Yet, malnutrition remains a global concern among children under 5 years of age. Malnutrition includes those who are both over- and underweight – impacting all ages. Globally, almost 240 million children under age 5 are suffering from malnutrition [2]. According to a recent World Health Organization (WHO) report, 45% of deaths in children under age 5 are due to malnutrition [3]. While many malnourished children are stunted or wasted, an increasing number are becoming overweight due to the nutrition transition [4]. The transition is causing a shift in dietary and physical
activity patterns with an increase in consumption of sugars and fat and a decrease in daily physical activity. The transition was initiated by a variety of changes within the economy as well as improvements to technology [5].
This chapter provides a brief review of both global patterns and selective data from India, where the 93rd Nestlé Nutrition Institute Workshop on “Global Landscape of Nutrition Challenges in Children” occurred. It focuses on infant and young child feeding (IYCF) recommendations and global adherence, the importance of caregiver feeding style and its impact on growth and development, and how nutrition interventions and future research can be used to improve current IYCF practices.
Global Infant Young Child Feeding Recommendations
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.
Assessment of IYCF
Many early childhood nutrition interventions and programs target IYCF practices. To assess the potential effect of these interventions, the WHO has published 15 IYCF indicators [16]. Eight of the 15 are classified as core, these include early initiation of breastfeeding, exclusive breastfeeding under 6 months, continued breastfeeding for 1 year, introduction of solid, semi-solid, or soft foods, consumption of iron-rich or iron-fortified foods, minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) [16]. These indicators provide the ability to evaluate and track feeding practices and patterns both within a country and globally.
Adherence to IYCF Recommendations
Breastfeeding
Early initiation of breastfeeding, within the first hour of life, provides many benefits to the newborn infant. First, it ensures the infant receives colostrum. Colostrum is important because it is rich in antibodies that confer passive immunity to the infant [7, 17]. Compared to infants who were put to breast within 1 hour of birth, the risk of death is 41% higher for those who initiated 2–23 h after birth and 79% higher for those who initiated 1 day or longer after birth [7]. Globally, only 41% of infants were put to breast within 1 hour of birth between years 2013 and 2018 [18]. East Asia and the Pacific region had the lowest rates with 32%, while the highest rates occurred in Eastern and Southern Africa at 65% [18]. In India, a nationally representative household survey conducted in 2015–2016 found that 41.6% of children under 3 years old had been breastfed within 1 hour of birth. This was a positive increase compared to the survey conducted in 2005–2006, where 23.4% of children under 3 years old had been breastfed within 1 hour of birth (Table 1) [19, 20].
Table 1. Child feeding practices and nutritional status of children in India comparing NFHS-4 and NFHS-3
In addition to the multiple benefits of early initiation, breastfeeding initiation within the first