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Adequate nutrition is one of the major determinants of health. Nutrition is the core for a healthy life; it is supported by intake of proper food, physical and mental care. It has been proved that health and nutrition are interlinked and are directly proportional. Sustained good health is supported through good nutrition. Good nutrition reduces the episodes of diseases; helps the person to attain proper physical growth and support cognitive development. This is applicable for all age groups, whether a baby in mother\'s womb, an infant, a child, adolescent, youth to the geriatric group.

Sustainable nutrition contributes to improving the social, cultural and economic productivity of the country by improving the efficiency of the person in terms of physical work- output and cognitive development. Good nutrition propagates the cycle of good health through generations after generations. It promotes the health of an individual by boosting the immunity system and thus waning the episodes of diseases. The fourth report on \"the world nutrition situation\" of ACC/SCN 2000, focused on the challenges lying in nutrition through intergeneration (Figure 1.1) and the ways to sustain nutrition and reduce malnutrition.

World Health Organization (WHO) considers that underprivileged nutrition is the single most important warning to the health of world\'s people. Poor nutrition makes a person disabled to the different form of physical and mental outcome, thus challenging the economic development and productivity of the country. Poor nutrition increases the health costs and school dropouts, in the inter-generational cycle, it increases the percentage of low birth weight baby, newborn and under 5 child mortality and also maternal mortality. UNICEF states that the foundation of child survival is influenced by good nutrition, undernutrition threats the life of 3 million children and results in different form of physical and mental challenges.

In the Lancet on Child survival series, Jones et al. (2003) showed that in low- income countries different interventions could prevent two-thirds of child deaths. Mortality rate was effectively reduced with the introduction of measles vaccine and oral rehydration solution in dehydrated children with diarrhea.

WHO Child Health Epidemiology Reference Group Bryce et al (2005) showed the proportion of death due to Pneumonia, diarrhea, malaria, measles in under 5 years children and the major causes of neonatal death (Figure 1.2). More than 54% of total child deaths were due to the four communicable disease. Undernutrition is the underlying cause of 53% of all deaths in under 5 years children.

In WHO Global Health Observatory (GHO) data on under 5 mortality figured that globally 5.9 million children died in 2015, almost 16000 every day, 11 per minute. Liu et al (2016) showed that of the 5.9 million deaths, almost half (2.7 million) occurred in the first 28 days of life. Leading causes were preterm birth complications (1.055 million), followed by pneumonia (0.921 million), intrapartum-related events (0.691 million). Pneumonia was the leading cause of maximum under-5 deaths in sub-Saharan Africa and pre-term birth complications in southern Asia. Reduction in mortality rates of pneumonia, diarrhea, and intrapartum-related events, malaria and measles reduced the Under 5 mortality by 61% (35 per 1000 live birth in 2000-15). Countries were advised to prioritize child survival policy and programs based on their child cause of death composition.

Bryce et al (2005) showed the leading cause of under-five death in WHO region (Figure 1.3). Black et al (2003) stated that in poor countries each year more than 10 million children die each year due to preventable causes. 50% under 5 mortality are from six countries and 90% in 42 other countries. The causes of the mortality also differ from country to country showing the need to understand child health epidemiology and importance of association of undernutrition with infectious diseases.   

Ahmad et al (2000) in a WHO bulletin stated that under 5 children in developing

countries are ten times more likely to die than the children in developed countries. Of the eight countries in Southern Asia India is one with billion plus population and has the second largest population of children along with Bangladesh and Pakistan.  Child mortality target as per MDG 4 is yet to achieve in India. UNICEF (2004) in the Child Progress Report of South Asian countries figured out that the annual rate of reduction of under 5 mortality should be accelerated by 6% rather than the present rate of 5.2%. In a printed media of India “The Indian Express” (2015), Dr. Ajay Khera Deputy Commissioner, Child Health Programme, Ministry of Health and Family Affairs stated that India has fallen short to achieve the target of under-five child mortality of 42 per 1000 per live births by 2015.

In Daily news bulletin of NIHFW, it was stated that India has the highest number of child deaths in the world, with an estimated 1.2 million deaths in 2015, i.e. 20 percent of the 5.9 million global deaths. Black et al (2010) in the lancet on children mortality highlighted that 43% (274.4 million /634.2 million) of under 5 children worldwide reside in five countries – India, Nigeria, the Democratic Republic of the Congo, Pakistan, and China. These countries bear \"high proportions of neonatal death due to birth asphyxia, sepsis, preterm birth complications and congenital abnormalities\". 52% death due to pneumonia, 51% of deaths due to diarrhea occurred in these five countries.

In Chhattisgarh, the under 5 mortality rate (U5MR) is 64 per 1000 live birth as per Annual Health Survey (AHS) (2012-13), whereas in Raipur the mortality rate of under 5 for urban was 48 per thousand live births. As per NFHS 4 (2015-16), the under 5mortality of the state is 64 per thousand live births, the trend shows that there has been a consistent reduction in the mortality rate of under five children in comparison to under five mortality rate data of NFHS 3.

Global Nutrition Targets:

WHO –Global Nutrition  Targets for 2025 ( figure 1.4) to improve infant and young child feeding has been set to improve the nutritional status of the children which in turn will help in the development of a healthy nation, upgrade economy of the country and maintain a healthy life cycle.

(Census of India, 2010-11) India is the second most populous country in the world. 39% of the total population represents children (0-18 years) of the country.  Of these, 29% constitute 0-5 year\'s children. The figure 1.5 shows that larger number of about 29 percent constitutes 0-5 years of children.  

The health of the child is influenced by certain determinants. Figure 1.6 shows Major determinants influencing the nutrition and health of the children. These determinants are interlinked. Certain determinants can be controlled and can give a better health. Factors related to nutrition also play as major determinants in influencing the health of the individual. Nutrition indicators like access to and distribution of food, dietary patterns, diversity of food available and home production, Food safety and foodborne illness hazards.

 (Black et al 2003; Houweling et al 2005) stated that the economy of the country influences the health outcome of under five children. They have shown the association of the different characteristic of the country like socio-economic, political etc. influences the under-five mortality. Higher national income countries have the lowest number of under-five mortality rate. (Chen et al 2002) stated that very few researches had been carried out on the effects of socio-economic status (SES) in childhood. SES has an indirect relation with the childhood health risks.

UNICEF states that the first five years of life are vital. These are the years of holistic development that shapes children\'s future health, somatic growth, cognitive development and learning achievement. McGregor et al (2007), stated in Lancet that under 5 children in developing countries are exposed to multiple risks, the interdependent domains of children\'s development are not only dependent on socio-emotional but also on cognitive and sensory-motor. First, five years of life are vital in a person\'s life, proper care during this period is important for proper development of child\'s brain. (Wachs, 2000) Development of children is predominantly influenced by psychosocial and biological factors. Researchers show that the newborn is born with almost all the neurons it will have in a lifetime. (Stuart and Stevenson, 1950) the brain of a newborn is 25% of its adult size, although the body weight of a newborn is only 5% as of adult weight. (Chudler, 2016) the first 3 years are really crucial as the brain grow 80% of the adult size within the first 2 years of life and 700 new neural connections are produced every second (0-3, early connections). 90% brain development is accomplished by the age of 5years, by three years a child\'s brain has 3 quadrillion connections, a four year\'s brain is twice as active like an adult. Due to this rapid development of both brain and body a constant energy is on demand, this can only be fulfilled if the child is provided proper feeding care.60% of a child\'s metabolic energy is spent on supporting the growth of the brain in contrast to the adult brain using only 25% metabolic energy.

(Gruszfeld and Socha, 2013) showed that nutritional status during pregnancy, lactation period (0-6 months) and during the first 24 months of a child\'s life has an important role in the future health of an individual. Breastfeeding has positive short-term as well as long-term outcomes. Morbidity and mortality chances are reduced in children with poor living conditions and pre-term infants. The long-term effect of breastfeeding is seen on the full growth of the brain and protective effect of type 2 diabetes, blood pressure control, cardiovascular disorders as well as obesity. Nutrients present in the breast milk have shown a positive impact on human health in contrast to same nutrient present in animal milk. For example protein in human milk has shown a positive impact on brain development, Docosahexaenoic acid also showed a good impact on the cognitive function of the children.

Figure 1.7 shows proper nutrition from the womb and at the young age will help to achieve right stature thus attainment of full growth of an individual and this in turn help to improve the economic condition of the country. Diet of the pregnant mother, nursing mother, and the under-five children should consist of both proximate and protective principles of food like carbohydrates, proteins, fats, vitamins, minerals etc. So that body reserve and body function both are maintained well.

(Huelke, 1998) stated that the first year of life is the phase of rapid physical growth, on average 10 inches (25 centimeters) increase in length and triple their birth weights. Body growth not only consists of attaining the full length but also an achievement of proper weight as per age and increase of all organs to their proportion size. (Krogman 1941) after birth the body weight is reduced  by 5 to 8% and again it start to increase from 10th day, since then it increases steadily and (Doyle ,n.d.) showed that by the first five months the weight is double and by end of the first year the weight gain is three times the birthweight. (Graber, 2016), showed that newborn to adolescent age( 10-19 years)  growth takes place in 2 distinct stages – In first phase swift growth take place from birth to 24 months and in second phase growth occurs annually.

At birth, the full-term infant\'s head circumference is 34 cm. The head circumference grows rapidly during the first year i.e. 2 cm monthly in the first 3 months, 3 cm during the last 6 months of the first year. By the age of one year, the head circumference grows by 12 cm. (Wiki Educator)

Proper nutrition of under-five helps to reserve the body fat. Mid-upper arm circumference (MUAC) is about 16 cm by the age of 12 months and till 5 years of age, the MUAC increases by only 1 cm.

Infant and Young Children Feeding:

The convention on the rights of children states that \"every infant and child has the right to good nutrition\". WHO (2016) in their infant and young child feeding fact sheet listed that adequate and safe complementary foods are received by a countable number of children, in many countries dietary diversity and feeding frequency as per age are met in less than a fourth of infants 6-23 months of age. Optimal breastfeeding from 0-23 months can save the life of 800000 under five children every year (Lancet breastfeeding series) and is the most effective intervention to reduce both child morbidity and mortality. Inappropriate infant and young child feeding are linked to long-term impairment of growth, cognitive development, and health. Proper food at right time of age is crucial for catering future provinces of cognitive development, linear growth achievement through proper ossification, maturation through the development of tissues of body organs. The first 1000 days of human life starting from the conception in mother\'s womb to first two years of life is a vital platform in an individual\'s life. (Black et al 2013) ideal breastfeeding timing within sixty minutes of birth, exclusive breastfeeding till 6 months, continued breastfeeding till 2 years along with complementary feeding have the ability to prevent episodes of diarrhea and pneumonia in children of underdeveloped countries and have more chances to survive than the non-breast-fed. The benefit of proper infant and young child not only keeps the child healthy but also to the mother and family. The mother has abundant health benefits whether short term or long term. The economy of the family is not challenged where the child is breastfed.

Decades before various acts and policies are recommended to protect the feeding practice of Infants and Young Children of India and to reduce the rate of malnutrition to achieve the MDG 4 target. Proper food for children is required to curtail the infant mortality rate and under-five mortality rate. In another way to ensure proper nutrition of the children and sustain the health of children. WHO and WHA since decades had been strongly combating against the infant milk substitute promotion in the market and ensure the right food for a child. The Indian Government adopted a National Code for Protection and Promotion of Breastfeeding since 1983. Since 1993, the Department of Women and Child Development implemented the Infant Milk Substitutes, Feeding Bottles, and Infant Foods (Regulation of Production, Supply, and Distribution) Act 1992. Despite Acts and recommendations still there exist lacunae in the feeding practices of infant and young children. Still, a few percentage of the newborn doesn\'t receive the colostrum within the first hour of birth. Many caregivers don\'t practice the proper complementary feeding protocol for children.

World Health Assembly recommendations:

In 55th World Health Assembly, it was endorsed that traditional practice of ‘annaprashan\' celebrated in India after 6 months of exclusive breastfeeding and before initiation of complementary feeding is really of benefit to child health. In 69th World Health Assembly, Geneva, Switzerland guidance was developed on \"ending the inappropriate promotion of foods for infants and young children\". The guidance is basically to end the promotion of inappropriate foods for infant and young child 6 to 36 months of age which occurs through government programs, non- profit organizations and private enterprises. The guidance does not put any restriction on vitamin and mineral food supplements, home fortified edible product such as micronutrient powders and small quantity lipid-based nutrient supplements. Recommendation on policies and programmers which will protect breastfeeding and optimal infant and young child feeding. The programs and policies should ensure that the caregivers, as well as parents, are able to access accurate information to make a right decision.

WHO was congratulated for providing strong evidence-based guidance and recommendation for ending the inappropriate promotion of foods for infants and young children. The guidance is a vital step to protect breastfeeding and healthy diets for infants and young children. (World Obesity Federation, n.d) The diet will be free of added sugars, salts, saturated fat and trans-fatty acids.

The seven recommendation of Guidance are:

Recommendation 1: WHO guiding principle for complementary feeding of breastfed child and non-breast-fed child 6-24 months of age should be promoted based on the WHO Guiding principles for complementary feeding of the breastfed child and the WHO Guiding principles for feeding non-breastfed children 6-24 months of age. Emphasis should be placed on the feeding of suitable, nutrient-rich, home-made and locally available foods and maintain the safety of feeds.

Recommendation 2: breast milk substitutes should not be promoted.

Recommendation 3: Market available food products for infants and young child which are not breast milk substitutes should be promoted when they meet the national, regional, global standards for national dietary guidelines in terms of composition, safety, quality and nutrient levels.

Recommendation 4: the messages used to promote infant and young children food should support optimal feeding practice suggested by WHO. Apart this no other messages which are related to inappropriate messages should be strictly restricted. Messages should include the importance of the timely introduction of complementary foods or appropriate age to introduce complementary food (6 months or 180 days), the importance of continued breastfeeding till two years or beyond. Any representation of images or messages should not be used which in any sense is discouraging breastfeeding, compared to breast milk, suggesting any product\'s nutritive value equivalent to or superior to breast milk. Specifically, approvals from regulatory authorities are required for endorsement of messages.

Recommendation 5: cross-promotion of breast-milk substitute indirectly by means of promotion of foods for infants and young children should be dogged.

Recommendation 6: conflict of interest in health facilities or throughout health systems is bunged for companies that market foods for infants and young children.

Recommendation 7: WHO set of recommendations on marketing of foods and non-alcoholic beverages to children should be implemented with attention. Marketing of foods free from saturated fats, trans fat, free sugar and salt should be of particular attention in the settings where infants and young children gather.

WHO states that in the 69th WHA two resolutions were adopted. \"First was to sketched in response to recently launched UN Decade of Action on Nutrition from 2016 to 2025, urges countries to make tangible policy and financial commitments to improve people\'s diets and report back regularly on those policies and investments\".

The first resolution basically calls on UN bodies to guide and implement national nutrition programs and support monitoring and reporting mechanisms. WHO and FAO was specially requested to work jointly to facilitate countries build up, reinforce and execute their plans and for public accountability commitments open access of database should be maintained.

The second resolution is on enforcing WHO guidance on putting to an end the inappropriate promotion of foods for infants and young children. \"The guidance clarifies that in order to protect, promote and support breastfeeding the marketing of \"follow-up-formula\" and \"growing-up milk\"- targeted for consumption by babies aged 6months to 3 years should be regulated in the same manner as infant formula for 0 to 6 months. This recommendation is in line with the International Code of Marketing of Breast- milk Substitutes adopted by the WHA in 1981\". Milk used as family food is not recorded in the guidance as it is not marketed specifically for the feeding of infants and young children.

Sterken (2016) shared that the 69th WHA has put a strong step to endorse breastfeeding promotion for children aged 0 to 3 years. She stated that infant milk formula containing added flavored and sweetened thus challenging the health of the infants and children putting them at high risk of obesity and obesity-related long-term health hazards.

Gupta (2013) states that breastfeeding practices, in reality, are threatened by the hostile promotion of baby foods. World Health Assembly adopted the International Code of Marketing of Breast Milk Substitute in 1981 keeping in view the decline in global breastfeeding rates and the antagonistic promotion of baby foods.  National legislations were ratified since then in many countries. Infant Milk Substitutes Feeding Bottles, Infant Foods (Regulation of Production, supply, and distribution) Act 1992 and Amendment Act 2003 (IMS Act) was enacted by India. All forms of promotion and advertisements of Infant Milk Substitutes, Feeding Bottles, and Infant Foods are prohibited by the Act. The Act also prohibits in providing any benefits to the health care provider and their associations in terms of sponsorship, gifts, fellowship and any other pecuniary benefits. The latest tool like e-marketing websites is increasingly making aggressive promotion. Baby food companies are risking the health of million infants even after 20 years of law enactment.  To control this adverse situation the Government of India needs to take a quick and strong action and impose the law successfully to end the promotion of unsafe infant and young children food and save the children. This is the stated objective of IMS ACT.

BPNI (2015) states that \"baby food manufacturers are playing with the life of innocent infants by manipulating health care professionals\". This is a serious offense and strict action will be taken against these manufacturers. India has more than 100 million internet users and nearly half of this population are opting online purchase facility. Various portals are there which are marketing the infant and baby foods and feeding bottles and thus are a foretaste of the IMS Act. An Internet search by BPNI was done and was found that e-marketing sites are providing attractive discounts and other promotional techniques like the catchy advertisement, promotions with health claims; free combo offers etc. are used to attract public. Definitely, the sale of these products will increase and violate IMS Act.

All infant and young child products have to meet the standards laid by Prevention of Food Adulteration (PFA) Act, 1954, or the Bureau of Indian Standards (BIS) or specification of central government then only then can be marketed. If any product is found to violating the PFA Act 1954, BIS then the substances may be seized. Imprisonment or Penalty charges for such offensive action will be taken.

International Code of Breastmilk Substitute (BMS):

Some regions of the world are showing a stagnant rate of breastfeeding, even the rates had been found to decline while there was found to be rapid amplifying figures in the sale of infant formula and baby food annually. In 1981 to protect and promote breastfeeding in all countries, UNICEF & WHO developed the International Code as a \"minimum\" standard to ascertain breast milk substitute safely if necessary. (WHO 2013), the code is anticipated to protect all mothers and babies. Contravention of the International Code of Marketing the Breastmilk Substitutes and subsequent pertinent WHA resolutions (34.22) are continuing. After 30 years of endorsement of the International Code, it was found that only 19% countries (37 out of 196) have passed laws reflecting all of the recommendations of the Code. 35% (i.e. sixty-nine countries) fully forbid the advertising of BMS. Free samples or low-cost supplies of BMS were ruled out in 31% countries (62 countries), 64 countries i.e. 32% forbid gifts and sponsorships from the relevant manufacturer of BMS to health workers. Only 23% countries reported having a proper implementation and monitoring system. The International Code of BMS and WHA resolutions remain the key instrument to protect the breastfeeding of children globally as well as to improve the health of both the mother and child.

The National Nutrition Policy (NNP) of India:

The Department of Women and Child Development in 1993 developed the National Nutrition Policy adopted by GOI put an emphasis on nutrition and health education strengthening and promotion. Strengthening the nutrition and health education of mothers on feeding their younger ones based on IYCF guidelines. The effort should be to bring about positive changes in the behavior of the mother and reduce the number of malnourished children under direct interventions. NNP direct intervention also aims to control micronutrient deficiencies among the vulnerable group. The policy also focuses on strengthening the production of low-cost foods which are locally available and popularize them also. Fortification of food with appropriate nutrient should be ventured. Growth monitoring should be improved with close involvement of mothers. The indirect long-term intervention of NNP which also help in sustainable nutrition of children are food security, improvement of dietary patterns through demonstration and production, monitoring of nutrition programmes , imparting basic health and nutrition knowledge.

National guidelines on infant and young child feeding:

Late Arjun Singh, the then Minister for Human Resource Development shared his view that to protect child feeding practices various arms of Government like health and family welfare, education and women and child development infrastructures, training institutions for nutrition, health and family welfare, home science and medical faculties, professional associations and social organizations will utilize the National Guideline for infants and young children to protect promote and support appropriate feeding. In 2004 the Ministry of Women and Child Development (Food and Nutrition Board) formulated the first National Guidelines on Infant and Young Child Feeding (IYCF) and was revised in 2006. The Guideline is to protect the nutritional status of children through early initiation of breastfeeding within 1 hour of birth, confirming exclusive breastfeeding for the baby till 6 months of age, introducing complementary food at 180 days along with continued breastfeeding till 2 years of age. Counseling on breastfeeding should be done when the mother is in her last trimester. Mothers and her family should be made aware about the timely introduction of complementary feeding, make them understand what to feed and how to feed. How to make homemade instant mixes.

Five Year Plans:

Five Year Plans are formulated by the Planning Commission to strengthen the various components of health, education, nutrition etc. and in turn, benefit the population of India. The First Plan was formulated in 1951, at present for the 2012-17 the Twelfth Plan is focusing on preventive health care along with curative health care. Convergence of various schemes of Ministries related to proper nutrition, safe drinking water, sanitation and child care is required. The focus on the health of the population had been an area of priority since the fourth five-year plans. The Fifth five-year plan adopted the National Policy for Children (1974) and launched the Integrated Child Development Services (ICDS).To improve the health of population various initiatives to improve the nutrition status of the population were implemented. Nutrition gained the highest priority and attention in the 11th Five Year Plans. (Planning Commission, 2012) In the 11th Five Year Plans the target of IMR to reduce to 28/1000live birth is yet to reach. Apart this the 11th Five Year Plan targeted to provide clean drinking water for all by 2009, reduce malnutrition by half the present value among 0-3 years. Progress has been seen in all areas but it is not up to the target. The vision for 12th Five Year Plan is to attain nutrition security for more vulnerable infant and young children.  The monitorable targets of the plan are – underweight among under 5 children should be reduced to 25%, improving early breastfeeding, exclusive breastfeeding and timely initiation of complementary food by 50% of current level.


National Policy for children-  

 National Charter for Children (2013) Stated that in 1974 the National Policy for Children was implemented to make a space for the programmes related to children in national plans for development of human resources, so that all children of the country should grow up as an able and empowered citizen, with full physical growth attainment and mental development, morally healthy, gifted with the societal motivation and skills. The policy also put importance on equal opportunities for development of all children during the growth phase of life that is should attain the full growth spurt. \"The National Charter for Children, 2003 which was adopted on 9th February 2004, underlined the intent to secure for every child its inherent right to be a child and enjoy a healthy and happy childhood, to address the root causes that negate the healthy growth and development of children, and to awaken the conscience of the community in the wider societal context to protect children from all forms of abuse, while strengthening the family, society and the Nation\". The policy also states that survival, health, and nutrition are an immutable right of every child and should be given high priority. It also states that children have \"right to adequate nutrition and to be safeguarded against hunger, deprivation, and malnutrition\".

Breast feeding status:

World Breastfeeding Trends Initiative (WBTi) is a pioneering initiative evolved by International Baby Food Action Network (IFBAN) Asia to track, assess and monitor the Global Strategy for IYCF. IFBAN does this tracking assessing and monitoring through web-based toolkit. IFBAN also coin out the gap in country\'s policies and plan for programs on IYCF. IFBAB report showed that only 8 million out of 26 million newborns born are breastfed within an hour of birth. India ranked 31 out of 51 countries of world surveyed by WBTi. Report on breastfeeding practices from 2008 -2012 of India it was found that 46% of newborns in India were only breastfed in the first 24hours of birth. While the percentage was satisfactory in neighboring countries like Sri Lanka, Bangladesh, and Afghanistan.

With huge development to stride in the newborn and child health care and facility-based delivery, India is still running slow to achieve the number of children who were breastfed within the first hour of birth. Raja (2016), shared that India ranks lowest among the South Asian countries. It was seen that only 44% women were able to breastfeed their child within the first hour of birth in India, Sri Lanka, Bangladesh, and Afghanistan. India is still lying at a long distance to reach its target to meet the objectives to strengthen the IYCF.   

The State of World\'s Breastfeeding: India 2005 stated that the then Secretary, Ministry of Women and Child development (MOWCD) Smt. Reva Nayyar shared the Report Card at the Delhi meeting of State Secretaries in charge of WCD.\"The Report Card shows that India stands at YELLOW on a range of four colors- Green-Blue-Yellow-Reds (ranging ‘excellent –good-fair-poor\') and also stated that this is an honest appraisal of India policy and programs on breastfeeding\". The Progress on implementing the Global Strategy for Infant and Young Child feeding made by India was shown in this card. India scored 69.5 out of 160 and ranks YELLOW.


The importance of breastfeeding has been mentioned in Vedas long 2000 years back Hindu Vedic literature and ancient Ayurvedic texts accentuate the significance of breastfeeding in the Hindu society. In verses 8/52:957, 8/46:950 of \"Charak Samhita\" the importance of breastfeeding has been depicted and in \"Kashyap Samhita\" the breastmilk composition has been described in terms of its quality. \"Sushruta Samhita\" describes Breastmilk having great powers to give life and increase the strength of the child. (Laroia & Sharma 2006) states that in today\'s era women are receiving guidance from health care professionals, grandmothers seems to have an important role in influencing the mother on breastfeeding practices.

(WHO 2000) Promoting sound infant and young child feeding practices were influenced by certain innovations:

WHO/UNICEF launched in 1992, the Baby-friendly hospital initiative with a strategy to protect and promote breastfeeding of the health system. Presently this initiative is functioning in 171 countries. The number of hospitals adopting the initiative has increased from 4300 in 1995 to 16000 in 1999.  WHO is involved in the capacity building and advocacy. Piwoz et al. (2003) Innocenti Declaration in one of their operational target ensures that every facility should practice all of the ten steps of successful breastfeeding.

Importance of Breastmilk along with complementary feeding:

• In a Lancet of Global Health (2015) it was stated that accurate breastfeeding practice has the ability to curtail the mortality rate in under 5 children. Rollins et al (2016) shared his opinion that though people are aware of the benefits of breastfeeding still there is a huge gap in the practice of breastfeeding. Breastfeeding is influenced by multifactorial determinants and for effective breastfeeding support is required constantly.  India is a land of many communities; these communities have their own rituals and faiths related to different practices in child rearing. Despite knowing the facts the caregivers are unable to practice the same due to family beliefs and rituals which have been in practice since long era. Proper intervention can help to bring out a responsive breastfeeding. (Victoria et al, 2016) in her research found that children who were breastfed for longer duration are having chances of lower infectious morbidity and mortality, less dental malocclusions and proper cognitive development as compared to those who had been breastfed for a shorter time. He also added that breastmilk act as personalized medicine for children. If during the early years of life the remains any deficit in the growth and development that is not possible to correct by providing supplementation of nutrients in later life so proper nutrition during the five years is crucial.

• Timely introduction of breast milk after birth plays an important role in maintaining the body temperature of newborns and thus prevent hypothermia, timely introduction of breastmilk and continuing the same will help in the development of a strong bond between mother and child. (Prentice,n.d.), stated that human breastmilk is composed of nutritional as well as non-nutritional components that are essential for infant health promotion, growth and development such as antimicrobial factors, digestive enzymes, hormones, tropic factors and growth modulators. Breastmilk has a unique composition. Tiwari (2010) IYCF technical guideline also suggests early initiation of breastmilk and importance of colostrum. The IYCF guideline has stated all the norms related to breastfeeding, even the support from health caregivers to the mothers who will breastfeeding for the first time. The importance of continued breastfeeding and Active feeding has also been explained in the guideline. Along with this the guideline also states the constituents and composition of the complementary feeding along with the age to initiate complementary feeding. Safety measures to be taken during the complementary feeding practice.

WHO (2001) laid certain a guideline on infant and young child feeding practice which have been enlisted below:

•  Exclusive breastfeeding must be practiced for 180 days and then complementary feeding to introduce along with continued breastfeeding till two years or more.

• Responsive feeding is the core of feeding with psycho-social care. Caregivers should understand the importance of psycho-social care and should avoid force feeding.

•  Variations in the diet should be brought about by the inclusion of food from all food groups and usage of locally and seasonally available food. Diet should be made attractive by using colorful vegetables and fruits.

•  Hygiene during feeding, cooking needs to be maintained. This should be maintained from field to finger. Hygiene at every step needs to be maintained.

•  The amount of complementary feeding should be of concern, too diluted food lack nutrient and make the child feel heavy early so they won\'t be able to have enough food. Increasing the amount of food gradually with age is an important part to maintain the growth of child along with other determinants.


•  The consistency of food should be made thicker with an increase in age. Food should be made into mashed soft diet and gradually to chewable soft foods with proceeding age.   

•  A number of times the child is provided meal also has a positive effect on the growth of the child. Breastfed child should get 2-3 meals per day along with breast milk. Minimum 4 times meals should be given. Additional snacks and fruits will be given to child along with meals. Additional numbers of meals and snacks to be given to a non-breastfed child.

•  Vitamin A and Iron rich fruits and vegetables should be provided. Nonvegetarian foods should be included. The egg should be included.

•  Additional feeds should be provided to children during an illness and recovery.


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