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Infant and young child feeding

  • Page updated onMarch 21, 2025
Infant and young child feeding
Photo: Bruno Abarca

The nutrition of infants and young children largely determines their health and nutritional status. However, there is limited adherence to the main recommendations for breastfeeding and complementary feeding.

In humanitarian contexts, the challenges of feeding young children are even greater, increasing the risk of acute malnutrition, chronic malnutrition, and infections. Therefore, humanitarian action must help to protect life-saving infant feeding and care practices.

Importance of proper infant and young child feeding

Newborn babies have an innate sucking reflex, which often manifests within minutes after leaving the womb. This allows them immediate access to their first line of defense against the risk of illness and death at their time of greatest vulnerability: breast milk.

It is recommended that breastfeeding be initiated within the first hour after birth and that exclusive breastfeeding be practiced for the first 6 months of life (without introducing additional liquids or foods). From that point on, the nutrient needs of children increase. Therefore, it is recommended that starting at six months of age, alongside breast milk (which should continue for at least two years), complementary feeding be gradually introduced.

Breastfeeding protects the lives of infants from the moment they are born

Breast milk is the best possible food and hydration for young children. Therefore, it is crucial for nutrition and physical and cognitive child development. It should always be done on demand, paying attention to the child’s needs, and offering the breast whenever they show hunger.

During the first days of the baby's life, breast milk is known as colostrum and is especially rich in nutrients. Over time, breast milk adapts its composition to always contain the right proportions of fats, proteins, carbohydrates, vitamins, minerals, and water that the baby needs.

Additionally, the live cells, microorganisms, and bioactive factors found in breast milk have a positive effect on the baby's innate immunity that no formula can replicate. Thus, breast milk strengthens the newborn's chemical barriers in the intestines against pathogens, helps compensate for the immaturity of epithelial cells and macrophages, contributes to establishing gut microbiota and its symbiosis with the host, and allows for the recognition and inactivation of pathogens. Furthermore, it helps control the inflammation that all these effects could produce. Moreover, there are other protective effects of breast milk that we still do not fully understand, such as the possible contribution of the stem cells it contains to the regeneration of the tissues and the infant's immune system. Thanks to all this, breast milk reduces morbidity and mortality from diarrheal infections and respiratory infections.

Breastfeeding also has important positive effects on mothers who practice it: it reduces the risk of ovarian and breast cancer, facilitates spacing between pregnancies, helps with the loss of weight gained during pregnancy, and reduces the risk of diabetes, among other benefits.

Breastfeeding and complementary feeding should be continued after 6 months of age

At 6 months of age, the nutritional demand of children increases. Therefore, breastfeeding should continue while introducing new foods. During this period, there is an increased risk of wasting and stunting if complementary feeding is inadequate. Additionally, this stage will be crucial for their development, as it is when future eating habits begin to be established.

Complementary feeding should be based on a diversified diet with products of different flavors and textures from all food groups. These include breast milk; cereals, roots, tubers, and bananas; legumes, nuts, and seeds; dairy products; meats; eggs; fruits and vegetables rich in vitamin A; and other fruits and vegetables. Thus, every day, breast milk should be combined with at least four other different groups. The introduction of foods should be gradual, offering healthy and nutritious food. Additionally, it should be left to the child to decide how much to eat, promoting autonomy and self-regulation, without forcing or distracting them to eat.

It is especially important that the diet includes daily consumption of fruits, vegetables, and animal products such as meat, fish, and eggs. Frequent consumption of legumes, seeds, and nuts is also essential, especially if vegetables and animal products are scarce in the diet, and always in a format that poses no choking risk. Starchy staple foods (potatoes, white bread, pasta, white rice, corn, etc.), although very common, should be minimized. They lack proteins and important micronutrients such as iron, zinc, or vitamin B12. Dairy products should also be part of the diet, although the best option is breast milk. Conversely, foods high in sugar, sweeteners, salt, and trans fats should be avoided.

Infant and young child feeding is globally deficient

Millions of young children are not getting the food they should be getting

Although the benefits of breastfeeding are well-documented, its actual practice is far from recommended. For example, waiting more than one hour to initiate breastfeeding increases mortality by 30% in the first 28 days of life, and waiting more than one day doubles the risk of mortality. However, only 48% of newborns practice early initiation of breastfeeding. Similarly, only 44% of these children receive exclusive breastfeeding during their first 6 months of life. The other 56% either do not practice breastfeeding or introduce other foods or liquids (such as water or formula milk). Finally, only 59% of children continue to receive some breast milk between 12 and 24 months of age.

Complementary feeding is also far from the recommended practices. Only 34% of children aged 6 to 23 months have a diet with the minimum recommended diversity of 5 food groups per day. Similarly, only one in two children in this age group receives complementary feeding at least 4 times a day. Overall, it is estimated that only 21% follow a minimally acceptable diet.

Infant and young child feeding
UNICEF, 2024

Infant and young child feeding problems have serious consequences

When the feeding of infants and young children is inadequate, they cannot meet their nutritional needs. As a result, their risk of malnutrition increases, including acute malnutrition, micronutrient deficiencies, and stunting. Furthermore, these children are much more vulnerable to infections. It is estimated that the low practice of breastfeeding causes 420,000 child deaths each year due to diarrhea and pneumonia.

The consequences, however, go far beyond this, also affecting maternal health and the economy of the most vulnerable families. The lack of breastfeeding is also attributed to more than 90,000 maternal deaths from type 2 diabetes and cancer, over 4.5 million annual cases of childhood obesity, the loss of up to 5% (Latin America) or 23% (Sub-Saharan Africa) of the income for families purchasing formula milk, and over $500 billion in global economic losses due to cognitive delays, mortality, and healthcare costs.

How to promote breastfeeding?

Breastfeeding promotion is critical to improving overall infant and young child feeding practices. It is not only about initiating breastfeeding, but also about making it a positive experience that feeds back. 

Promoting exclusive breastfeeding and its continuation is a public health priority

When breastfeeding is a positive experience, its practice reinforces itself. Similarly, when it is not established or carried out correctly, its practice becomes increasingly difficult. For example, when exclusive breastfeeding is replaced by formula milk or accompanied by the premature introduction of other foods or liquids, several negative effects occur. First, the use of these other foods results in a lower intake of breast milk, which is much more nutritious and has more protective effects than any other alternative. Additionally, the baby's demand for breast milk decreases, along with the sucking stimulus, and ultimately, milk production diminishes. Without support, mothers facing this situation may be forced to rely entirely on the substitutes for breast milk that initiated the problem.

Promoting breastfeeding involves more than just explaining its benefits. It is essential to ensure that choosing breastfeeding is perceived as the most advantageous, convenient, and easy option for mothers, who are the ones that must make and continue this decision. It should also be regarded as the best option by their partners and families, who need to support the mothers. Therefore, it is necessary to approach this objective from health centers and hospitals, but also from the community and public health policies, always considering gender equity.

Promotion of breastfeeding from the health services

The information that mothers, their families, and their communities have about breastfeeding will largely determine the decisions they make regarding the nutrition and care of their future children. Therefore, the promotion of breastfeeding should begin as soon as pregnancy is confirmed and continue through childbirth and the postpartum period.

Prenatal follow-up visits are a key opportunity. They can be complemented by additional activities such as "courses" on childbirth preparation and newborn care. The information offered during this period should cover the importance and benefits of breastfeeding for the health of the baby and the mother and the family economy. It should also address techniques and skills for successful breastfeeding, the challenges and difficulties that may appear, how to overcome them, and the support services available to make breastfeeding a positive experience.

The moment of childbirth is also fundamental. Generally, a little help is enough for a newborn to initiate breastfeeding in the first hour of life with ease. From that moment on, it will be the baby’s own sucking that stimulates the release of maternal prolactin and the immediate production of milk. Therefore, it is important to place the baby on the mother with skin-to-skin contact. This also fosters a wonderful emotional bond, proper temperature regulation, and the transfer of protective bacteria to the newborn. Alongside this, the mother should be guided and given additional advice for a good latch, recommended to breastfeed exclusively on demand, informed about the risks of using bottles, and kept with the baby in the same room. Health institutions should have appropriate policies and trained staff to ensure compliance with all these measures.

Promotion of breastfeeding in the community

After discharge and throughout the duration of breastfeeding, mothers, their partners, and families should be able to access some form of additional support to address any questions that may arise over time. This also helps to clarify rumors or contradictory messages they receive from other sources of information.

The creation of support groups and networks among mothers and families going through a similar life stage can be very helpful in identifying and properly overcoming difficulties. Examples of difficulties include the self-perception of producing insufficient milk or of insufficient quality, or the incorrect interpretation of normal baby behaviors as signs of a problem. Some issues, which are easy to prevent or address, often lead to the introduction of supplements or artificial formulas, and to the premature and definitive cessation of breastfeeding and its benefits.

Promotion of breastfeeding through public policies

The approach to promoting breastfeeding cannot be limited to the family and community circle. It makes no sense to promote breastfeeding within the family and healthcare facilities if the workload of the mother or her return to paid work prevents her from maintaining breastfeeding as she would like, or if she continuously receives messages encouraging her to stop breastfeeding through all possible communication channels.

Society is permeated with aggressive messages from the infant formula industry. These companies often violate the International Code of Marketing of Breast-Milk Substitutes (in place since 1981) and exploit the fears of mothers and caregivers. These substitutes impose a significant economic burden on families and do not adequately replace breast milk (which has unique properties that cannot be artificially replicated). However, the companies that market these products have no qualms about distorting information about their benefits while simultaneously creating doubts and distrust towards breast milk in the population. Thus, the infant formula and breast milk substitute industry generates $55 billion in annual profits.

Exposure to formula milk marketing
WHO and UNICEF, 2022.

Governments and authorities must develop and implement gender-sensitive labor and public health policies that promote breastfeeding. These policies should, for example, allow for flexible work schedules that accommodate the care and feeding of infants. They should also facilitate and promote the shared responsibility of partners in this regard, as well as encourage messages consistent with these policies that increase their social acceptability. Furthermore, public policies must regulate the advertising and marketing practices of breast milk substitutes, in line with the International Code and breastfeeding recommendations.

Challenges for infant and young child feeding in emergencies

Breastfeeding more difficult for mothers affected by humanitarian crisis

During humanitarian crises, mothers and caregivers face additional challenges in providing their children with the nutrition they need.

On one hand, as a result of conflicts, climate events, and displacement, mothers who wish to breastfeed their children may find themselves physically, mentally, and emotionally exhausted. In the conditions they live in, there may be no safe spaces for families to care for and play with their young children, nor privacy to breastfeed on demand. Support networks and community structures also break down. As a result, and especially if they are not prioritized in humanitarian assistance, mothers and caregivers may find themselves alone, unsupported, and unable to feed and care for their young children.

On the other hand, during these crises, access to health services, information, and support regarding breastfeeding and infant feeding becomes difficult. This complicates the early initiation of breastfeeding and turns minor difficulties in its practice into insurmountable problems and obstacles.

Unsolicited donations of breastmilk substitutes are a huge risk

It is common for humanitarian emergencies to see unsolicited donations of breast milk substitutes from unethical companies and from well-intentioned but misinformed solidarity actions. These donations contribute to increasing the risks for the feeding of infants and young children by forcing the interruption of breast milk production and creating a total dependence on formula milk.

The negative effects of using formula milk multiply during a humanitarian crisis. Not only does it increase the risk of malnutrition at a time of maximum vulnerability, but it also heightens the danger of disease and death from diarrhea and dehydration, especially when clean water and means to maintain hygiene of the utensils used to prepare and offer formula milk are scarce.

Donations are also not permanent or guaranteed. When donations become scarce or inaccessible, the production of breast milk has already decreased. Therefore, families find themselves without the financial means to acquire a product inferior to breast milk that is extremely expensive, putting their children at risk.

Protecting infant and young child feeding in emergencies

Humanitarian action in emergencies must include actions such as support for assisted childbirth (and the early initiation of breastfeeding), food or cash assistance (with cash or vouchers) to caregivers, and the protection of infants who are exclusively dependent on formula milk. The latter must be done with great care, minimizing the risk of infections and avoiding undermining breastfeeding in other families. Additionally, it is essential to have coordination to monitor and control unsolicited donations of breast milk substitutes. Other humanitarian sectors should also prioritize the needs of mothers and fathers of the youngest children, thereby creating a positive environment for their care and nutrition.

The creation of community spaces to support the feeding of infants and young children (often called Baby-Friendly Spaces or Supportive Spaces for Infant and Young Child Feeding in Emergencies) is also a common priority action. These are safe spaces in displaced or highly vulnerable communities, with exclusive access for pregnant women and mothers of children under 2 years old (occasionally also fathers). They provide psychosocial support and specialized advice on feeding and child care practices, as needed, as well as scheduled activities. These spaces can also offer referrals to other available protection and assistance services for these mothers.

Sometimes it may be necessary to offer multiple micronutrient supplements (that do not displace other foods in the diet). Small-quantity lipid-based nutrient supplements (SQ-LNS) can also be used when there is food insecurity and significant nutritional deficiencies. If families are already consuming foods based on flours and cereals (wheat, corn, or rice), these can be mixed with soy and fortified with micronutrients.

Hunger and malnutrition

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