feeding.
 Periodic feeding should be practiced only on medical advice.
 Exclusive breastfeeding should be practiced from birth till six months
requirements.

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 After completion of six months of age, with introduction of optimal
complementary feeding, breastfeeding should be continued for a minimum for 2
years and beyond depending on the choice of mother and the baby.
 Even during the second year of life, the frequency of breastfeeding should be 4-6
times in 24 hours, including night feeds."

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Artificial Feeding
 At every health visit, the harms of artificial feeding and bottle feeding should be
explained to the mothers. Inadvertent advertising of infant milk substitute in
health facility should be avoided.
 Artificial feeding is to be practiced only when medically indicated.
 All efforts should be taken to provide appropriate facilities so that mothers can
breastfeed babies with ease even in public places.
 Adoption of latest WHO Growth Charts is recommended for growth monitoring

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Complementary Feeding
An appropriately thick complementary food of homogenous consistency made
from locally available foods should be introduced at six completed months to all
babies while continuing breastfeeding a long with it. This should be the standard
and universal practice. During this period breastfeeding should be actively
supported and therefore the term ''weaning'‘ should be avoided.

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 To address the issue of a small stomach size, each meal must be made energy
dense by adding sugar/jaggery and ghee/butter/oil. To provide more calories from
smaller volumes, food must be thick in consistency- thick enough to stay on the
spoon without running off, when the spoon is tilted.
 Foods can be enriched by making a fermented porridge, use of germinated or
sprouted flour and toasting of grains before grinding

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 Parents must identify the staple homemade food comprising of cereal-pulse
mixture (as these are fresh, clean and cheap) and make them calorie and nutrient
rich with locally available products.
 Iron-fortified foods, iodized salt, vitamin A enriched food etc. are to be
encouraged.
 As the babies start showing interest in complementary feeds, the variety should be
increased by adding new foods in the staple food one by one. Easily available,
cost-effective seasonal uncooked fruits, green and other dark colored vegetables,
milk and milk products pulses/legumes, animal foods, oil/ butter, sugar/ jaggery
may be added in the staples gradually.

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 Junk food and commercial food, ready-made, processed food from the market,
e.g. tinned foods/juices, cold-drinks, chocolates, crisps, health drinks, bakery
products etc. should be avoided."
 Giving drinks with low nutritive value, such as tea, coffee and sugary drinks
should also be avoided.
 Hygienic practices are essential for food safety during all the involved steps viz.
preparation, storage and feeding

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 Practice of responsive feeding is to be promoted. Young children should be
encouraged to take feed by praising them and their foods. Self-feeding should be
encouraged despite spillage
 Each child should be fed under supervision in a separate plate to develop an
individual identity
 Forced feeding, threatening and punishment interfere with development of good
proper feeding habits
 A skilled help and confidence building is also required for complementary feeding
during all health contacts and also at home through home visits by community
health workers.

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 Consistency of foods should be appropriate to the developmental readiness of
the child in munching, chewing and swallowing. Foods which can pose choking
hazard are to be avoided. Introduction of lumpy or granular foods and most
tastes should be done by about 9 to 10 months.
 Missing this age may lead to feeding fussiness later. So use of mixers/grinders
to make food semisolid/pasty should be strongly discouraged.

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 Lecture Summary
Introduction of IYCF
Optimal IYCF practices
Importance of IYCF
Nutrition goals
Objectives of national guidelines on IYCF
Advantages of breast feeding
Complementary feeding and its importance

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Thank You !
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