Infant and Young Child Growth

Excerpt

Each year, undernutrition—including fetal growth restriction, stunting, wasting, and micronutrient deficiencies—and suboptimum breastfeeding (BF) underlie nearly 3.1 million deaths of children younger than age five years worldwide, accounting for 45 percent of all deaths in this age group (Liu and others 2012). Fetal growth restriction and suboptimum BF together are responsible for more than 1.3 million deaths, or 19.4 percent of all deaths among children younger than age five years.

Although the prevalence of stunted children has decreased from 40 percent in 1990 to 26 percent in 2011, an estimated 165 million children younger than age five years globally are stunted, based on the World Health Organization’s (WHO’s) Child Growth Standards (map 12.1). South Asia and Sub-Saharan Africa have the highest estimated prevalence; 68.0 million and 55.8 million stunted children live in South Asia and Sub-Saharan Africa, respectively (UNICEF, WHO, and World Bank 2012). Stunting prevalence among children younger than age five years is substantially higher in the poorest population quintiles and in rural areas, compared with the richest quintiles and urban areas, respectively (Black and others 2013). The complex interplay of social, economic, and political determinants of undernutrition results in substantial inequalities among population subgroups (Black and others 2013).

Optimum nutrition during the crucial periods of pregnancy and the first two years of life, known as the 1,000 days window of opportunity, is essential to health and growth, and its benefits can extend throughout life. A major component of infant and young child feeding (IYCF) in the early years of life is the provision of breast milk and appropriate, nutrient-dense complementary foods (PAHO and WHO 2003). In 2003, the WHO and the United Nations Children’s Fund (UNICEF) published a jointly developed global strategy for IYCF to refocus attention on the impact that feeding practices have on infant nutrition and health (WHO and UNICEF 2003). In 2008, the WHO published a set of population-level IYCF indicators developed in response to the need for simple, practical indicators of appropriate feeding practices in children ages 6–23 months (WHO 2002; WHO and UNICEF 2008). A core set of eight indicators (three for BF and five for complementary feeding [CF]) includes measures of dietary diversity, feeding frequency, and consumption of iron-rich or iron-fortified foods, as well as indicators of appropriate BF practices (table 12.1) (Jones and others 2014).

This chapter discusses key concepts in nutrition and growth during this early phase of life, intrauterine growth and maternal interventions (balanced energy and micronutrient supplementation), nutrition interventions to improve infant and child feeding (BF, CF, and micronutrient supplementation), other nutrition-related interventions, and challenges in infant and child feeding.