|Fact sheet No 178: Reducing Mortality from Major Killers of Children - Revised September 1998 (WHO, 1998, 7 p.)|
Although malnutrition is rarely listed as the direct cause, it contributes to about half of all childhood deaths. 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.
Infection, particularly frequent or persistent diarrhoea, pneumonia, measles and malaria, undermines nutritional status. Poor feeding practices - inadequate breastfeeding, offering the wrong foods, giving food in insufficient quantities and without ensuring that the child eats its share - contribute to malnutrition. Malnourished children are, in turn, more vulnerable to disease.
IMCI improves the nutrition of children by:
· Promoting breastfeeding;
· Improving feeding practices;
· Providing micronutrient supplements routinely for children who need them.
IMCI-trained health workers check the nutritional status and feeding practices of every child under two years of age, and those with a low weight for their age. They counsel parents on the correct foods for each age group and help them to overcome various feeding problems. They are able to assess a mother breastfeeding her child and to correct any difficulties.
It is between 6 and 24 months, the transition between exclusive breastfeeding and sharing fully in the family diet, that children are most at risk of becoming malnourished. Changing family habits and the kinds of food offered to children is an important element of IMCI. An effective way of doing this is through talking to mothers individually about home care and their child's feeding difficulties, and finding feasible solutions for them to adopt. Relatively simple changes to feeding practices, such as helping toddlers to eat rather than leaving them to fend for themselves, can ensure that a child gets enough to eat during this critical period.
The special importance of breastfeeding: a modest increase in breastfeeding rates could prevent up to 10% of all deaths of children under five:
Breastfeeding plays an essential and sometimes underestimated role in the treatment and prevention of childhood illness. When mothers breastfeed exclusively during at least the first four months and, if possible, six months of life, there is a dramatic decrease in episodes of diarrhoea and, to a lesser extent, respiratory infections. Even small amounts of water-based drinks decrease breastmilk intake and weight gain, and increase the risk of diarrhoea. Continuing to breastfeed up to two years of age, in addition to giving complementary foods, maintains good nutritional status and helps prevent diarrhoea. IMCI promotes breastfeeding by:
· Encouraging maximum support to mothers to establish optimal breastfeeding from birth;
· Equipping health workers with counselling skills;
· Providing individual counselling and support for breastfeeding mothers.
Mothers often give their babies other food and fluids before six months because they doubt their breastmilk supply is adequate and they do not know how to improve the situation. IMCI recommends one-on-one counselling with mothers on breastfeeding techniques and benefits. WHO has developed courses in breastfeeding counselling for healthcare providers. Moreover, whenever a sick young child is taken to a clinic or health facility, the IMCI-trained health worker enquires about and assesses breastfeeding and provides the help and support needed to solve most common difficulties, while referring more serious problems to specialists.
WHO's tips for feeding your child
* Breastfeed your child. Give only breastmilk up to at least the age of 4 months and, if possible, up to 6 months.
Giving only breastmilk (no other foods or fluids, even water) helps to protect your child against sickness. Most mothers have enough breastmilk. By feeding your child frequently and for longer periods, you can increase the amount of breastmilk.
* When your child is 6 months old, begin to offer other foods.
Thick cereal, meat, fish, eggs, beans, fruits and vegetables will give your child energy and will help your child to grow.
* Continue to breastfeed up to the age of two years - as often as your child wants.
Even when you give other foods, breastfeeding will help to protect your child against sickness.
* Feed your child actively.
Sit with and encourage your child to eat. Put your child's serving in a separate plate or bowl to ensure that he or she has an adequate share of the family food.
* If your child is sick:
- Breastfeed more often.
· Note: Mothers who are found to
be HIV-positive require counselling about possible alternatives to
breastfeeding. Three documents on the subject soon to be available from WHO's
Division of Distribution and Sales (tel: +41 22 791 2477) are:
1. HIV and Infant Feeding: Guidelines for Decision Makers (WHO/FRH/NUT/CHD/98.1);
3. HIV and Infant Feeding: A review of transmission of HIV through breastfeeding (WHO/FRH/NUT/CHD/98.3).