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Module 4. Infant and Young Child

Feeding in Emergencies
(IYCF-E)
 Overview
• This module presents basic principles and
practices on Infant and Young Child Feeding in
Emergencies. This includes breastfeeding,
timely and safe complementary feeding from six
months onwards while continuing
breastfeeding; the recent provisions of the Milk
Code and its RIRR as well as AO 2007-0017.
The assessment of IYCF needs and practices
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and important interventions to support IYCF-E

are also in this session.
 Learning Objectives
At the end of this module, the participants should be able
to:
• Discuss the basic principles in infant and young child
feeding and its importance during emergencies.
• Explain the breastfeeding and complementary feeding
basics.
• Identify the policies, guidelines and provisions of the
revised IRR of the Milk Code which must be especially
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emphasized during emergencies.

• Describe important practical interventions to support
IYCF-E.
• Demonstrate skills in conducting IYCF-E assessment
(simple rapid and full assessment)
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SESSION 4.1

The Basics of Infant and Young

Child Feeding
 Basic principles in IYCF-E

• The protection, promotion and support

for appropriate feeding in infants and
young children under the age of two
years in emergency situations.

• Breastfeeding, safe artificial feeding

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when necessary and appropriate as well

as timely and safe complementary
feeding from six months.
 Basic principles in IYCF-E
• Control of the manufacture, labeling,
procurement, management and distribution of
breast milk substitutes (BMS), milk products,
commercial baby foods and infant feeding
equipment which comply with the Operational
Guidance on Infant Feeding in Emergencies
(IFE) and the Milk Code.
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• Handling of donations in accordance with best

practice as set out in the Operational Guidance
on IFE.
 Importance of IYCF-E
• Infants and children are among the most
vulnerable victims of emergencies and
disasters. Interrupted breastfeeding and
inappropriate complementary feeding heighten
the risk of malnutrition, illness and mortality.

• Uncontrolled distribution of breast milk

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substitutes, for example in evacuation settings

can lead to early and unnecessary cessation of
breastfeeding
 Importance of IYCF-E
• Inappropriate IYCF increases the risk of illness,
malnutrition and death.
• Not being breastfed increases the risk of
mortality by 6 times in infants <2 months old
and even between 9 and 11 months, the risk is
increased by 40%.
- Delayed breastfeeding (more than 24 hours
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after birth) increases the risk of dying by 2-4

times during first month of life.
- Risk of neonatal death is 4 times greater if
milk-based fluids or solids are provided to
breastfed infants less than 4 weeks.
 Advantages of Breastfeeding

• Breastfeeding is the most appropriate

way of providing ideal food for the
healthy growth and development of
infants.

• Infants should be exclusively breastfed

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for the first six months of life as the way

of providing ideal food to achieve optimal
growth, development and health (WHO).
 Advantages of Breastfeeding
Health Benefits- It protects against infections,
particularly diarrhea, respiratory and ear
infections even after breastfeeding has stopped.

• Reduction of maternal bleeding after delivery by

helping the uterus to contract
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• Birth spacing – When a mother is exclusively

breastfeeding her baby, lactation amenorrhea
method (LAM) may be considered a natural
method for birth spacing
 Advantages of Breastfeeding
Health Benefits
• easier to care for
• less burden on the health care system (children
less likely to be ill)
• promotion of bonding between mother and baby
with psychosocial development of the child
• reduction of the risk of some cancers (breast
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and ovarian cancers) in the mother

• reduced risk of obesity and cardiovascular
disease
 Advantages of Breastfeeding

• Food security- Breastfeeding being

nutritionally perfect provides all the energy,
nutrients and fluid required in the first six
months of life. Food security is ensured for the
infant without dependence on supplies (breast
milk substitutes, cups, cooking utensils).
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• Food safety- Breast milk is clean, safe, at the

right temperature and easily digestible.
 Components of Effective
Breastfeeding

• Good attachment and positioning

• Age appropriate

• Adequate milk production

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• Milk flow and confidence

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Good and poor attachment

 Four key points of attachment

• More areola above baby‟s top lip than

below bottom lip

• Baby‟s mouth wide open

• Lower lip turned outwards

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• Baby‟s chin touches breast

 Good positioning

• Baby‟s face and body

are in a straight line.
• Baby‟s body is facing
and close to the mother
• The mother is
supporting the head and
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the neck of the baby

• Baby approaches the
breast, nose to nipple.
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SESSION 4.2

Feeding Infants and Young

Children in Emergencies
 Best way to feed infants and
young children

Infants from zero up to six months (120

days) of age
• Babies should start breastfeeding within an hour
of birth.
• Babies should breastfeed exclusively and on
demand for six months.
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Exclusive breastfeeding means that a baby is

given only breast milk (which can be expressed
if necessary) but no other foods or drinks, not
even water. BUT medicines and vitamin drops
are allowed, if medically necessary and are not
diluted.
 Best way to feed infants and
young children

Children 6-24 months of age

• Continue breastfeeding with complementary
feeding until children are at least two years old
or beyond. Frequency and the length of
breastfeeding should not be reduced.
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• Complementary feeding is the provision of

additional foods and liquids in addition to breast
milk for infants from 6 months of age onwards.
It complements breastfeeding rather than
replaces it.
 Complementary Feeding
• Complementary foods should be nutritionally
adequate, safe/hygienically prepared, easy to
eat and digest, given to infant in a caring
manner, and introduced at 6th month of life
onwards.
• Preparation and giving of complementary foods
should be the responsibility of the family even
in evacuation centers or camps.
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• Caregivers should have a secure and

uninterrupted access to appropriate ingredients
with which to prepare and feed nutrient-dense
complementary foods.
 Complementary Feeding
• When available, food aid in the form of blended
foods (like corn soya blend or fortified infant
cereals) especially with essential nutrients may
be used provided the child‟s caregiver is
informed on its proper use.
• Samples of complementary foods are thick
porridge or “lugaw” with fish or meat flakes.
These can be given
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- 2-3 X a day at the age of 6-8 months

- 3-4 X a day at the age of 9-24 months
plus 1-2 snacks a day as desired such as
bread or biscuits spread with margarine or
peanut butter and fresh fruits.
 Best way to feed infants and
young children

Non-breastfed children
• need more frequent meals.
• should receive 4-6 cups of water each
day, animal source foods like fish, iron
rich or fortified foods or supplements, 1-
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2 cups milk per day and extra 1-2 meals

per day.
 Promoting, protecting and
supporting IYCF-E

The Milk Code in the Philippines or E.O. 51 as

well as AO 2007-0017 (Guidelines on
acceptance and processing of donations during
emergencies and disasters) provide that:
• There should be no donation of products
covered by the law
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• Donation of products, equipments, and the like

not otherwise falling within the Scope of the
Milk Code, whether in kind or in cash should be
coursed through the Interagency Committee,
which shall determine whether such donation be
accepted or otherwise.
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SESSION 4.3

Practical Interventions
Supporting IYCF-E
 Assessment of IYCF Needs
and Practices

Profiling of the population affected in terms of:

• Number of women of reproductive age
• Number of pregnant and lactating women
• Number of infants and young children 0-24
months
• Number of infants not exclusively breastfed
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• Number of infants 6 months and older who are

not receiving complementary feeding
• Extent of practice of proper complementary
feeding
 IYCF-E Assessment
• Predominant feeding practices which may
include the feeding practices before the
emergency and any changes when in the
evacuation or relocation camp
• Noticeable availability of BMS, milk products,
bottles and teats.
• Reported feeding problems of infants and young
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children
• Observed and pre-emergency approaches to
feeding orphaned infants
• Previously identified underweight preschool
children (wasted and stunted)
 IYCF-E Assessment
• Determining the presence of other risk factors
(e.g. child-headed households, orphan-hosting
households), elderly – headed households
(caring for grandchildren), households caring
for chronically sick members, high prevalence of
HIV further worsened by the foregoing risk-
situations.
• Assessment of food security status
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• Extent of diarrhea and acute respiratory tract

infections among preschool children
• Child mortality
• Security risks to women and children
 Interventions supporting IYCF-E

• General Interventions

• Supportive Care for Women

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• Skilled Support to Individuals

 General Interventions
• Recognition of vulnerable groups (ensure
demographic breakdown at registration of
children under two years with specific age
categories)

• Registration of newborns (establish registration

of newborns within two weeks of delivery)
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• Shelter and privacy (In the case of refugees and

displaced populations, ensure rest areas in
transit and establish, culturally appropriate,
secluded areas for breastfeeding)
 General Interventions

• Ensure easy and secure access for

caregivers to water and sanitation
facilities, food and non-food items.

• Meeting the nutritional need of the

general population ( If the population is
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dependent on food aid, micronutrient

fortified foods should be included in
ration for older infants and young
children)
 Supportive Care for Women
Well-nourished mothers need 500 kcal/day which
is equivalent to
• 1 ½ cups rice or 3 rice equivalents
• 2 matchbox-sized meat
• fish or poultry
• ½ cup cooked green leafy vegetables
• 1 tsp sugar and
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• 1 tsp oil
Malnourished mother need 675 kcal/day - the
addition of 1 cup of whole milk to the above
food plan will meet the recommended content
of energy.
 Supportive care for women
• Provide micronutrients especially Vitamin A, B
complex, Vitamin C and Iodine
• Support to malnourished mothers
• Dehydration in mothers:
- Drinking water needs to be freely available
to breastfeeding mothers even if supplies
are limited.
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• Supportive maternity services:

- Women may seek assistance of
community health workers.
- The Mother Baby Friendly Hospital
Initiative (BFHI) should be applied to maternity
services in emergency settings
 Supportive care for women
Appropriate health services
• Encourage optimal IYCF that is age-appropriate
• Recognize mothers and infants with feeding
problems.
• Mothers may have difficulties with breastfeeding
such as lack of time to breastfeed, loss of
confidence and may doubt the inadequacy of
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breast milk due to myths, may be socially

isolated or depressed or may not want to
breastfeed in public (when in evacuation
centers).
 Supportive care for women
There is a need to create a supportive
breastfeeding environment by observing
the following:
• Reduce isolation
• Educate family and community members
• Remove conflicting messages
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• Make breastfeeding corner – for privacy/

area where mothers can meet / get
additional breastfeeding support.
 Supportive care for women

• Provide personal attention and

counseling by listening and building
confidence of breastfeeding mothers.

• Ensure that pregnant and nursing

mothers get basic support. A
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breastfeeding support group or trained

health service providers can provide
appropriate counseling to the lactating
mothers
 Supportive care for women
A mother may be supported to re-lactate and help
her rebuild a milk supply very successfully. The
following steps can be done to stimulate milk
production.
• Putting baby to breast to suckle at each feeding
and for comfort between feedings as often as
possible.
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• Using hand expression.

• Encourage more skin-to-skin contact of mother
and baby.
• Avoiding the use of bottles, teats and pacifiers.
 Some common misconceptions on
breastfeeding during emergencies
• “STRESS MAKES THE MILK DRY UP”
• MALNOURISHED MOTHERS CANNOT
BREASTFEED
• “ONCE BREASTFEEDING HAS STOPPED, IT
CANNOT BE RESUMED”
• “IF THE MOTHER IS STRESSED, SHE WILL PASS
THE TENSION ON TO THE BABY”.
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• “BABIES WITH DIARRHEA NEED WATER OR

TEA”
• WOMEN FORMULA-FED HERE BEFORE THE
CRISIS & „KNOW HOW TO DO IT‟ (WE ARE
„DEVELOPED‟ AND ONLY FORMULA FEED)
 Support to a feeding child
• Keep the mother and baby together

• If the baby can suckle, encourage the mother to

continue or increase breastfeeding. If the child
cannot suckle, show the mother how to express
milk by hand to maintain production and keep
the breasts healthy.
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• When the child is ready for naso-gastric feeds,

feed the expressed breast milk by tube, syringe
or dropper but under supervision of health staff
 Support to a feeding child
• If the mother is feeding expressed breast milk
at home, teach her how to give it by cup
• If ORS is given, give by cup and spoon, never a
feeding bottle.
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 Promoting breastfeeding
during maternal illness

• Treat the mother

• Keep the mother and infant together if possible

and encourage the mother to continue
breastfeeding
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• Seek a relative or other person who can help to

care for the infant, and bring him/her to the
mother for breastfeeds.
 Promoting breastfeeding
during maternal illness

• If mother cannot breastfeed, she can hand

express to keep the milk flowing and the
breasts in good condition.

• If the mother is too weak to express her milk,

ask if you or another person can express the
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milk for her.

• Help the mother to increase her milk production

as she recovers.
 • Consider other infant feeding options like :
Wet nursing- breastfeeding by another
woman who is not her biological child
Milk banking- providing for a place for
collection and storage of human milk for
dispensing to those who require it such as
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infant whose mother‟s milk is unavailable.

Milk expressed from mother‟s breast or from
another healthy mother
 Hand expression of breast milk
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 Support for HIV positive mothers
• The first main recommendation is that HIV
positive mothers who are breastfeeding should
receive antiretroviral drugs (ARVs) throughout
the period of time the baby is breastfeeding and
until one week after all breastfeeding has
stopped.
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• The second recommendation is that HIV positive

mothers who breastfeed should exclusively
breastfeed their infants for the first six months
of life, introduce complementary foods
thereafter, and continue breastfeeding for the
first 12 months of age.
 Support for HIV positive mothers
• The third recommendation is that, if the mother
decides to stop breastfeeding, she should do it
gradually within one month.

• If infants and young children are known to be

HIV-infected, mothers are strongly encouraged
to exclusively breastfeed for the first six months
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of life and continue breastfeeding as per

recommendations for the general population
that is up to two years and beyond. These
babies should be started all along to lifelong
antiretroviral treatment as soon as possible.
 HIV-infected mothers should only give
commercial infant formula milk as a
replacement feed to their HIV-negative infants
or infants who are of unknown HIV status, when
specific conditions are met:

• Safe water and sanitation are assured at household level and in

the community
• The mother or other care giver can reliably provide sufficient
infant formula milk to support normal growth and development
• The mother or caregiver can prepare it cleanly and frequently
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enough so that it is safe and carries a low risk of diarrhea and

malnutrition.
• The mother or caregiver can in the first 6 months, exclusively
give infant formula milk.
• The family is supportive of this practice.
• The mother or caregiver can access health care that offers
comprehensive child health services.
 Skilled support to individual
mothers

Assessment of need for individual mothers

• Assess what help is required on an individual
level.
• The aim is to decide whether the baby is at
immediate risk or inadequate feeding and
should be referred for full assessment, or the
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baby is not at immediate risk and the mother

needs only supportive care.
Basic aid and further help for breastfeeding
• Teaching mothers how to express breast milk
by hand.
 Hand expression of breast milk
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 Kangaroo Mother Care Technique
• Kangaroo Mother Care is a technique of holding
an infant in continuous skin-to-skin contact with
the mother. This is useful particularly for care of
low birth weight babies
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 Reducing dangers related
with artificial feeding

In order to reduce the dangers associated with

artificial feeding, caregivers should know:

• What breast milk substitute (BMS) to give

• How much and how often to feed BMS
• How to keep feeding utensils clean and safe
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• How to prepare the feeds

• How to give the feeds
 Issues in artificial feeding
• Estimating requirements for infant formula

• Other supplies - safe and secure water source,

preparation area, clean surface, heat source,
preparation equipment, storage area and
feeding utensils.
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• Staffing – adequate numbers of capable and

trained skilled staff who will demonstrate proper
preparation and cup feeding
 Issues in artificial feeding
• Transportation and storage

• Availability of artificial feeds – may require

careful targeting and follow-up to protect them
as much as possible.

• Breast milk substitutes and the health care

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system – In accordance with the Milk Code and

it IRR, there must be no donations of BMS to
the health care system.
 Key Messages
• During emergencies, child mortality can soar
from 2 to 70 times higher than the average.

• Supply of potable water should be ensured.

Bottles and teats are hard to sterilize with lack
of water, fuel, equipment, etc.
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• Inappropriate infant and young child feeding

increases the risk of disease, malnutrition and
infections.
 Key Messages
• Exclusive breastfeeding means giving a baby
only breast milk, and no other liquids or solids,
not even water. Drops or syrups consisting of
vitamins, mineral supplements or medicines are
permitted.

• When complementary foods are introduced after

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six months, breastfeeding should continue for

up to two years of age or beyond.
 Key Messages
• In emergency situations, the Milk Code is
especially important for controlling donations,
preventing the distribution of unsuitable
products, and preventing companies from using
emergencies to increase market share or for
public relations.
• The current recommendation for HIV positive
mothers continues to promote exclusive
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breastfeeding and complementary feeding with

continued breastfeeding but now ARVs should
be given. Gradual cessation of breastfeeding is
recommended rather than stopping abruptly as
was previously recommended.
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THANK YOU!