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Childhood undernutrition remains a major health problem in resource-poor settings. Approximately one-third of children less than five years of age in developing countries are stunted (low height-for-age), and large proportions are also deficient in one or more micronutrients. Recent data shows that just over half of 6-9 month olds are breastfed and given complementary foods and only 39 per cent of 20-23 month olds are provided with continued breastfeeding.
It is well recognized that the period from birth to two years of age is the “critical window” for the promotion of optimal growth, health, and development. Insufficient quantities and inadequate quality of complementary foods, poor child-feeding practices and high rates of infections have a detrimental impact on health and growth in these important years. Even with optimum breastfeeding children will become stunted if they do not receive sufficient quantities of quality complementary foods after six months of age (Lancet 2008). An estimated six per cent or six hundred thousand under-five deaths can be prevented by ensuring optimal complementary feeding.
Improved feeding of children under two years of age is particularly important because they experience rapid growth and development, are vulnerable to illness and there is evidence that feeding practices are poor in most developing countries. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breastmilk is no longer sufficient. From 6-12 months, breastfeeding – if implemented optimally – should continue to provide half or more of the child’s nutritional needs, and from 12-24 months, at least one-third of their nutritional needs. In addition to nutrition, breastfeeding continues to provide protection to the child against many illnesses and provides closeness and contact that helps psychological development. Appropriate complementary foods can be readily consumed and digested by the young child from six months onwards and provides nutrients - energy, protein, fat and vitamins and minerals - to help meet the growing child's needs in addition to breastmilk.
Low-quality complementary foods combined with inappropriate feeding practices put under-twos in developing countries at high risk for undernutrition and its associated outcomes. Too often, solid, semi-solid and soft foods are introduced too soon or too late. The frequency and amount of food offered may be less than required for normal child growth, or their consistency or nutrient density may by inappropriate in relation to the child's needs. Too much of a poor complementary food could displace the more nutritive breastmilk in the child's diet.
UNICEF supports countries to implement the priority actions to improve complementary feeding outlined in the Global Strategy for Infant and Young Child Feeding. The first approach for improving complementary feeding is to increase the nutritional adequacy of complementary foods. Different strategies may be required for different populations (e.g. rural vs. urban populations, the very poor, populations affected by emergencies), however among all these groups locally available foods should be exploited whenever possible.
Secondly, vulnerable segments of the population (i.e. non-breastfed children, children from very poor households and children with HIV, malnutrition, or living under emergency conditions etc.) need to be identified. These groups may require targeted food aid, multi-micronutrient or lipid-based nutrient supplements. Food can be targeted in different ways, for example to the poorest families in a community, or to all families in the poorest communities in a targeted area, or to households with children with evidence of growth faltering.
Education for improved feeding practices is another essential component. Evidence shows that mothers are willing to prepare enriched complementary foods if they are culturally acceptable, and that improving maternal knowledge and feeding practices can lead to increased dietary intake and growth of infants. Good counseling and negotiation with the mother in health system and community health care settings is crucial to ensuring optimal complementary feeding practices.
UNICEF’s focus is on supporting countries to ensure that there is an appropriate infant and young child feeding policy and strategy framework at national level that adequately addresses complementary feeding, plans to operationalize the strategy are developed and implemented, appropriate legislation is in place such as the International Code of Marketing of Breastmilk Substitutes, and that marketing of foods for children under-two is also Code-compliant. Further, support is provided to implement interventions in the health system, such as curricula and training of health workers to provide support and counseling on complementary feeding and health information systems.
At community level, support for complementary feeding is provided for community-based health and mother support activities involving, for example, community health workers, lay counselors and mother to mother support groups. Communication and advocacy activities on complementary feeding are also a key component of UNICEF support. Finally, UNICEF supports interventions to address complementary feeding in the especially difficult circumstances of high HIV prevalence and emergencies.