Indian Pediatr 2010;47: 995-1004
Infant and Young Child Feeding Guidelines:
Infant and Young Child Feeding Chapter, Indian Academy of Pediatrics
Correspondence to: Dr. Satish Tiwari, Yashoda Nagar
No.2, Amravati, 444606 Maharashtra, India.
The first National Guidelines on Infant and Young Child Feeding (IYCF)
were formulated by Ministry of Women and Child Development (Food &
Nutrition Board) in 2004, and the same guidelines were revised in 2006.
India is committed to halving the prevalence of under weight children by
2015 as one of the key indicators of progress towards the Millennium
Development Goals (MDG). By the end of 2009 nutritional achievement
goals did not make for happy reading. So there was need to revise the
existing guidelines and to have more viable and scientifically accepted
national guidelines on Infant and Young child feeding.
Process: A National Consultative Meet was
organized by Indian Academy of Pediatrics at Gurgaon in 2009 where
members of IYCF and Nutrition Chapters of IAP, BPNI, WHO, UNICEF, USAID,
WFP were present. Each group made detailed presentations after reviewing
recent literature on the subject. After extensive discussions a
consensus was reached and the guidelines were formulated.
Objectives: To formulate, endorse, adopt
and disseminate guidelines related to Infant & Young Child feeding from
an Indian perspective (including infant feeding in the context of HIV
Recommendations: Optimal infant and young
child feeding: Early initiation of breastfeeding, exclusive
breastfeeding for the first six month of life followed by continued
breastfeeding for up to two years and beyond with adequate complementary
foods is the most appropriate feeding strategy for infants and young
children. Adequate nutrition and anemia control for adolescent girls,
pregnant and lactating mother is also advocated.
Key words: Early initiation, Exclusive breastfeeding,
Complementary feeding, Hand washing, Malnutrition, IMS Act.
India is home to more than a third of the
world’s undernourished children. In 1999, the National Family Health
Survey (NFHS II) found that 47 percent of all children under age three
were under weight. Data from NFHS-3 (2006) shows only a very small
decline, with under-nutrition level remaining around 45 percent for
children below three(1). Despite vast improvements in the country’s
economy, undernutrition remains a challenge in India. The Tenth Five year
Planning Commission had set up the National Nutritional Goals which were
to be achieved by 2007(2). The major goals were:
1. Intensify nutrition and health education to
improve infant and child feeding and caring practices so as to bring
down the prevalence of under-weight children below three years from the
current level of 47 percent to 40 percent and reduce prevalence of
severe under-nutrition in children in the 0-6 years age group by 50
2. Increase early initiation of breastfeeding (colostrum
feeding) from the current level of 15.8 percent to 50 percent.
3. Enhance the exclusive breastfeeding rate for the
first six months from the current rate of 55.2 percent to 80 percent.
4. Enhance the complementary feeding rate at six
months from the current level of 33.5 percent to 75 percent.
By the end of 2007, the nutritional achievement results
were not satisfactory. Reasons for this include the inadequate knowledge
of caregivers regarding correct infant and young child feeding, frequent
infections, high population pressure, low social and nutritional status of
girls and women, suboptimal delivery of social services and lack of more
To formulate new guidelines, the IYCF chapter of Indian
Academy of Pediatrics organized a National Consultative Meet on the 20th
anniversary of the signing of the Convention on the Rights of the Child.
Various partners from WHO, UNICEF, USAIDS, WFPO, Ministry of Child Welfare
Department and Academicians from various states of India met and drafted
To formulate, endorse, adopt and disseminate guidelines
related to Infant and Young Child
Feeding from an Indian perspective (including infant
feeding in the context of HIV infection).
APPROPRIATE AND OPTIMAL INFANT AND YOUNG CHILD FEEDING
A. Technical Guidelines
2. Complementary feeding
3. Feeding in the context of HIV infection
4. Feeding in other specific situations
B. Operational Guidelines
1. Recommendations for Governmental and International
2. Role of NGOs
3. Recommendations for the media
4. Training recommendations
A. TECHNICAL GUIDELINES
(a) Breastfeeding should be promoted to
mothers and other caregivers as the gold standard feeding option for
(b) Pre-birth counseling individually or in
groups organized by maternity facility regarding advantages of
breastfeeding and dangers of artificial feeding should prepare expectant
mothers for successful breastfeeding.
(c) Breastfeeding must be initiated as early
as possible after birth for all normal newborns (including those born
by caesarean section) avoiding delay beyond an hour. In case of
operative birth, the mother may need motivation and support to initiate
breastfeeding within the first hour. Skin to skin contact between the
mother and new born should be encouraged by ‘bedding in the mother and
baby pair’. The method of "Breast Crawl" can be adopted for early
initiation(3). Mother should communicate, look into the eyes, touch and
caress the baby while feeding. The new born should be kept warm by
promoting Kangaroo Mother Care and promoting local practices to keep the
(d) Colostrum must not be discarded but should
be fed to newborn as it contains high concentration of protective immunoglobulins
and cells. No pre-lacteal fluid should be given to the newborn.
(e) Baby should be fed "on cues"- The early
feeding cues includes; sucking movements and sucking sounds, hand to
mouth movements, rapid eye movements, soft cooing or sighing sounds, lip
smacking, restlessness etc. Crying is a late cue and may interfere with
successful feeding. Periodic feeding is practiced in certain situations
like in the case of a very small infant who is likely to become
hypoglycemic unless fed regularly, or an infant who ‘does not demand’
milk in initial few days. Periodic feeding should be practiced only on
(f) Every mother, specially the first time
mother should receive breastfeeding support from the doctors and the
nursing staff, or community health workers (in case of non institutional
birth) with regards to correct positioning, latching and treatment of
problems, such as breast engorgement, nipple fissures and delayed
‘coming-in’ of milk.
(g) Exclusive breastfeeding should be
practiced from birth till six months requirements. Mean intakes of human
milk provide sufficient energy and protein to meet requirements during
the first 6 months of infancy. Since infant growth potential drives milk
production, the distribution of intakes likely matches the distribution
of energy and protein. This means that no other food or fluids should be
given to the infant below six months of age unless medically
indicated(5). After completion of six months of age, with introduction
of optimal complementary feeding, breastfeeding should be continued for
a minimum for 2 years and beyond depending on the choice of mother and
the baby. Even during the second year of life, the frequency of
breastfeeding should be 4-6 times in 24 hours, including night feeds.
(h) Mothers need skilled help and confidence
building during all health contacts and also at home through home visits
by trained community worker, especially after the baby is 3 to 4 months
old when a mother may begin to doubt her ability to fulfill the growing
needs and demands of the baby.
(i) Mothers who work outside should be
assisted with obtaining adequate maternity/breastfeeding leave from
their employers, should be encouraged to continue exclusive
breastfeeding for 6 months by expressing milk for feeding the baby while
they are out at work, and initiating the infant on timely complementary
foods. They may be encouraged to carry the baby to a work place crèche
wherever such facility exists. The concept of "Hirkani’s rooms" may be
considered at work places (Hirkani’s rooms are specially allocated room
at the workplace where working mothers can express milk and store in a
refrigerator during their work schedule). Every such mother leaving the
maternity facility should be taught manual expression of her breast
(j) Mothers who are unwell or on medication
should be encouraged to continue breastfeeding unless it is medically
indicated to discontinue breastfeeding.
(k) At every health visit, the harms of
artificial feeding and bottle feeding should be explained to the mother.
Inadvertent advertising of infant milk substitute in health facility
should be avoided. Artificial feeding is to be practiced only when
(l) Health and Nutrition (ICDS) workers should
be trained in various skills of counseling and especially in handling
sensitive subjects like breastfeeding and complementary feeding.
(m)If the breastfeeding was temporarily
discontinued due to an inadvertent situation, "re-lactation" should be
tried as soon as possible. Such cases should be referred to a trained
lactation consultant/health worker. The possibility of "induced
lactation" shall be explored according to the situation.
(n) All efforts should be taken to remove
hurdles impeding breastfeeding in public places.
(o) Adoption of latest WHO Growth Charts is
recommended for monitoring growth(6).
2. Complementary Feeding(7,8)
(a) Appropriately thick homogenous
complementary foods made from locally available foods should be
introduced at six completed months to all babies while continuing
breastfeeding ad libitum. This should be the standard and
universal practice(9). During this period breastfeeding should be
actively supported and the term "Weaning" should be avoided(10).
(b) To address the issue of a small stomach
size which can accommodate limited quantity at a time, each meal must be
made energy dense by adding sugar/jaggery and ghee/butter/oil. To
provide more calories from smaller volumes, food must be thick in
consistency - thick enough to stay on the spoon without running off,
when the spoon is tilted(11).
(c) Foods can be enriched by making a
fermented porridge, use of germinated or sprouted flour and toasting of
grains before grinding(10,12).
(d) Adequate total energy intake can also be
ensured by addition of one to two nutritious snacks between the three
main meals. Snacks are in addition to the meals and should not replace
meals. They should not to be confused with foods such as sweets, chips
or other processed foods(12).
(e) Parents must identify the staple homemade
food comprising of cereal-pulse mixture (as these are fresh, clean and
cheap) and make them caloric and nutrient rich with locally available
(f) The research has time and again proved the
disadvantages of bottle feeding. Hence bottle feeding shall be
discouraged at all levels.
(g) Population-specific dietary guidelines
should be developed for complementary feeding based on the food
composition of locally available foods. A list of appropriate,
acceptable and avoidable foods can be prepared.
(h) Iron-fortified foods, iodized salt,
vitamin A enriched food etc. are to be encouraged.
(i) The food should be a "balanced food"
consisting of various (as diverse as possible) food groups/ components
in different combinations. As the babies show interest in complementary
feeds, the variety should be increased by adding new foods in the staple
food one by one. Easily available, cost-effective seasonal uncooked
fruits, green and other dark colored vegetables, milk and milk products,
pulses/legumes, animal foods, oil/butter, sugar/jaggery may be added in
the staples gradually(10,11).
(j) Avoid Junk and Commercial food. Avoid
giving ready-made, processed food from the market, e.g. tinned
foods/juices, cold-drinks, chocolates, crisps, health drinks, bakery
(k) Avoid giving drinks with low nutrient
value, such as tea, coffee and sugary drinks.
(l) Hygienic practices are essential for food
safety during all the involved steps viz. preparation, storage and
feeding. Freshly cooked food should be consumed within one to two hours
in hot climate unless refrigerated. Hand washing with soap and water at
critical times- including before eating or preparing food and after
using the toilet (11, 12).
(m) Practice responsive feeding. Young
children should be encouraged to take feed by praising them and their
foods. Self feeding should be encouraged despite spillage. Each child
should be fed under supervision in a separate plate to develop an
individual identity. Forced feeding, threatening and punishment
interfere with development of good / proper feeding habits(11). Along
with feeding mother and care givers should provide psycho-social
stimulation to the child through ordinary age-appropriate play and
communication activities to ensure early childhood development.
(n) A skilled help and confidence building is
also required for complementary feeding during all health contacts and
also at home through home visits by community health workers.
(o) Consistency of foods should be appropriate
to the developmental readiness of the child in munching, chewing and
swallowing. Avoid foods which can pose choking hazard. Introduce lumpy
or granular foods and most tastes by about 9 to 10 months. Missing this
age may lead to feeding fussiness later. So do not use mixers/grinders
to make food semisolid/pasty. The details of food including; texture,
frequency and average amount are enumerated in Table I.
Amount of Food to Offer at Different Ages(12,13)
Average amount of each meal
||Start with thick porridge, well
||2-3 meals per day plus frequent
Start with 2-3 tablespoonfuls
Finely chopped or mashed foods,
3-4 meals plus breastfeed.
½ of a 250 mL cup/bowl
and foods that baby can pick up
Depending on appetite offer 1-2 snacks
Family foods, chopped or mashed
3-4 meals plus breastfeed .
3/4 to one 250 ml cup/bowl
Depending on appetite offer 1-2 snacks
If baby is not breastfed, give in addition: 1-2
cups of milk per day, and 1-2 extra meals per day. The
amounts of food included in the table are recommended when the energy
density of the meals is about 0.8 to 1.0 Kcal/g. If the energy density
of the meals is about 0.6 Kcal/g, recommend to increase the energy
density of the meal (adding special foods) or increase the amount of
food per meal. Find out what the energy content of complementary foods
is in your setting and adapt the table accordingly.
3. HIV and Infant Feeding
(a) As regards infant feeding the earlier 2006
guidelines suggested that health workers should individually counsel all
HIV positive mothers and help them each determine the most appropriate
infant feeding strategy for their circum-stances(14). However, the
current 2009 recommendations state that national health authorities
should promote a single infant feeding practice as the standard of
care(15). Hence based on various considerations like international
recommendations, socioeconomic and cultural contexts of the country’s
population, the availability and quality of health services, the local
epidemiology including HIV prevalence among pregnant women and main
causes of infant mortality and under-nutrition, the National health
authorities should decide upon the strategy that will most likely give
infants the greatest chance of remaining HIV uninfected and alive. They
will have to decide whether they will recommend that all HIV infected
mothers will breastfeed and receive ARV interventions OR will avoid
all breastfeeding. Currently WHO is developing guidance to assist
countries in this decision-making process and will lay out steps to
reach these standards of care. Whichever option is chosen, mothers
should be helped and empowered to sustain that option.
(b) Current WHO recommendations advocate that
all mothers known to be HIV-infected should be provided with
antiretroviral therapy or antiretroviral prophylaxis to reduce mother to
child transmission and in particular to reduce postnatal transmission
through breastfeeding. Details about these interventions can be seen in
the document- Revised WHO recommendations on the use of
antiretroviral drugs for treating pregnant women and preventing HIV
infection in infants 2009 are available at http://www.who.int/hiv/topics/mtct/.
(c) Pregnant women and mothers known to be HIV
infected should be informed of the infant feeding strategy recommended
by the national authority to improve HIV free survival of HIV exposed
infants and informed that there are alternatives that mothers might wish
(d) Hence, mothers who are known to be HIV
negative OR whose HIV status is unknown OR infants of HIV positive
mothers known to be HIV-infected should exclusively breastfeed their
infants for the first six months of life and then introduce
complementary foods while continuing breastfeeding for 24 months or
(e) HIV-infected mothers on antiretroviral
therapy or prophylaxis (whose infants are HIV uninfected or of unknown
HIV status) should exclusively breastfeed their infants for the first 6
months of life, introducing appropriate complementary foods thereafter,
and continue breastfeeding for the first 12 months of life.
Breastfeeding should then only stop once a nutritionally adequate and
safe diet without breast milk can be provided. As per the new
guidelines, baby should receive daily Nevirapine from birth until one
week after all exposure to breast milk has ended if the mother received
only Zidovudine prophylaxis and Nevirapine from birth to 6 weeks if
mother has received triple ARV prophylaxis(16).
(f) If a HIV positive mother chooses not to
breast feed in spite of receiving ARV prophylaxis, Zidovudine or
Nevirapine is indicated for 6 weeks for the baby from birth.
Replacement feeding as mentioned below is advocated in this situation.
(g) Whenever HIV-infected mothers decide to
stop breastfeeding, it should be done gradually within one month.
Mothers or infants who have been receiving ARV prophylaxis should
continue prophylaxis for one week after breastfeeding is fully stopped.
(h) Infants born to HIV infected women
receiving ART for their own health should receive daily Nevirapine from
birth till 6 weeks of age and for those being breastfed daily,
Zidovudine or Nevirapine from birth until 6 weeks of age is recommended.
Alternatives to breastfeeding include
For infants less than 6 months of age
(i) Expressed, heat-treated breast milk
(ii) Unmodified animal milk
(iii) Commercial infant formula milk.
(The choice/selection shall be based on AFASS
For children over 6 months of age
(iv) All children can be given complementary
foods from six months of age (as discussed in the section on
complimentary feeding). Meals including; foods, combination of milk
(based / containing) feeds (especially in those who consume strict
vegetarian diet) and other foods, should be provided.
Other options for all ages
(v) Breastfeeding by another woman who is HIV
(vi) Human milk from breast milk banks
Replacement feeding (RF) is the process of feeding a
child who is not receiving any breast milk, with a diet that provides all
the nutrients until the child is fully fed on family foods. The
replacement feeding option should be selected, only if all of the AFASS
criteria are completely fulfilled (AFASS refers to Acceptability,
Feasibility, Affordability, Safety and Sustainability)(14). Cup feeding
should be the method of choice if replacement feeding needs to be done and
bottles should be totally avoided. If any of the AFASS criteria is not
met, the mother should practice exclusive breastfeeding till 6 months
along with early treatment of breast and nipple problems of HIV+ve mother.
Mixed feeding must be avoided (except the short
transition period of around a month when breast-feeding is being gradually
stopped) as it causes a two fold increase in the risk of postnatal HIV
transmission. Local breast conditions like nipple fissures can increase
the risk of HIV transmission and hence should promptly be treated.
Mothers known to be HIV infected may consider
expressing and heat-treating breast milk as an interim feeding strategy
in special circumstances such as:
When the infant is born with low birth weight or is
otherwise ill in the neonatal period and unable to breastfeed; or
When the mother is unwell and temporarily unable to
breastfeed or has a temporary breast health problem such as mastitis;
If antiretroviral drugs are temporarily not available.
4. Feeding in Other Specific Situations
(a) Feeding during sickness is important for
recovery and for prevention of under nutrition. Even sick babies mostly
continue to breastfeed and the infant can be encouraged to eat small
quantities of nutrient rich food but more frequently and by offering
foods that the child likes to eat. After the illness the nutrient intake
of child can be easily increased by increasing one or two meals in the
daily diet for a period of about a month; by offering nutritious snacks
between meals; by giving extra amount at each meal; and by continuing
(b) Infant feeding in maternal illnesses
1. Painful and/or infective breast conditions like
breast abscess and mastitis and psychiatric illnesses which pose a
danger to the child’s life e.g. postpartum psychosis, schizophrenia may
need a temporary cessation of breastfeeding. Treatment of primary
condition should be done and breastfeeding started as soon as possible.
2. Chronic infections like tuberculosis, leprosy, or
medical conditions like hypothyroidism need treatment of the primary
condition and don’t warrant discontinuation of breastfeeding.
3. Breastfeeding is contraindicated when the mother
is receiving certain drugs like anti-neoplastic agents, immuno-suppressants,
antithyroid drugs like thiouracil, amphetamines, gold salts, etc.
Breastfeeding may be avoided when the mother is receiving following
drugs- atropine, reserpine, psychotropic drugs. Other drugs like
antibiotics, anesthetics, antiepileptics, antihistamines, digoxin,
diuretics, prednisone, propranolol etc. are considered safe for
(c) Infant feeding in various conditions
related to the infant
(i) Breastfeeding on demand should be promoted
in normal active babies. However, in difficult situations like very LBW,
sick, or depressed babies, alternative methods of feeding can be used
based on neuro-developmental status. These include feeding expressed
breastmilk through intra-gastric tube or with the use of cup and spoon.
For very sick babies, expert guidance should be sought.
(ii) Gastro-Esophageal Reflux Disease (GERD):
Mild GERD is often treated conservatively through thickening the
complementary foods, frequent small feeds and upright positioning for 30
minutes after feeds.
(iii) Primary Lactose Intolerance is
congenital and may require long term lactose restriction. Secondary
Lactose Intolerance is usually transient and resolves after the
underlying GIT condition has remitted. Most of the cases of diarrhea do
not require stoppage of breastfeeding.
(iv) Various Inborn Errors of
Metabolism warrant restriction of specific offending agent and certain
dietary modifications e.g. in Galactosemia, dietary lactose and
galactose should be avoided. This is probably the only absolute
contraindication to breastfeeding.
(v) During emergencies, priority health and
nutrition support should be arranged for pregnant and lactating mothers.
Donated or subsidized supplies of breastmilk substitutes (e.g. infant
formula) should be avoided, must never be included in a general ration
distribution, and must be distributed, if at all, only according to well
defined strict criteria. Donations of bottles and teats should be
refused, and their use actively avoided.
B. Operational Guidelines
1. Recommendations for Governmental and
(a) Global legislation, binding to all states
and private organizations including labor benefits. Six months maternity
and appropriate paternity leave is strongly recommended.
(b) Scientific and unbiased IYCF practices
must be promoted through regular advertisements in state, public or
private owned audiovisual and print media. Public should be made aware
that artificial, junk or packaged food can be injurious to the health
of the children.
(c) Necessary and adequate arrangements should
be made for propaganda and implementation of the provisions of Infant
Milk Substitute (IMS) Act which prevents advertising or promoting infant
milk substitutes. In addition, further strengthening of the existing Act
must be tried.
(d) Adopt a National policy to avoid conflict
of interests in the areas of child health and nutrition. Popularization
of "unscientific health claims" by commercial ads through media needs to
(e) Government should explore the possibility
of appointing or making Lactation counselor available at least at Block
(f) Government along with International
agencies should formulate National policy on Fortification of food with
(g) The experts, academicians and government
shall formulate/develop guidelines for management of Severe Acute
Malnutrition (including effective home based care and treatment) in
2. Role of NGOs
(a) Various programs or community projects
should be initiated to provide home care and counseling on IYCF through
formation of mother support groups especially by women’s organizations.
(b) The voluntary organizations should
understand and advocate important recommendations at all levels. Various
like-minded organizations should work preferably on the same platform
and co-ordinate with each-other in promoting the IYCF practices.
3. Recommendations for Media
(a) Media has to take concrete steps to avoid
directly or indirectly glamorizing/promoting bottle feeding, artificial,
commercial and ready to use food. Instead, the risks involved in
artificial feeding and other suboptimal feeding practices should be
advertised prominently in bold prints.
(b) Media support is even more important on
certain occasions, celebrations, and social mobilization activities such
as World Breast Feeding Week and Nutrition Weeks.
4. Recommendations for Training
It is recommended that all the community health
workers, PPTCT counselors, and other personnel caring for children
including doctors should undergo three days skill training on IYCF
(including IMS Act). IYCF should also be included in the curriculum
of undergraduate and postgraduate medical education, nursing education,
home science, child nutrition courses etc. Anganwadi workers, ASHA, Dai‘s
and other grass root level workers should be empowered by basic,
scientific information related to IYCF.
Baby Friendly Concepts:
Baby Friendly Hospitals Initiatives (BFHI) is
recommended to be spread to all especially medical college hospitals
departments. The revised and expanded version of BFHI has been implemented
by UNICEF and WHO in 2009 (18). BFHI was implemented partially in some
states of India in 1992 but over the years it has not been reinforced or
reevaluated. Strengthening of this initiative in the community would lead
to better child survival.
The guidelines do not provide all the answers but
through the application of these guidelines in day to day practice, child
nutrition in the Indian subcontinent is expected to improve remarkably.
Members of the National Consultative Meet: Dr
Panna Choudhury - President IAP,2009; Dr R K Agarwal - Chairperson; Dr
Satish Tiwari - Convener; Dr AP Dubey (Co-ordinatar); Dr Rajesh Mehta, WHO
(could not attend), Dr Balraj Yadav; Dr Vishesh Kumar; Dr Nidhi Choudhury
(WHO); Dr CR Banapurmath; Dr ML Agnihotri; Dr Akash Bang; Dr Kajali
Paintal (UNICEF); Dr Tanmay Amladi (Hon Secretary-IAP, 2010); Dr Sailesh
Gupta; Dr Sanjay Prabhu; Dr Prashant Gangal; Dr Ketan Bharadva; Dr
Rajinder Gulati; Dr S Aneja; Dr Rajiv Tandon (USAID); Dr N C Prajapati; Dr
Ajay Gaur; Dr Shariqua Yunus (World Food Program); Dr Anchita Patil (USAID);
Dr Sarath Gopalan; Dr Amitava Sengupta.
Writing Committee: Dr K. Rajeshwari,
Dr Akash Bang, Dr (Mrs.) P Chaturvedi, Dr Vishesh Kumar, Dr Balraj Yadav,
Dr Ketan Bharadva; Dr Sailesh Gupta; Dr Piyush Gupta; Dr Dheeraj Shah; Dr
Satinder Aneja; Dr A P Dubey; Dr Satish Tiwari; Dr Panna Choudhury and Dr
R K Agarwal.
Competing interests: None stated.
We thankfully acknowledge the help, co-operation,
assistance and guidance from the WHO, UNICEF, Ministry of Health- Family
Welfare & Ministry of Women Child - Development. We thank Mr Amit Mohan
Prasad (Joint Secretary - MHFW); Dr Shreeranjan (Joint Secretary - MWCD);
Dr B Kishore (Assistant Commissioner for Child Health- MHFW) & Dr Sangita
Saxena (Assistant Commissioner for Child Health MHFW) for their constant
help, guidance and support in organizing this National Meet. Dr Kunal
Bagchi (Regional Advisor- WHO SEARO); Dr Neena Raina (Regional Advisor -
WHO SEARO); Dr Nidhi Chaudhary (NPO - WHO India); Dr Victor, Dr Deepika
Shrivastava & Dr Anand from UNICEF needs special thanks for their timely
help & Guidance. We specially thank and acknowledge Dr Rajesh Mehta (NPO-FCH
WHO) for designing and technical assistance.
• Initiation of breastfeeding as early as
possible after birth, preferably within one hour.
• Exclusive breastfeeding in the first six months
of life i.e., only breastfeeding or breast milk feeding and no other
foods or fluids (no water, juices, tea, pre-lacteal feeds), with the
exception of drops or syrups consisting of micro nutrition
supplements or medicines in compromised/diseased babies.
• Appropriate and adequate complementary feeding
after completion of six months of age while continuing
breastfeeding. Complementary foods should not be confused with
• Optimal infant and young child feeding:
Exclusive breastfeeding for the first six month of life followed by
continued breastfeeding with adequate complementary foods for up to
two years and beyond.
• Hand washing with soap and water: Hand washing
with soap and water at critical times – including before eating or
preparing food and after using the toilet.
• Full immunization and Vitamin-A supplementation
• Appropriate feeding for children during and
• Effective home based care and treatment of
children suffering from severe acute malnutrition.
• Adequate nutrition and anemia control for
adolescent girls, pregnant and lactating mothers.
• Effective implementation and monitoring of IMS Act.
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From: http://www.nfhsindia.org /data/India/indch7.pdf. Accessed on April
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Accessed on April 12, 2010.
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