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Mother and Child Nutrition

Mother, Infant and Young Child Nutrition & Malnutrition

Mother, Infant and Young Child Nutrition & Malnutrition The fight against persistent underweight, stunting and wasting among children in developing countries is based on appropriate maternal, infant and young child feeding practices including micronutrient deficiencies prevention and control. However, wasted children are those at immediate risk of dying and will need timely detection and correct management for their survival. More than half of all child deaths are associated with malnutrition, which weakens the body's resistance to illness. Poor diet, frequent illness, and inadequate or inattentive care of young children can lead to malnutrition. Of the 6.6 million deaths among children aged 28 days to five years: 1.7 million (26%) are caused by diarrhoea. 1 million (61%) of these deaths are due to the presence of undernutrition. What is needed: Enough food and the right kinds of food, Nutritional needs of girls and women, Nutritional needs of young children, Protecting children from infections, Quality care when children fall ill, prevention of Micronutrient deficiencies.


Nutrition is a fundamental pillar of human life, health and development across the entire life span. From the earliest stages of fetal development, at birth, and through infancy, childhood, adolescence and on into adulthood, proper food and good nutrition are essential for survival, physical growth, mental development, performance, productivity, health and well-being. More than half of all child deaths are associated with malnutrition, which weakens the body's resistance to illness. Poor diet, frequent illness, and inadequate or inattentive care of young children can lead to malnutrition. If a woman is malnourished during pregnancy, or if her child is malnourished during the first two years of life, the child's physical and mental growth and development may be slowed. This cannot be made up when the child is older – it will affect the child for the rest of his or her life. Children have the right to a caring, protective environment and to nutritious food and basic health care to protect them from illness and promote growth and development.

Deaths among children aged 28 days to 5 years - 6.6 million/year

Child deaths: Causes and epidemiological dimensions
Robert E. Black, M.D., M.P.H.
Johns Hopkins Bloomberg School of Public Health
Full text at The Lancet


Progress For Children: A Report Card on Nutrition

The Case for Preventing Malnutrition Through Improved Infant Feeding and Management of Childhood IllnessDownload pdf4 pages 219 kb


The advent of ready-to-use therapeutic food (RUTF) products has greatly improved the coverage and effectiveness treatment for severe acute malnutrition (SAM). The excitement surrounding this development has led to rapid expansion of SAM treatment activities, often without regard to the prevalence of SAM, the capacity of local health systems to absorb expansion, or the contribution of SAM to overall child mortality. In the context of limited health budgets, on epidemiological and ethical grounds treatment approaches are in most situations a less rational public health investment than approaches that prevent SAM and other types of malnutrition.


Diarrhoea is an important cause of undernutrition. This is because nutrient requirements are increased during diarrhoea, as during other infectious diseases, whereas nutrient intake and absorption are usually decreased. Each episode of diarrhoea can cause weight loss and growth faltering. Moreover, if diarrhoea occurs frequently, there may be too little time to "catch up" on growth between episodes, the result being a flattening of the normal growth curve. Children who experience frequent episodes of acute diarrhoea, or have persistent diarrhoea, are more likely to become undernourished than children who experience fewer or shorter episodes of diarrhoea. In general, the impact of diarrhoea on nutritional status is proportional to the number of days a child spends with diarrhoea each year. In turn, undernutrition contributes to the problem of diarrhoea. In children who are undernourished as a result of inadequate feeding, previous diarrhoeal episodes, or both, acute diarrhoeal episodes are more severe, longer lasting, and probably more frequent; persistent diarrhoea is also more frequent and dysentery is more severe. The risk of dying from an episode of persistent diarrhoea or dysentery is considerably increased when a child is already undernourished. In general, these effects are proportional to the degree of undernutrition, being greatest when undernutrition is severe. Thus, diarrhoea and undernutrition combine to form a vicious circle which, if it is not broken, can eventually result in death; the final event may be a particularly severe or prolonged episode of diarrhoea or, when severe undernutrition is present, another serious infection such as pneumonia. Deaths from diarrhoea are, in fact, usually associated with undernutrition. In hospitals where good management of dehydration is practised, virtually all mortality from diarrhoea is in undernourished children. Diarrhoea is, in reality, as much a nutritional disease as one of fluid and electrolyte imbalance, and therapy is not adequate unless both aspects of the disease are treated. However, in contrast to fluid replacement, nutritional management of diarrhoea requires good feeding practices both during the illness and between episodes of diarrhoea, when the child is not sick. When this is done, and undernutrition is either prevented or corrected, the risk of death from a future episode of diarrhoea is greatly reduced.

Infant and Young Child Feeding and Nutrition

Feeding is a critical aspect of caring for infants and young children. Appropriate feeding practices stimulate bonding with the caregiver and psycho-social development. They lead to improved nutrition and physical growth, reduced susceptibility to common childhood infections and better resistance to cope with them. Improved health outcomes in young children have long-lasting health effects throughout the life-span, including increased performance and productivity, and reduced risk of certain non-communicable diseases.

Child Feeding and Nutrition ( 2-5 years age ) Malnutrition contributes to more than half of all childhood deaths, although it is rarely listed as the direct cause. For most children, lack of access to food is not the only cause of malnutrition. Poor feeding practices and infection, or a combination of the two, are both major factors of malnutrition. Infection – particularly frequent or persistent diarrhoea, pneumonia, measles and malaria – undermines nutritional status. Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, giving insufficient quantities, and not ensuring that the child gets enough food, contribute to malnutrition. Malnourished children are, in turn, more vulnerable to disease and the vicious circle is established. Improved feeding practices to prevent or treat malnutrition could save 800,000 lives per year.

  • Counselling for mothers and caretakers
  • Micronutrient supplements
  • Management of severe malnutrition

Adolescent Nutrition

Adolescence represents a window of opportunity to prepare for a healthy adult life. During adolescence, nutritional problems originating earlier in life can potentially be corrected, in addition to addressing current ones. It is also a timely period to shape and consolidate healthy eating and lifestyle behaviours, thereby preventing or postponing the onset of nutrition-related chronic diseases in adulthood. As adolescents have a low prevalence of infections such as pneumonia and gastroenteritis compared with younger children, and of chronic disease compared with ageing people, they have generally been given little health and nutrition attention, except for reproductive health concerns. However, there are nutritional issues, which are adolescent-specific, and which call for specific strategies and approaches. The main issues in adolescent nutrition are:

  • Micronutrient deficiencies (iron deficiency and anaemia)
  • Malnutrition and stunting
  • Obesity and other nutrition-related chronic diseases
  • Adolescents eating patterns and lifestyles
  • Nutrition in relation to early pregnancy

Infant and young child feeding

Breast milk is the ideal food for infants and is all they need for optimal growth and health during the first six months of life. Breastfeeding is considered a pillar of child survival; it provides nourishment, helps develop the immune system, improves response to vaccines, and prevents many infections, including diarrheal diseases.1 Because of the unique benefits of breast milk, it is recommended that infants continue breastfeeding for up to two years and beyond. Breastfeeding also provides health benefits for the mother. It is estimated that 1.5 million children die each year because they were not breastfed, particularly not exclusively breastfed through six months of age. These deaths could be avoided by educating mothers and health workers about the vital role that breastfeeding plays in keeping infants healthy and by providing support to encourage appropriate feeding practices. In many developing countries, counseling and support have proven very effective for increasing rates of exclusive breastfeeding for up to six months, in turn reducing infant morbidity and mortality.

Malnutrition, caused by inadequate nutrient intake and disease, is a direct cause of 30 percent of all child deaths in developing countries and can result in a five-to-ten-fold increase in a child’s risk of death from diarrhea.3 Characterized by low weight and height for age, and low weight for height, malnutrition can be prevented through optimal infant and young child feeding—exclusive breastfeeding in the first six months, along with continued breastfeeding and nutritious, hygienically prepared complementary foods during the six to 24 month period. Feeding should continue during an episode of diarrhea, as well as increased feeding after the episode to counteract weight loss and prevent malnutrition. PATH’s Infant and Young Child Nutrition project works in developing countries to promote optimal infant and young child feeding practices—proven methods for reducing malnutrition and enhancing child growth and survival. UNICEF works to protect, promote and support optimal infant and young child feeding practices as a means to improve nutrition status, growth, development, and health.

Key resources Below are some key documents on breastfeeding and infant nutrition. Please also browse our list of other helpful websites for more resources.

Other helpful websites

References

1 Davis MK. Breastfeeding and chronic disease in childhood and adolescence. Pediatric Clinics of North America. 2001;48(1):125–141, ix.

2 Victora CG, Smith PG, Vaughan JP, et al. Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. The Lancet. 1987;2(8554):319–322.

3 The Lancet's Series on Maternal and Child Undernutrition. Available at: www.globalnutritionseries.org/. Accessed 23 February 2009.

Photo: PATH/Carib Nelson.


Reproduced from the PATH Resources for Diarrheal Disease Control website at www.eddcontrol.org, [6 November, 2009].


Nutrition Resources

Infant and Young Child Nutrition (IYCN) Project

The Infant and Young Child Nutrition (IYCN) Project maintains a collection of useful resources on maternal nutrition, infant and young child feeding, prevention of mother-to-child transmission of HIV (PMTCT), and more. Our collection offers a variety of high-quality training materials, publications, web links, and other helpful resources. After five years of maternal, infant, and young child nutrition programming around the world, USAID's Infant & Young Child Nutrition (IYCN) Project completed activities in most countries in December 2011. Resources > Agriculture and food security | Behavior change communication | Infant feeding and emergencies | Infant feeding and HIV | Maternal nutrition
Micronutrients | Monitoring and evaluation | Multilanguage resources | Policy and advocacy | Research | Technical publications

WHO Resources

Nutrition for Health and Development (NHD)

Reproductive Health and Research (RHR

UNAIDS

1. Country Focused Nutrition Policies and Programmes

Feto-maternal nutrition
Infant and young child feeding
School-age children and adolescents
Obesity and other diet-related chronic diseases
Older persons

Dietary recommendations/Nutritional requirements
Household food security
Food and nutrition policies and programmes

2. Reduction of Micronutrient Malnutrition

Norms and standards
Anaemia/iron deficiency
Iodine deficiency
Vitamin A deficiency

3. Growth Assessment and Surveillance

Child growth standards
Growth reference data for 5-19 years

4. Nutrition in Development and Crisis

Emergencies
Nutrition and HIV/AIDS
Moderate malnutrition
Severe acute malnutrition

General

Planning

Guidelines and Training

Monitoring and Evaluation

Research

Infant and young child feeding list of publications

The documents and articles listed below can be accessed, downloaded, or ordered from the WHO bookshop.
Strengthening action to improve feeding of infants and young children 6-23 months of age in nutrition and child health programmes (2009)
Report of proceedings, Geneva, 6-9 October 2008 Infant and young child feeding: Model Chapter for textbooks for medical students and allied health professionals (2009) Indicators for assessing infant and young child feeding practices - Part I: Definitions (2008)
Conclusions of a consensus meeting held 6–8 November 2007 in Washington D.C., USA Planning guide for national implementation of the global strategy for infant and young child feeding (2007) Implementing the global strategy for infant and young child feeding (2003)
Meeting report, Geneva, Switzerland, 3-5 February 2003 Infant and young child feeding: A tool for assessing national practices, policies and programmes (2003) Global strategy for infant and young child feeding (2003) Infant feeding the physiological basis (1990)
Bulletin of the World Health Organization, Supplement to Volume 67, 1989

Baby-friendly hospital initiative

Baby-Friendly Hospital Initiative (2009)
Revised, updated and expanded for integrated care Acceptable medical reasons for use of breast-milk substitutes (2009) The Baby-Friendly Hospital Initiative (1999)
Monitoring and reassessment: Tools to sustain progress Protecting, promoting and supporting breast-feeding (1989)
The special role of maternity services

Breastfeeding

Learning from large-scale community-based programmes to improve breastfeeding practices (2008) Nutrient adequacy of exclusive breastfeeding for the term infant during the first six months of life (2002) Report of the expert consultation of the optimal duration of exclusive breastfeeding (2001)
Geneva, Switzerland, 28-30 March 2001 The optimal duration of exclusive breastfeeding: a systematic review (2001) Complementary feeding

Feeding the non-breastfed child 6-24 months of age (2004)
Meeting report, Geneva, Switzerland, 8-10 March 2004 Complementary feeding: report of the global consultation (2003)
Summary of guiding principles for complementary feeding of the breastfed child Report of informal meeting to review and develop indicators for complementary feeding (2002)
Washington, D.C, 3-5 December 2002 Complementary feeding: family foods for breastfed children (2000) Complementary feeding of young children in developing countries (1998)
A review of current scientific knowledge Complementary feeding of infants and young children : report of a technical consultation (1998)
Joint WHO/UNICEF Consultation on Complementary Feeding, Montpellier, France, 28-30 November 1995 International code of Marketing of breast-milk substitutes

The International Code of Marketing of Breast-Milk Substitutes (2008)
Frequently asked questions (updated version 2008) The International Code of Marketing of Breast-Milk Substitutes (1998)
Summary of action taken by WHO Member States and other interested parties, 1994-1998 The International Code of Marketing of Breast-Milk Substitutes (1996)
A common review and evaluation framework The International Code of Marketing of Breast-Milk Substitutes (1992)
Survey of national legislation and other measures adopted (1981-1991) Review and evaluation of national action taken to give effect to the International Code of Marketing of Breast-Milk Substitutes (1991)
Report of a technical meeting, The Hague, 30 September - 3 October 1991 The International Code of Marketing of Breast-Milk Substitutes (1990)
Synthesis of reports on action taken (1981-1990) International Code of Marketing of Breast-Milk Substitutes (1981) Infant formula and related trade issues in the context of the international code [pdf 18kb] The WHO briefing note on "Follow-Up Formula in the Context of the International Code of Marketing of Breast-milk Substitutes" is presently being considered for revision by the World Health Organization pending review of new and emerging information on the subject. It has therefore been decided by the Organization to withdraw the current version of the briefing note from its website.


HIV and Infant feeding

HIV transmission through breastfeeding (2008)
A review of available evidence - update 2007 HIV and infant feeding: Update (2007)
Based on the technical consultation held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV infections in pregnant women, Mothers and their Infants, Geneva, Switzerland, 25-27 October 2006 HIV and infant feeding: new evidence and programmatic experience (2007)
Report of a technical consultation held on behalf of the Inter-agency Task Team (IATT) on Prevention of HIV infections in pregnant women, Mother and their Infants, Geneva, Switzerland, 25-27 October 2006 UNICEF and WHO call for stronger support for the implementation of the joint United Nations HIV and infant feeding framework (2004) HIV and infant feeding: a guide for health care managers and supervisors (2003) HIV and infant feeding: guidelines for decision-makers (2003) HIV and infant feeding: framework for priority action (2003) Training courses


BFHI Section 3: Breastfeding Promotion and Support in a Baby-friendly Hospital, a 20-hour course for maternity staff (2009)
Baby-friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care Infant young child feeding counselling: An integrated course (2006) BFHI Section 2: Strengthening and sustaining the Baby-friendly Hospital Initiative (2006)
Baby-friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care Complementary feeding counselling: a training course (2004)

Management of Severe Acute Malnutrition and Out Patient Therapeutic Program
Training Material

Ethiopia Links: Federal Ministry of Health | UNICEF | Play Therapy Africa


Regional publications


AMRO


Guiding Principles for Complementary Feeding of the Breastfed Child (2004) EMRO

Report on the Regional Workshop on the Implementation of the International Code of Marketing of Breast-Milk Substitutes (1994)
Cairo, Egypt, 19-23 September 1993 EURO

Feeding and nutrition of infants and young children (2003)
Guidelines for the WHO European region, with emphasis on the former Soviet countries Development of a global strategy on infant and young child feeding : report on a WHO/UNICEF consultation for the WHO European Region (2001)
Budapest, Hungary 28 May-1 June 2001 Comparative analysis of implementation of the Innocenti Declaration in WHO European member states (1999)
Monitoring Innocenti targets on the protection, promotion and support of breastfeeding Breastfeeding and healthy eating in pregnancy and lactation (1998)
Report on a WHO workshop, Arkhangelsk, Russian Federation, 5-8 October 1998 Breastfeeding : how to support success (1997)
A practical guide for health workers Health workers and the WHO International Code of Marketing of Breast-Milk Substitutes (1987)
Report on a WHO meeting, Copenhagen, 31 October 1986 WPRO

Biregional Workshop on the Implementation of the International Code of Marketing of Breast-Milk Substitutes (1994)
Manila, Philippines, 7-11 March 1994 Peer-reviewed articles

Special Issue Based on a World Health Organization Expert Consultation
Food and Nutrition Bulletin, vol. 24, no. 1, 2003

The Innocenti Declaration: progress and achievements, parts I, II and III
WHO Weekly Epidemiological Record, 1998, 73(5):25-32, 73(13):91-94 and 73(19):139-144

English and French: Part I Part II Part III
Information and attitudes among health personnel about early infant-feeding practices: World Health Organization's infant-feeding recommendation
WHO Weekly Epidemiological Record, 1995, 70(17):117-120 Related publications

Rapid advice: revised WHO principles and recommendations on infant feeding in the context of HIV – November 2009 Guiding principles on feeding non-breastfed children 6-24 months of age (2005) Evidence for the ten steps to successful breastfeeding (1998) Breastfeeding counselling: A training course (1993)


updated: 21 April, 2014

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