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Pediatric Nutrition: Challenges and Approaches to Address Them
Michaelsen KF, Neufeld LM, Prentice AM (eds): Global Landscape of Nutrition Challenges in Infants and Children. Nestlé Nutr Inst Workshop Ser, vol 93, pp 15–24, (DOI: 10.1159/000503353) Nestlé Nutrition Institute, Switzerland/S. Karger AG., Basel, © 2020
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When Does It All Begin: What, When, and How Young Children Are Fed
Margaret E. Bentley · Alison K. Nulty
University of North Carolina, Chapel Hill, NC, USA
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Abstract
The first 2 years of life are a critical period to promote nutrition and dietary behaviors for optimal growth and development. Exclusive breastfeeding is recommended until 6 months with the addition of safe, nutritionally adequate complementary foods thereafter. Caregiver adherence to international guidelines for feeding infants and toddlers varies depending on the setting, access to information, quality of food, and cultural beliefs. Caregiver feeding style also plays an important role in what foods and drinks are offered and whether young children accept those foods. Feeding guidelines often include what is called “responsive feeding,” which is the importance of caregiver attention to child cues of hunger and satiety. While there are data on food consumption and dietary diversity in early childhood, the literature on early childhood beverage consumption is limited. With the increased consumption and availability of sugar-sweetened beverages, future research should aim to understand the status of global beverage consumption among children under 2 years old and its impact on growth and development. This chapter highlights current infant and young child feeding recommendations, what young children eat and drink, and the role that parental feeding styles can have on diet and early childhood outcomes.
2020 Nestlé Nutrition Institute, Switzerland/S. Karger AG, Basel
Introduction
It is well established that the first 1,000 days of life are a critical period of rapid growth and development. During this period, adequate nutrition is required to meet the nutrient needs for proper growth [1]. Yet, malnutrition remains a global concern among children under 5 years of age. Malnutrition includes those who are both over- and underweight – impacting all ages. Globally, almost 240 million children under age 5 are suffering from malnutrition [2]. According to a recent World Health Organization (WHO) report, 45% of deaths in children under age 5 are due to malnutrition [3]. While many malnourished children are stunted or wasted, an increasing number are becoming overweight due to the nutrition transition [4]. The transition is causing a shift in dietary and physical
activity patterns with an increase in consumption of sugars and fat and a decrease in daily physical activity. The transition was initiated by a variety of changes within the economy as well as improvements to technology [5].
This chapter provides a brief review of both global patterns and selective data from India, where the 93rd Nestlé Nutrition Institute Workshop on “Global Landscape of Nutrition Challenges in Children” occurred. It focuses on infant and young child feeding (IYCF) recommendations and global adherence, the importance of caregiver feeding style and its impact on growth and development, and how nutrition interventions and future research can be used to improve current IYCF practices.
Global Infant Young Child Feeding Recommendations
Both the WHO and the United Nations International Children’s Emergency Fund (UNICEF) have published IYCF guidelines to ensure children are receiving adequate nutrition that promotes proper growth and development through childhood. The guidelines recommend that mothers initiate breastfeeding within 1 hour of birth and to breastfeed exclusively for the first 6 months of life [6]. Early initiation and exclusive breastfeeding provide multiple benefits to infants such as decreased risk of infant mortality and increased protection against disease [7]. Victora et al. conducted a review of 28 meta-analyses on the associations between breastfeeding and its corresponding maternal/child outcomes [8]. Results showed breastfed infants had a decreased risk of death, diarrhea, and respiratory infections compared to those who were not breastfed [8].
At 6 months, the WHO and UNICEF recommend introducing nutritionally adequate, safe complementary food while continuing to breastfeed. They specify to begin by introducing iron-rich foods with no specific order thereafter. In low-access settings, fortified foods or vitamin–mineral supplements may be needed [6, 9]. Complementary feeding (CF) should begin with small portions of food that gradually increase as the child develops [6]. Failure to adhere to these recommendations during early childhood has been linked to long-term growth impairment and is directly associated with an increased risk of illness [10].
The WHO also published IYCF recommendations specific to mothers living with HIV. “Mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or beyond while being fully supported for ART adherence” [11]. In special circumstances,
