Читать книгу Global Landscape of Nutrition Challenges in Infants and Children - Группа авторов - Страница 26

Both the WHO and the United Nations International Children’s Emergency Fund (UNICEF) have published IYCF guidelines to ensure children are receiving adequate nutrition that promotes proper growth and development through childhood. The guidelines recommend that mothers initiate breastfeeding within 1 hour of birth and to breastfeed exclusively for the first 6 months of life [6]. Early initiation and exclusive breastfeeding provide multiple benefits to infants such as decreased risk of infant mortality and increased protection against disease [7]. Victora et al. conducted a review of 28 meta-analyses on the associations between breastfeeding and its corresponding maternal/child outcomes [8]. Results showed breastfed infants had a decreased risk of death, diarrhea, and respiratory infections compared to those who were not breastfed [8].

At 6 months, the WHO and UNICEF recommend introducing nutritionally adequate, safe complementary food while continuing to breastfeed. They specify to begin by introducing iron-rich foods with no specific order thereafter. In low-access settings, fortified foods or vitamin–mineral supplements may be needed [6, 9]. Complementary feeding (CF) should begin with small portions of food that gradually increase as the child develops [6]. Failure to adhere to these recommendations during early childhood has been linked to long-term growth impairment and is directly associated with an increased risk of illness [10].

The WHO also published IYCF recommendations specific to mothers living with HIV. “Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or beyond while being fully supported for ART adherence” [11]. In special circumstances, for example, if the mother is temporarily ill and unable to breastfeed, the recommendation is to express and heat-treat the breastmilk before providing it to the infant [11]. These recommendations were informed by the results of multiple IYCF interventions and systematic reviews [11, 12].

While the WHO and UNICEF guidelines are global recommendations, some countries have their own national IYCF guidelines as well. For example, in 2015, India finalized their Optimal and Appropriate Infant and Young Child Nutrition Practices and Strategies after consulting with a variety of infant feeding experts such as partners from the WHO, UNICEF, Ministry of Child Welfare Department, and the Human Milk Banking Association of India [13]. Most of these guidelines align with the WHO and UNICEF recommendations, including the guideline that specifies to practice responsive feeding (RF). For caregivers, RF involves recognizing and encouraging a child’s hunger and fullness cues and responding accordingly [14, 15]. The importance and the impact of RF are discussed further below.