Infant feeding support

Existing ANC/PNC services for women should be the delivery platform of choice. Where these don’t exist, activities should be merged with ongoing health platforms/interventions for pregnant or breastfeeding mothers and neonatal/young child services. It may also be Integrated into other health and nutrition services or community platforms.

Core interventions include:

1. Establishment of supportive spaces (eg, IYCF corner and/or mother and baby area).
2. Group education and information sharing on health, nutrition and IYCF practices.
3. Nutrition care and counselling for PBWGs.
   1. Support for early initiation of exclusive breastfeeding.
   2. Skilled IYCF counselling (one–to–one) provided as part of routine care.
4. Further IYCF support for particularly vulnerable children, eg, orphans, LBW, infants aged less than 6 months at risk of poor growth and development.
5. Adherence by all actors to the Code of Marketing of Breastmilk Substitutes (the Code).

• Nutrition education and counselling (NEC) support to PBWGs is critical in situations where normal services and support have been disrupted. Wherever possible, attempts should be made to offer safe spaces for PBWG to discuss their concerns and receive nutrition and wellbeing counselling and support. This should be integrated with other supportive health services, including psychosocial care, where this exists. In situations where food supplementation is required for mothers of infants less than six months or support is needed for infant feeding, assessment of the physical and mental health status of mothers or caregivers should be promoted and relevant treatment or support provided.
• In order for counselling to have the most benefit for the prevention of wasting and for other child health and nutrition outcomes, personnel carrying out the counselling should have comprehensive training and be supervised regularly. Dedicated resources and time need to be allocated in planning for this intervention.
• Infants less than six months of age should be exclusively breastfed where possible and their mothers or female caregivers should be supported to breastfeed the infants. If an infant is not breastfed, support should be given to the mother or female caregiver to re–lactate. If this is not possible, wet nursing should be encouraged/explored. If there is no realistic prospect of being breastfed, infants should be given appropriate and adequate replacement feeds such as commercial (generic) infant formula, with relevant support provided to caregivers to enable safe preparation and use at home, as well as adequate supply for the duration required (until the infant reaches six months).
• Where infant formula is indicated, infant formula requirements should be determined through individual– level assessment by a qualified health or nutrition worker trained in breastfeeding and infant feeding issues. Provide individual–level education, one–to–one demonstrations and practical training on safe preparation to the caregiver. Ensure follow–up (at least twice a month) and trace defaulters.
• Accessible IYCF support services should be established to provide for higher risk infants, young children and mothers, such as orphans, unaccompanied children, infants who are not breastfed; children with disabilities that affect feeding or whose caregivers are disabled; mothers in detention; children whose mothers are ill; adolescent mothers; premature infants; LBW infants; and children and/or mothers who are acutely malnourished.
• Mothers/caregivers and their infants less than six months of age at risk of poor growth and development should receive regular care and monitoring by health professionals. The immediate goal is the early detection of any acute medical or psychological problems and preventing infants from becoming severely underweight or severely wasted. The mother/caregiver and infant must be considered and cared for as an inter–dependent pair. This can involve the following activities (according to local capacity):
  • comprehensive medical assessments (plus providing medical interventions when necessary)
  • growth monitoring and promotion
  • breastfeeding assessment and support
  • replacement feeding assessment and support for non– breastfed infants
  • physical and mental health assessment of the mother/ caregiver (or referral to appropriate services if this is not possible at the initial point of care).
• It is critical in emergency contexts to adhere to the Code of Marketing of Breastmilk Substitutes (the Code) to protect infants from malnutrition, illness and death. Key elements of this include:

  • Do not solicit, donate, accept, or distribute donations of commercial milk formula (CMF) and other products 

    (see list below).

  • Never include BMS/Commercial Milk Formula in standard family kits.
  • Detect and manage unprevented donations: Detect and report; intercept, transport and securely store; sort and handle.
  • Donations and uncontrolled distributions of the following products put infants at risk:
    • Commercial milk formula including infant formula, follow–on formula and growing–up milk.
    • Other milk products, eg, dried or liquid cow’s milk, soya milk, evaporated or condensed milk, fermented milk or yoghurt.
    • Baby teas, juices and waters marketed as suitable for infants under six months.
    • Bottles, teats, breast pumps.
    • Any commercial complementary food marketed for use for infants under six months.
• Government, health and nutrition cluster coordinators and partners should: Endorse and disseminate a policy clearly stating that donations will not be accepted.
  • Ensure Violation/Donation Alert and Monitoring System is in place.
  • Repeatedly sensitise key actors, including other sectors and potential donors, on the dangers of donations and blanket distributions.
  • Systematically share information, including reports of violations, for action (eg, enforcement) at a national level and global level (eg, NetCode).
  • Establish a Donation Prevention and Management Taskforce.
  • Develop and widely disseminate a joint statement to key stakeholders, including media, communications, logistics, donors and partner agencies.