Iycf sithun ppt

I Y C FD R . S I T H U N K U M A R P A T R O

WHAT IS IYCF ??? I = Infant (0 11 months)

Y = Young (up to 2 years)

C = Child

F = Feeding

INFANT AND YOUNG CHILD FEEDING

Set of Well known and common recommendations

For appropriate feeding

New born & Children under 2 years of age

THE GLOBAL STRATEGY FOR INFANT AND YOUNG CHILD FEEDING(IYCF) Developed by WHO and UNICEF to

revitalize world attention on the impact that feeding practices have on infants and young children.

Malnutrition has been responsible, directly or indirectly, for over 50% of the 10.9 million deaths annually among children

MAJOR CAUSES OF DEATHS AMONG CHILDREN UNDER 5 YEARS

18%

15%

10%5%4%

23%

25%Acute RespiratoryInfectionsDiarrhoea

Malaria

Measles

HIV/AIDS

Perinatal

Other

Deaths associated

With malnutrition

54%

Chart1

0.18

0.15

0.1

0.05

0.04

0.23

0.25

Sheet1

Acute Respiratory Infections18%

Diarrhoea15%

Malaria10%

Measles5%

HIV/AIDS4%

Perinatal23%

Other25%

Sheet1

Sheet2

Sheet3

OPTIMAL IYCF PRACTICES1. Early initiation of breastfeeding; immediately after birth, preferably within one

hour.

2. Exclusive breastfeeding for the first six months of life i. e 180 days

3. Timely introduction of complementary foods (solid, semisolid or soft foods) after the age of six months i. e 180 days.

4. Continued breastfeeding for 2 years or beyond

5. Age appropriate complementary feeding for children 6-23 months, while continuing breastfeeding.

6. Active feeding for Children during and after illness.

PresenterPresentation Notes

Point 2: (no other foods or fluids, not even water; but allows infant to receive ORS, drops, syrups of vitamins, minerals and medicines when required)

IYCF TECHNICAL GUIDELINES

1. Breastfeeding

2. Complementary feeding

3. HIV and Infant feeding

4. Special situations

PresenterPresentation NotesI wil discuss the iycf under 4 headingsthese are

BREAST FEEDING Should be promoted to mothers and other

caregivers as the gold standard feeding option for babies

Antenatal Counselling to be done : Individual

Groups

To be initiated as early as possible after birth (for all normal newborns and those born via C-section)

PresenterPresentation Notes2nd point : Antenatal Counseling individually or in groups organized by maternity facility should contain messages regarding advantages of breastfeeding and dangers of artificial feeding.

The objective should be to prepare expectant mothers for successful breastfeeding.

3rd point.

Operative birth : Mother may need motivation and support (for initiating breast feeding within 1 hour)

Skin to skin contact should be encouraged : Bedding in Mother and Baby pair Breast Crawl

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.

Bedding in mother & baby pair

Mother looking into baby while feeding

Breast Crawl

Colostrum MUST NOT be discarded

NO PRELACTEAL fluids should be given

Baby should be fed ON CUES Early Feeding Cues:

Sucking movements and sucking sounds Hand to mouth movements Rapid eye movements Soft cooing or sighing sounds Lip smacking Restlessness

PresenterPresentation NotesAfter last point restlessness::::

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

After 6 months : Complementary food

Breast Feeding for a minimum of 2 years and beyond

Even during 2nd year of life : Breast Feeding frequency should be

4-6 times in 24 hrs. (Including night feeds)

PresenterPresentation Notes(Hirkanis room is a specially allocated room at the workplace where working mothers can express milk and store in a refrigerator during their work schedule). Every such mother leaving the maternity facility should be taught manual expression of her breast mil

HEALTH VISITS : Harms of artificial feeding and bottle feeding to be explained

Inadvertent advertising of infant milk substitutes in health facilities to be avoided

Artificial Feeding ?????? Only when medically initiated

Efforts to provide appropriate facilities : For mothers to breastfeed babies easily at Public Places

Adoption of WHO Growth Charts : For growth monitoring

PresenterPresentation NotesWhen should artificial feeding done??

Animal milk,, infant milk substitutes

COMPLEMENTARY FEEDING Appropriately thick complementary foods to be prepared from locally available

foods

TO BE INTRODUCED at 6 completed months

Breast Feeding should be continued

AVOID the term WEANING

PresenterPresentation NotesAvoid weaning coz its complementary and baby shuldnt be deprived of breast milk at 6 mnths

Each meal should be made energy dense by adding : Sugar / Jaggery

Ghee / Butter

(To address the issue of small stomach size)

Food must be Thick enough : Thick enough- to stay on spoon without running off, - when the spoon is tilted

Foods can be enriched by making afermented porridge by:

Use of germinated flour

Sprouted and toasting grains before grinding.

PresenterPresentation NotesSay 1st.some salient points about the complementary food to be given

Parents???? Identify STAPLE HOME MADE food (cereal pulse mixture)

Foods to be encouraged??? Iron-fortified foods Iodized salts Vitamin A enriched foods

Variety of foods to be increased to keep the baby motivated on complementary feeding

Junk food and commercial food, Ready-made foods and processed foods??? AVOID

Drinks with low nutritive values : Tea, Coffee and sugary drinks ???? AVOID

HYGIENIC practices to be followed??? PREPARATION, STORAGE , FEEDING

PresenterPresentation NotesWhat should parents do???

PresenterPresentation NotesParents must identify from local foods

lentils

beans

peas nuts

seeds

Groundnut paste

Vitamin A rich foods

RESPONSIVE FEEDING practices : PROMOTE SELF FEEDING : ENCOURAGE Forced Feeding / Threatening / Punishment : AVOID Role of COMMUNITY HEALTH WORKERS ???

Skilled help and Confidence building during all health contacts Also at home visits

Foods possessing choking hazards : Avoid . Introduction of lumpy or granular foods and most tastes should be

done by about 9 to 10 months How to reduce Feeding Fussiness ??

So use of mixers/grinders to make food semisolid/pasty should be strongly discouraged.

PresenterPresentation NotesYoung children should be encouraged to take feed by praising them and their foods.

Say after choking hazards : Consistency of foods should be appropriate to the developmental readiness of the child in munching, chewing and swallowing

Say after lumpy : Missing this age may lead to feeding fussiness later. So use of mixers/grinders to make food semisolid/pasty should be strongly discouraged.

Responsive FeedingSelf Feeding

Forced Feeding

PresenterPresentation NotesIf baby is not breastfed, give in addition: 1-2 cups of milk per day, and 1-2 extra meals per day. The amounts of food included in the table are recommended when the energy density of the meals is about 0.8 to 1.0 Kcal/g. If the energy density of the meals is about 0.6 kcal/g, the mother should increase the energy density of the meal (adding special foods) or increase the amount of food per meal. For example: for 6 to 8 months, increase gradually to two thirds cupfor 9 to 11 months, give three quarters cupfor 12 to 23 months, give a full cup.

1Iron requirement is based on 5% bio-availability from cereal-pulse based diets.2Green leafy vegetables like amaranth (chaulai sag), spinach (palak), turnip leaves (shalgam ka sag), mint leaves (pudhina) and small amounts of lemon (nimbu) and tamarind (imli) added to the diet daily will sum up to provide the amount of iron recommended.

HIV AND INFANT FEEDING Best time for counselling ?? ANTENATAL PERIOD EXCLUSIVE BREAST FEEDING is better than EXCLUSIVE

REPLACEMENT FEEDING . Prevention of parent to child transmission interventions should

begin in early pregnancy. EBF is the recommended infant feeding choice ,irrespective of the

fact that mother is on ART early or infant is provided with anti retroviral prophylaxis for 6 weeks

No mixed feeding is to be done in initial 6 months

PresenterPresentation NotesMaternal art re replace azt with nevirapine

Also comtinue triple drug regimen for prophylaxis upto 1 week after stopping of breast milk feeding

INFANT EXPOSED TO HIV

Mothers who are HIV infected and insist on not breastfeeding and opt for exclusive replacement feeding should be explained they are so at their own risk and this is contrary to the WHO / NACOs guidelines.

ADVANTAGES of exclusive replacement feeding . No risk of HIV transmission ERF milk can be given by anyone (Mother Not required)

DISADVANTAGES OF ERF Animal milk is not a complete food for baby . Formula milk may be complete but it is expensive . Baby has more risk of infections Careful and hygienic preparation is needed

FEEDING IN SOME OTHER CONDITIONS

Feeding During Sickness of Babies?? IMPORTANT Prevents sickness and prevents undernutrition

Infant Feeding in Maternal Illness?? Treatment of primary condition (Breast abcess / postpartum psychosis) must be

treated 1st

Chronic infections (TB/Leprosy/Hypothyroidism) need treatment of primary condition and do not warrant discontinuation of breastfeeding

CONTRAINDICATIONS OF BREASTFEEDING ??? Ant thyroid drugs

Immunosuppressant

Antineoplastic agents

Atropine

Amphetamines

Reserpine

Psychotropic drugs

Antibiotics

Antihistamines

Digoxin

Diuretics

Prednisone

Propranolol

SOME SPECIFIC CONDITIONS OF INFANTS Very Low Birth Weight, Sick, Or Depressed Babies :

ALTERNATIVE METHODS can be used depending on Neurodevelopmental status

Includes : expressed breast milk through intra-gastric tubes

GERD : To be treated CONSERVATIVELY through Thickening of complementary foods Frequent small feeds Upright positioning for 30 minutes after feeds

During EMERGENCIES ??? Priority health and nutrition support for pregnant and lactating mothers

Donated or subsidized supplies of breast milk substitutes should be avoided

Donation of bottles and teats should be refused and their use to be actively avoided

FEEDING IN PRETERM/LOW BIRTH WEIGHT INFANTS All LBW / VLBW infants : Breast Feeding

Should be fed with EXPRESSED breast milk via katori / spoon if unable to suckle or cant be fed orally

LBW infants : EBF for 6 months

VLBW babies : 10 ml/kg of enteral fluids (preferably Breast Milk) + IV Fluids (Remaining)

LBW infants who cant be breast fed with their own mothers milk?? DONOR HUMAN MILK

PresenterPresentation NotesVlbw from day 1

Last point : only in facilities where safe and affordable milk banking facilities are available

TRENDS IN IYCF INDICATORS - INDIA

INTERVENTIONS FOR PROMOTING IYCF PRACTICES IN HEALTH SYSTEMS

PROTECTION

IMS Act Amendment act 2003

PROMOTION

Providing accurate info and skilled counselling to women family and community members

SUPPORT For sustained appropriate feeding through maternity protection

PresenterPresentation NotesInfant Milk Substitutes feeding bottles, and infant foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003

IMS ACT The Infant Milk Substitutes, Feeding Bottles and Infant Foods

(Regulation of Production, Supply and Distribution) Act, 1992 and Amendment Act in 2003

This Act provides for the regulation of production, supply and distribution of infant milk substitutes, feeding bottles and infant foods with a view to the protection and promotion of breastfeeding and ensuring the proper use of infant foods and for matters connected to it. It extends to the whole of India. It also lays the responsibility of health workers and of the government to provide accurate information to people

PROVISION OF IMS ACTIMS Act is violated if any baby Food Company, its distributor or supplier, or any person

1. Promotes any food by whatever name, for children up to two years.

2. Promotes use of infant foods before the age of six months.

3. Advertises by any means--television, newspapers, magazines, journals, through SMS, emails, radio, pamphlets etc.

4. Distributes the product or samples to any person.

5. Contacts pregnant or lactating mothers using any person.

6. Gives any kind of inducements like free gifts, tied sales, to anyone.

7. Demonstrates to mothers or their family members how to feed these products. However, a doctor can demonstrate this to the mother.

8. Distributes information and educational material to mothers, families etc. (They can give educational material to health professionals like doctors, nurses etc provided it has information prescribed in clause 7 of the IMS Amendment Act, 2003. The education material should have only factual information and should not promote the products of the company).9. Gives tins, cartons, accompanied leaflets of these products having pictures of mothers or babies, cartoons or any other such images to increase saleability.10. Displays placards, posters in a hospital, nursing home, chemist shop etc. for promoting these products.11. Provides direct or indirect inducements to health workers12. Gives benefits to doctors, nurses or associations like IAP, IMA, NNF etc, for example, funds for organizing seminars, meeting, conferences, contest, fee of educational course, sponsoring for projects, research work or tours.13. Fixes commission of employees on the basis of volume of sales of these products.

PENALTIES

Violations of the Act attract imprisonment for up to three years and/or fine up to Rs.5000

Penalty with regard to the Label on container or quality of infant milk substitute, feeding bottle and infant food is punishable with imprisonment up to 6 month extended to 3 years and fine at least Rs.2000.

PROMOTING IYCF PRACTICES

Mothers and children have regular contacts with the health service providers during pregnancy and the first two years of life of the child, be it for pre and postnatal care or immunization.

Actions to promote infant and young child feeding have been grouped at the following three levels:

(1) at health facilities

(2) during community outreach activities and

(3) during community and home based care.

HEALTH FACILITIES

During and after Institutional Deliveries

Outpatient services and consultations

for pregnant women, mothers

and children:

Inpatient services

for children

PROMOTION OF IYCF IN A HEALTH FACILITY

PresenterPresentation NotesDuring and after institutional delivery- Medical Officers, Staff Nurses, LHVs and ANMs actions: measure birth weight, identify low birth weight babies, counsel and support mothers to initiate breastfeeding soon after birth.

Inpatient services for children : pediatric wards and sncus

Outpatient :: ancs, iycf counselling centres, sick child consultation in opd

KEY INTERVENTIONS AT COMMUNITY OUTREACH LEVEL

1. MCH contact opportunities during Community outreach-The key responsibility for communication and counselling of mothers /care givers during these contacts is of ANMs along with support from ASHAs & AWWs.:

a. Village Health and Nutrition Days

b. Routine immunization sessions

c. Biannual rounds

d. IMNCI/sick child consultation at community level

e. Special campaigns (eg; during Breastfeeding Week)

f. Any State specific initiative

2. Activities for reaching out to mothers/care givers at community outreacha. Growth Monitoring Sessions: Growth

monitoring (weight recording in MCP card) is undertaken at AWC and /or during VHNDsa. Group counselling sessions: at fixed day and

time, should be organised at VHND.

b. One to one counselling and group counselling should be conducted during outreach by the ANM/ ASHA for children with moderate/ severe under-nutrition.

c. Display of Appropriate IEC material (eg; posters)

KEY INTERVENTIONS DURING COMMUNITY AND HOME BASED CARE

1. MCH contact opportunities during home visits-Community contacts include:

a. Postnatal Home visits

b. Home visits for mobilizing families for VHND

c. Growth monitoring and health promotion sessions at AWC

d. Mothers Group Meetings /Self Help Groups Meetings

2. Activities for reaching out to mothers/ caregivers during home visits and community level activities:

a. One to one counselling during home visits by the ANM and ASHA is the best way to reach out to mothers and caregivers in the community.

b. Group counselling sessions, at fixed day and time, should be organized at VHND.

c. Display of Appropriate IEC material . Specific points for discussion on feeding, examination/observation and

key messages to be delivered at each of the 6 visits (or 7 in case of home delivery) should be clearly specified to ASHAs and ANMs during the training on IYCF.

Mothers of children identified as moderately or severely underweight or with weight plotting in yellow & orange zone of the growth chart (Mother and Child Protection Card) should be counselled more intensively.

TEN STEPS FOR SUCCESSFUL BREASTFEEDING

1. Have a written Breastfeeding policy that is routinely communicated to all health care staff.2. Train all health care staff in skills necessary to implement this policy.3. Inform all pregnant women about the benefits and management of breastfeeding.4. Help mothers initiate breastfeeding within a one-hour of birth.5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants

6. Give newborn infants no food or drink other than breast milk, unless medically indicated.

7. Practice rooming-in -- allow mothers and infants to remain together -- 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital.

-THANK YOU

IycfWhat is iycf ???Infant and Young Child FeedingThe Global Strategy for Infant and Young Child Feeding(IYCF)Major causes of deaths among children under 5 years OPTIMAL IYCF PRACTICESIYCF TECHNICAL GUIDELINESBreast feedingSlide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14COMPLEMENTARY FEEDINGSlide Number 16Slide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22HIV AND INFANT FEEDING Slide Number 24Slide Number 25Infant exposed to hivSlide Number 27Feeding in some other conditionsSlide Number 29Some specific conditions of infantsSlide Number 31FEEDING IN PRETERM/LOW BIRTH WEIGHT INFANTSTrends in IYCF Indicators - IndiaInterventions for promoting IYCF practices in Health SystemsIMS ActProvision of IMS ActSlide Number 37PenaltiesPROMOTING IYCF PRACTICESpromotion of IYCF in a health facilityKey interventions at community outreach levelKey interventions during community and home based care Slide Number 43Ten Steps for Successful BreastfeedingSlide Number 45-Thank you