4. Learning Objectives
At the end of this section the participant should:
Understand the role of optimal nutrition and IYCF in ECD
The magnitude of problems related to IYCF
The changes in IYCF according to the developmental stage
Responsive feeding
What should be done in the well child visits
5. Optimal Nutrition, IYCF & ECD
• Nutrition: process of providing or
obtaining food necessary for growth
and development
• Provides macro & micronutrients
• Optimal nutrition important for child
survival
• Comparison of interventions in
decreasing under 5 mortality:
maximally effective
6. Food & Energy Requirements
• Breast feeding is the only source of energy till 6 m of age
• If CF not of proper quantity & quality beyond 6 m growth falters
7. • Minerals and vitamins play a major role in growth and development
• Micronutrient deficiency (‘hidden hunger’): Does not cause hunger per se but
nonetheless leads to undernutrition, e.g. Zinc, Iodine, Iron, vitamin A
• Intake or absorption too low to sustain health and development in children
Micronutrients & ECD
8. IYCF Indicators
National Health Family Survey 4 (2015-16)/ NHFS 5 (2019-21)
Children < 3 y breastfed within one hour of birth: 41.6%/ 41.8%
Children < 6 m being exclusively breastfed: 54.9%/ 63.7%
Children aged 6-8 m receiving solid/semi-solid food and breastmilk: 42.7%/ 45.9%
Breastfed children aged 6-23 m receiving adequate diet: 8.7%/ 11.1%
Non-breastfed children aged 6-23 m receiving adequate diet: 14.3% / 12.7%
Total children aged 6-23 m receiving adequate diet: 9.6%/ 11.3%
10. Development and Determinants
of Complementary Feeding
Parameter 7-8 months 9-11 months 12 – 24 months
No of
meals
2 – 3 3 – 4 3 – 4, 1 – 2 snacks
Size of
serving
30 -45 ml (2 – 3 tbsp)
to 125 ml (1/2 cup)
125 – 180 ml
(½ to ¾ cup)
180 – 250 ml
(¾ to 1 cup)
Consistency Pureed food (soft) Mashed/chopped finger
foods (semi-solid)
Solid food from the
family pot
Feeding
stage
Up and down
munching
Biting and chewing
movements
Rotatory chewing,
stable jaw
11. Food Groups
• Complete food: Proteins,
carbohydrates, fats, minerals, vitamins
and fibers, etc.
• Balanced Food: All components present
in appropriate proportions
• Diverse Food: ≥ 4 out of 7 food groups
12. Responsive feeding
• Offering food based on cues (hunger and satiety) with
understanding, love, patience and play
• Infant encouraged to eat a variety of textures, tastes,
and food groups
• Process should be enjoyable for both- parents
maintaining eye contact and talking with child
• No force feeding, indifferent feeding or using screens
as distractors
Allow the child to try to feed
himself/ herself even if
messy or spills occur
13. ECD Companion for Pediatrician
The way forward
Visit Ask Assess Office staff Counsel Parents
<7 d Any concerns,
Details of BF
If concerns check
attachment,
positioning, nipple /
breast issues
Identify gap between
recommended amount,
number, consistency, food
groups, responsive
feeding, extent of
supervision, food safety
and what is being
practised.
Counsel using ALPAC
strategy.
Support EBF during first 6
m & adequate responsive
CF >6 m with continued BF
into 2nd year of life.
Check maternal diet, child
and mother’s supplements
Tell about benefits of
BF/CF & drawbacks of not
BF/giving CF
Routine Supplements
Iron, Vit. D, USI, Vit. A,
deworming
6 w
10 w
14 w
6 m Any concerns,
details of BF
& CF,
responsive
feeding, food
safety
Assess quality of
responsive feeding if
concerns voiced
/fussy eater
Nutritional status &
deficiencies
9 m
12 m
18 m
24 m
30 m
36 m
14. Key Messages
EBF till 6 m & timely introduction of CF is essential for optimal ECD
Pediatricians should check attachment, positioning, suckling and breast/nipple
problems if there are concerns regarding breastfeeding.
Parents should be instructed about EBF and timely, adequate, safe, and nutritious CF
(with presence of ≥ 4 food groups)
Tell them about the Do’s (responsive feeding) and Don'ts of IYCF
The advantages and consequences of good and poor nutrition on ECD
Adequate Nutrition components in the ECD companion are easy to follow
Editor's Notes
Total session 15 min
Please read the concerned chapter in Module 1 for background. Also read the chapter on communication. The skills of counselling will need to be highlighted in slide 52. This will form the basis of counselling of all the other components.
Please do not waste time on EBF/ breast feeding problems. Every pediatrician knows that. We want the focus on things that are not being routinely counselled.
The timing should be such that maximal time is on the responsive feeding and food diversity
Nothing to be explained. Only that out of the 5 pillars the component that is encircled will be discussed.
At the end of this section the participant should:
Do not take more than 60 sec on this slide. Young children flourish on exclusive breastfeeding from birth to the age of 6months
This should be frequently fed, sufficient in amount, and diverse to support rapid growth of the body and brain.
In the graph only message to be emphasized is the grey insert 13 + 6 = 19
By 1 y energy derived from breast feeds start falling sharply and by 24 months family foods becomes the main source of energy.
Do not take more than 30 sec on this slide. Only the key messages that emerge from this slide.
Causes include poor diet, disease, or increased micronutrient needs not met during pregnancy and lactation
Do not go into the treatment part.
Emphasize only on the detrimental effects of deficiency on the brain and development
All pediatricians will know the first 2nd adnd 3rd rows.
Just focus on telling them that they need to tell the parents about the feeding stage so that the parents have ownership in providing the first 3 rows.
This is very important.
Spend time on this slide,
Ask the participants what kind of food is given in a home based diet that they can tell their parents to give.
This is the slide on which maximal time should be spent, Get active participation on this aspect.
Ask the participants how they fed their own children,
Read the relevant section and cover everything given in the module.
Do not go into the details.
Spend time on this slide to sensitize the participant to two things 1) how to do a gap analysis and 2) How to communicate effectively.
Main focus is how to do a gap analysis (recommended – practiced at home) = gap. This will be applicable to all the components.
Then focus on the way the counselling is to be done using ALPAC (Ask-Listen-Praise-Advise-Check) questions. Please refer to the chapter on communication.
Pediatricians must be told that these key messages need to be conveyed to the parents.
Behavior change will come in parents only if they know the advantages of what is being proposed and the consequences of what inappropriate things are being practiced.