3.

MATERNAL
AND
CHILD NUTRITION
 2/7

Maternal nutrition during pregnancy

and lactation

Provide correct nutrition

information and counseling
Mothers body needs extra
food than her usual daily
intake
Provide energy and nutrition
for the growing baby
Pregnant = Eat 1 extra small
meal or snack
National policy support: DOH AO 2008-0029 Implementing Health Reforms for Rapid
Reduction of Maternal and Neonatal Mortality
 2/8

Maternal nutrition during pregnancy

and lactation

Lactating = Eat 2 extra

small meals or
snacks
Adolescent mothers
need more food, extra
care and more rest
 2/9

Practice good nutrition during

pregnancy and lactation

Mothers need to eat a variety of locally available

nutritious food each day
Drink plenty of water
Avoid taking tea or coffee with meals
 2/10

Practice good nutrition during

pregnancy and lactation

Take iron and folic acid tablets once a day during

pregnancy and once a week after birth until the
mother gets pregnant again to prevent anemia
(DOH AO No. 2010-0010)
Take vitamin A supplements immediately after
birth or within 1 month after delivery (DOH AO No.
2010-0010)
Encourage consumption of fortified foods
Use iodized salt
National policy support: DOH AO No. 2010-0010 Revised Policy on Micronutrient
Supplementation; RA No. 8172 ASIN Law; RA 8976 Philippine Food Fortification Act of 2000
 2/11

Protecting health during pregnancy

and lactation

Attend antenatal care at least 4 times during

pregnancy
Take plenty of rest
Attend postpartum care/visits
Take deworming tablets to help prevent anemia
To prevent malaria, sleep under an insecticide-
treated mosquito net and take anti-malarial tablets as
prescribed
Know the HIV status; if HIV-infected, consult a health
care provider
 2/12

Mothers Illness and Breastfeeding

With tuberculosis
She and her infant should be treated together according
to national guidelines
Continue breastfeeding
With hepatitis (A, B, or C)
Continue breastfeeding
If a mother is HIV-positive
She needs counselling about different feeding options
and support for her choice
The Importance of Infant
and Young Child
Feeding and
Recommended
Practices
 3/2

Objectives
After completing this session, participants
will be able to:

Discuss the importance of IYCF.

Describe the current status of IYCF.
Discuss recommended practices for IYCF
and the evidence for these
recommendations.
 3/3

Growth, health and development

The first 1,000 days a critical window of
opportunity for ensuring a childs appropriate
growth and development through optimal
feeding

Poor nutrition increases the risk of illness and

death.
 3/4

Growth, health and development

Early nutritional deficits are linked to long-
term impairment in growth and health:

Stunting when malnutrition occurs in the first

two years of life

Impaired intellectual performance and

reduced capacity for physical work in
adults who were malnourished in early
childhood
 3/5

Growth, health and development

Early nutritional deficits are linked to long-
term impairment in growth and health:

Women malnourished as children have

reduced reproductive capacity and higher risk
of complicated deliveries.
 3/6

The Global Strategy for IYCF

Adopted by WHO and
UNICEF in 2002 to
refocus attention on the
impact of feeding
practices on nutritional
status, growth and
development, health and
survival.
 3/7

Global Strategy for IYCF

WHO and UNICEF recommend Exclusive
breastfeeding for the first 180 days (6
months).
An infant receives:
only breast milk from his/her mother or a wet
nurse, or expressed breast milk, AND
no other liquids or solids, not even water,
with the exception of oral rehydration solutions,
drops or syrups consisting of vitamins, mineral
supplements or medicines.
 3/8

Global Strategy for IYCF

WHO and UNICEFs recommendations for
optimal infant feeding:
Nutritionally adequate and safe complementary
feeding from the age of 6 months, WITH
Continued breastfeeding up to 2 years of age or
beyond.
 Recommended
Feeding Practices
 3/18

Evidence for recommended feeding

practices Breastfeeding
Short-term benefits for breastfed infants:

6 10x increase in mortality in the first

months of life among non-breastfed infants
Diarrheal illness more common in artificially-
fed infants
Other acute infections are less common and
less severe in breastfed infants
 3/19

Evidence for recommended feeding

practices Breastfeeding
Long-term benefits for breastfed infants:

Increased risk of long-term diseases with an

immunological basis among artificially-fed infants
Artificial feeding is linked to risks in cardiovascular
health
Obesity in later childhood and adolescence is less
common
Scores of cognitive function 3.2 points higher in
breastfed children
 3/20

Evidence for recommended feeding

practices Breastfeeding

Benefits for mothers:

Decreased risk for:

Postpartum hemorrhage
Breast and ovarian cancer
 3/21

Evidence for recommended feeding practices

Exclusive breastfeeding for 6 months

Benefits for the mother:

Delays return of fertility

Accelerates recovery of pre-pregnancy weight
 3/22

Evidence for recommended feeding practices

Exclusive breastfeeding for 6 months

1980s: evidence of risk of death from

diarrhea
Partially breastfed infants <6 months of
age = 8.6 times the risk for exclusively
breastfed children
Infants who received no breast milk at all =
25 times the risk for exclusively breastfed
children
 3/23

Evidence for recommended feeding practices

Exclusive breastfeeding for 6 months

Exclusive breastfeeding for 6 months reduces

the risk of diarrhea and respiratory illness

Deaths from diarrhea and pneumonia could be

reduced by 1/3 if infants were exclusively
instead of partially breastfed
 3/24

Evidence for recommended feeding practices

Exclusive breastfeeding for 6 months

Healthy infants do not need additional water

during the first 6 months if they are exclusively
breastfed, even in a hot climate.
Extra fluids displace breast milk.
Giving water and tea to infants increases the risk
of diarrhea.
 3/25

Evidence for recommended feeding practices

Complementary feeding from 6 months onward

The period of 6-23 months coincides with the

peak incidence of growth faltering,
micronutrient deficiencies and infectious
illnesses in many countries.
 3/26

Evidence for recommended feeding practices

Complementary feeding from 6 months onward

Breastfeeding benefits even after

complementary foods have been introduced:
Childs 1st year- breast milk provides around
of an infants energy needs
Childs 2nd year- breast milk provides up to
1/3 of a childs energy needs
 3/27

Evidence for recommended feeding practices

Complementary feeding from 6 months onward

Complementary foods need to be:

Nutritionally adequate
Safe
Appropriately fed
 4/1

Session 4

The Physiologic Basis Of

Breastfeeding
 4/2a

Objectives
After completing this session Participants
will be able to:
Name the main parts of the breast and their
functions.
Describe the hormonal control of breast milk
production and ejection.
Discuss the feedback inhibition of lactation.
Explain how babys reflexes help in appropriate
breastfeeding.
Describe the difference between good and poor
attachment of a baby at the breast.
 4/2b

Objectives
After completing this session Participants
will be able to:
Describe the difference between effective and
ineffective suckling.
Discuss the composition of breast milk.
Differentiate the colostrum and mature milk.
Explain the difference between animal milk and
infant formula.
 4/3

Anatomy of the Breast

 4/4

Prolactin
Increases markedly during pregnancy
Stimulates the growth and development of
mammary tissue for milk production
During the first two weeks, the more a baby
suckles and stimulates the nipple, the more
prolactin is produced, and the more milk is
produced.
More prolactin is produced at night
 4/5

Oxytocin Reflex
Induces milk flow
Let-down reflex or milk ejection reflex
Causes contraction of the uterus and helps to
reduce bleeding.
Starts working when a mother expects a feed as
well as when the baby is suckling.
It is inhibited when a mother is in severe pain or
emotionally upset.
 4/6

Feedback Inhibitor of Lactation (FIL)

FIL, a polypeptide present in breast milk, helps control

milk production.

If milk is not removed from a breast, FIL collects and

stops the cells from secreting any more.
If breast milk is removed, FIL is also removed, and
secretion resumes.
 4/7

Reflexes in the Baby

A babys reflexes are important for appropriate
breastfeeding.
Rooting reflex when a babys lip or cheek is
touched, s/he turns to find the stimulus, opens
his/her mouth, and puts his/her tongue forward.
Suckling reflex a baby starts to suck when
something touches his/her palate.
Swallowing reflex a baby swallows when
his/her mouth fills with milk
 4/8

Good Attachment Inside the Infants

Mouth
 4/9

Poor Attachment Inside the Infants

Mouth
 4/10

Good and Poor Attachment External

Signs
 4/11

Causes of Poor Attachment

Use of a feeding bottle
Functional difficulties
Most important causes: mothers inexperience
and lack of skilled help
 4/12

Positioning the Baby for Good Attachment

SITTING LYING DOWN

 4/13

Effective Suckling
Signs of effective suckling:

Baby takes slow, deep suckles followed by a

visible or audible swallow about once per second
Babys cheeks remain rounded during the feed
Suckling usually slows down towards the end of a
feed, with fewer deep suckles and longer pauses
between them
The nipple may look stretched out for a second or
two, but it quickly returns to its resting form.
 4/14

Ineffective Suckling
Signs of Ineffective Suckling:

Suckle quickly all the time, without swallowing

Cheeks may be drawn in as s/he suckles,
The nipple may stay stretched out when baby
stops feeding, look squashed from side to side,
with a pressure line across the tip
 4/15

Consequences of Ineffective Suckling

Breast engorgement, blocked ducts, or even

mastitis
Overstimulation of breast oversupply of milk
Insufficient intake of breast milk
Frustration and refusal of baby to feed
Prolonged suckling that does not sate the baby,
or very frequent feedings
 4/16

Composition of Breast milk

Breast milk contains ALL THE

NUTRIENTS an infant needs in the
first 6 months of life.
 4/17

Composition of Breast milk:

FATS
3.5 g fat / 100 ml of milk
Amount increases as the feed progresses
Foremilk - contains less fat and looks bluish-
grey in color
Hindmilk - is rich in fat and looks creamy
white
Contains long chain PUFAs DHA
(decosahexaenoic acid) and AA (arachidonic
acid) that are important for a childs neurological
development.
 4/18

Composition of Breast milk:

CARBOHYDRATES

Disaccharide lactose
7 g lactose/100 ml milk
Oligosaccharides - provide protection against
infection
 4/19

Composition of Breast milk: PROTEIN

0.9 g protein/100ml milk

Breast milk contains less of the protein casein.
Human milk vs. Animal Milk
Human milk has a lower protein concentration
than animal milks.
Among the whey (or soluble) proteins, human
milk contains more alpha-lactalbumin; cows milk
contains beta-lactoglobulin, to which infants can
become intolerant.
 4/20

Composition of Breast milk: VITAMINS

AND MINERALS
Contains sufficient vitamins for an infant, unless the
mother herself is deficient.
Vitamin D.
Needs exposure to sunlight
Minerals iron and zinc
Low concentration, but high bioavailability and absorption.
Babies are born with sufficient iron stores if maternal iron
status is adequate
Only infants born with low birth weight may need
supplements before 6 months.
 4/21

Composition of Breast milk: ANTI-

INFECTIVE FACTORS

Immunoglobulin A (sIgA)
which coats intestinal mucosa and prevents
bacteria from entering the cells
White blood cells
kill microorganisms;
Whey proteins (lysozyme and lactoferrin)
kill bacteria, viruses and fungi
Oligosaccharides
prevent bacteria from attaching to mucosal surfaces
 4/22

Composition of Breast milk: OTHER

BIOACTIVE FACTORS
Bile-salt stimulated lipase

facilitates complete digestion of fat of milk

Epidermal growth factor

stimulates maturation of lining of infants
intestine
 4/23

Differences Between Colostrum and

Mature Milk
Colostrum
First 2 3 days after delivery
40-50 ml on the first day
Rich in WBC and antibodies, protein, minerals and fat-
soluble vitamins (Vitamin A)
Yellowish in color.

Transitional milk - produced from day 7 to day 14

Mature milk
Produced after 2 weeks
 4/24

Differences Between Animal Milk and

Infant Formula

They do not confer the same anti-infective

properties as breast milk.
Qualitative differences in fat and protein, and
anti-infective and bioactive factors are still
absent.
Powdered milk formula is not a sterile product.
 5/1

Session 5

Complementary Feeding
 5/2

Objectives
After completing this session Participants
will be able to:
Describe the important considerations in
complementary feeding.
Describe good feeding practices:
diet diversification
meal frequency
micronutrient supplementation
handwasing, hygiene, sanitation and water
safety
 5/3

Definition of complementary feeding

Complementary feeding means giving

other foods in addition to breast milk
These other foods are called
complementary foods
 5/4

Complementary feeding

Infants shall be given

appropriate
complementary foods at
age six months in order
to meet their evolving
nutritional requirements
(DOH AO 2005-0014)

National policy support: DOH AO 2005-0014 National Policies on IYCF

 5/5

Considerations in complementary feeding

A = Age of infant/young child

F = Frequency of foods (Meal frequency)
A = Amount of foods
T = Texture (thickness/consistency)
V = Variety of Foods
A = Active or responsive feeding
H = Hygiene
 5/6

1. Age of infant/young child

Consider age of the child during complementary

feeding
Start complementary feeding when the baby can
no longer get enough energy and nutrients from
breast milk alone
Children from different age group have different
nutritional needs
 5/7

Energy required by age and the amount

supplied from breast milk

1000 Energy Gap

800
Energy (kcal/day)

600
Energy from
400 breast milk

200

0
0-2 m 3-5 m 6-8 m 9-11 m 12-23 m
Age (months)
 5/8

When to start complementary feeding

Starting other foods in addition to
breast milk at 6 completed months
helps a child to grow well

At 6 months, babies:
Show interest in food
Like to put things in their
mouth
Can control tongue better
Start to make up and down
munching movements with
their jaws
 5/9

Adding foods too soon

Adding foods too soon may:

take the place of breast milk
result in a low nutrient diet
increase risk of illness
less protective factors
other foods not as clean
difficult to digest foods
increase mothers risk of pregnancy
 5/10

Starting other food too late

Insufficient food requirement

Impaired growth and development
May result in malnutrition and deficiencies
 5/11

Infant and young child age

groups
6 up to 9 months
which is the same as 6 8 or 6 8.9 months
9 up to 12 months
which is the same as 9 11 or 9 11.9 months
12 up to 24 months
which is the same as 12 23 or 12 23.9 months
 5/12

2. Frequency of foods

Meal frequency should be increased as the child

gets older
Appropriate number of feedings depends on:
energy density of the local foods
usual amounts consumed at each feeding
A growing child needs 2-4 meals a day plus 1-
2 snacks if hungry
 5/13

Recommended meal frequency (per day)

Age Frequency per day

At 6 months 2-3 meals plus frequent breastfeeds

From 6 up to 9 2-3 meals plus frequent breastfeeds

months 1-2 snacks may be offered

From 9 up to 12 3-4 meals plus frequent breastfeeds

months 1-2 snacks may be offered

From 12 up to 24 3-4 meals plus frequent breastfeeds

months 1-2 snacks may be offered

Less than 24 months, Add 1-2 extra meals

not breastfed 1-2 snacks may be offered
 5/14

3. Amount of foods
Amount of foods varies from each age group as
the childs total energy requirements also vary
Energy needs from complementary foods = total
energy requirements average breast milk
energy intake
In practice, caregivers will not know:
precise amount of breast milk consumed
energy content of complementary foods offered
Amount should be based on principles of
responsive feeding
 5/15

Recommended amount of food an average

child will usually eat at each meal

Age Amount of food per feed

At 6 months start with 2-3 tablespoons starting with
tastes
From 6 up to 9 2-3 tablespoons; gradually increase to
months of a 250 mL cup/bowl
From 9 up to 12 of a 250 mL cup/bowl
months
From 12 up to 24 to one 250 mL cup/bowl
months
Less than 24 months, Same as above according to age group
not breastfed
 5/16

4. Texture
(thickness/consistency)
Gradually increase food consistency and variety as
the infant gets older
Neuromascular developments of infants dictate
readiness to ingest particular types of foods

Semi-solid or pureed foods at first

Food with some lumps for munching (up and down mandibular
movements)

Food with some lumps for chewing (use of teeth)

Family foods
 5/17

Thick foods

Foods that are thick Just right

enough to stay in
the spoon give
more energy to the
child

Too thin
 5/18

Recommended texture
(thickness/consistency)
Age Amount of food per feed
At 6 months Start with thick porridge
From 6 up to 9 Thick porridge, mashed family foods
months
From 9 up to 12 Finely chopped family foods, sliced foods,
months finger foods
From 12 up to 24 Sliced foods, family foods
months
Less than 24 months, Same as above according to age group
not breastfed
 5/19

5. Variety of foods
Feed a variety of foods to ensure that nutrient needs
are met
Meat, poultry, fish or eggs should be eaten daily, or as
often as possible
Vitamin A-rich fruits and vegetables should be eaten
daily
Provide diets with adequate fat content
Avoid giving drinks with low nutrient value, such as
tea, coffee and sugary drinks such as soda
Limit the amount of juice offered so as to avoid
displacing more nutrient-rich foods
 5/20

Recommended variety
Age Food groups
At 6 months Breast milk (frequent breastfeeding)
From 6 up to 9 +
months Animal foods
+
From 9 up to 12 Staples
months +
Legumes
From 12 up to 24 +
months Fruits and vegetables
Less than 24 months, Same as above in addition to
not breastfed 1-2 cups of milk per day +
2-3 cups of extra fluid
 5/21

6. Active or responsive feeding

Active or responsive feeding should be practiced,
applying the principles of psycho-social care
- feed infants directly
- assist older children when they feed themselves
- be sensitive to their hunger and satiety cues
- feed slowly and patiently
- actively encourage but do not force baby to eat
- experiment with different food combinations, tastes,
textures and methods of encouragement
- minimize distractions
- feeding times are periods of learning and love - talk to
children during feeding, with eye to eye contact
 5/22

7. Hygiene
Practice good hygiene and proper food handling
- washing caregivers and childrens hands before food
preparation and eating
- storing foods safely and serving foods immediately
after preparation
- using clean utensils to prepare and serve food
- using clean cups and bowls when feeding children
- avoiding the use of feeding bottles, which are difficult
to keep clean
 5/23

Ensure access to appropriate

complementary food

Encourage diversified
approaches to ensure access to
foods that will adequately meet
energy and nutrient needs of
growing children (DOH AO 2005-
0014)

National policy support: DOH AO 2005-0014 National Policies on IYCF

 5/24

Diet diversification
Food-based strategy to improve the availability,
access, and consumption of foods with a high content
and bioavailability of micronutrients throughout the
year
Involves changes in food production practices and
dietary modifications
Ensures that the nutritional needs of children are met
to achieve optimal nutritional status
Diet diversity has the potential of increasing the
intake of multiple food components simultaneously
 5/25

4-star**** Diet
Staples: rice, corn, bread, Animal-source:
potatoes, sweet potatoes, meat, chicken,
cassava fish, liver, eggs,
milk, and milk
products

Legumes: string beans, Vitamin A-rich fruits and

bataw, patani, peanuts vegetables: papaya, mango,
squash and other fruits and
vegetables: banana,
pineapple, cabbage
 5/26

Three meals and two snacks

Percentage of daily needs

250%
225%
200%
morning
evening 175%
snack
150%
snack 125%
100%
mid-day 75%
50%
25%
Snacks Mid-day meal 0%
Gap Morning meal Energy Protein Iron Vitamin A
Evening meal Breast milk Nutrients from meals
 5/27

Frequency of feeding
A growing child needs 2-4 meals a day plus 1-2
snacks if hungry: give a variety of foods
 5/28

Snacks and liver, but no breast milk

100% Gap
Percentage of daily needs

75%

50%
Nutrients
from foods

25%

0%
Energy Protein Iron Vitamin A
Nutrient
 5/29

Complementary feeding upon 6 months

RECOMMENDATIONS

Age Frequency Amount Texture Variety

2 to 3
tablespoon Breast milk
When s +Animal foods
baby 2 to 3
Start with Thick + Staples
reaches + frequent
tastes porridge + Legumes
6 breastfeeds
months Gradually + Fruits/
increase Vegetables
amount
 5/30

Complementary feeding at 6-9 months

RECOMMENDATIONS

Age Frequency Amount Texture Variety

2 to 3
2 to 3 + tablespoon Thick Breast milk
frequent s porridge +Animal foods
From 6 breastfeeds
Increase Mashed/ + Staples
up to 9
months 1 to 2 gradually pureed + Legumes
snacks may to of 250 family + Fruits/
be offered ml foods Vegetables
cup/bowl
 5/31

Complementary feeding at 9-12 months

RECOMMENDATIONS

Age Frequency Amount Texture Variety

Finely
3 to 4 + chopped Breast milk
From 9 frequent family +Animal foods
breastfeeds of 250 foods
up to + Staples
ml
12 1 to 2 Sliced + Legumes
cup/bowl
months snacks may foods
+ Fruits/
be offered Finger Vegetables
foods
 5/32

Complementary feeding at 12-24 months

RECOMMENDATIONS

Age Frequency Amount Texture Variety

3 to 4 + Breast milk
From frequent Family +Animal foods
to 1
12 up breastfeeds foods + Staples
to 24 250 ml
1 to 2 Sliced + Legumes
months snacks may cup/bowl foods + Fruits/
be offered Vegetables
 5/33

Recommendations for feeding the non-

breastfed child
Extra meals (1-2 meals per day)
Additional snacks may be offered (1-2 per day)
Amount per feed and texture same as breastfed
child per age group
Extra water each day (2-3 cups in temperate
climate and 4-6 cups in hot climate)
Essential fatty acids (animal-source foods, fish,
avocado, vegetable oil, nut pastes)
Adequate iron (animal-source foods, fortified foods
or supplements)
Milk (1-2 cups per day)
 5/34

Responsive Feeding

Responsive (or Active) feeding is being alert

and responsive to the babys signs that he/she
is ready-to-eat; actively encourage, but dont
force the baby to eat
 5/35

Responsive feeding practice #1

Assist children to eat,

being sensitive to
their cues or signals.
 5/36

Responsive feeding practice #2

Feed slowly and

patiently, encourage
but do not force.
 5/37

Responsive feeding techniques

Sit down with the child, be patient and actively
encourage him/her to eat
Respond positively to the child with smiles, eye
contact and encouraging words
Feed the child slowly and patiently with good humor
Feed the child as soon as he or she starts to show
early signs of hunger
Try different food combinations, tastes and textures
to encourage eating
Give finger foods that the child can feed him/herself
 5/38

Responsive feeding techniques

If your young child refuses to eat, encourage him/her
repeatedly; try holding the child in your lap during
feeding
Do not insist if the child does not want to eat. Do not
force feed.
Wait when the child stops eating and then offer
again
Minimize distractions if the child loses interest easily
Stay with the child through the meal and be
attentive.
Help older child to eat.
 5/39

Responsive feeding practice #3

Talk to children
during feeding with
eye-to-eye contact.
 5/40

Feeding times are periods of learning and

love
Feed when child is alert and happy
Have regular meal times and minimize distractions
Children are more likely to eat if they like the person
who is feeding them
Engage the child in "play" trying to make the eating
session a happy and learning experiencenot just
an eating experience
Congratulate the child when he or she eats
Older siblings may help with feeding but still with
adult supervision
The child should eat in his/her usual setting.
 5/41

Overall feeding environment

Sit with the family or other children at mealtimes so
the child sees them eating
Child should eat in his/her usual setting
Sit with others eating to provide an opportunity to
offer extra food to the young child
Let the child eat from his/her own plate so the
caregiver can see the amount eaten
Talk with the child
Encourage all the family to help with responsive
feeding practices
 5/42

Interventions to combat micronutrient

deficiencies
Three-pronged strategy to combat micronutrient
deficiencies:
Micronutrient supplementation
Diet diversification
Food fortification
AO 2010-0010 Revised Policy on Micronutrient
Supplementation
AO No. 2007-0045 Zinc Supplementation and
Reformulated Oral Rehydration Salt in the
Management of Diarrhea
DOH AO 2005-0014 National Policies on IYCF
 5/43

Micronutrient supplementation
interventions for children
Vitamin A supplementation
Reduce the risk of child mortality
Protect children against severity of subsequent
infections
Reduce the complications of existing infections
Iron supplementation
Reduce occurrence of anemia
Zinc supplementation in the management of diarrhea
Reduce the duration and episodes of diarrhea
Micronutrient powder (MNP)
Improves hemoglobin concentration and iron stores
 5/44

Micronutrient powder
Premix of 15 micronutrients in powder form
Added into any semi-solid food

Micronutrient Amount Micronutrient Amount

Vitamin A 400 ug Folic Acid 150 ug
Vitamin C 30 mg Niacin 6 mg
Vitamin D 5.0 ug Iron 10 mg
Vitamin E 5 mg a-TE Zinc 4.1 mg
Vitamin B1 0.5 mg Copper 0.56 mg
Vitamin B2 0.5 mg Iodine 90 ug
Vitamin B6 0.5 mg Selenium 17.0 ug
Vitamin B12 0.9 ug
 5/45

Micronutrient supplementation guideline

for infants 0-11 months old
1. Routine iron (drops once a day for 3 months) and
vitamin A supplementation (single dose capsule) to
all 6-11 month-old infants
If MNP is already available, iron requirement will
be in the form of MNP
2. Regular vitamin A and iron supplementation
starting at 6 months of age
3. Therapeutic dose of iron to 6-11 month old
infants clinically diagnosed with iron deficiency
anemia
 5/46

Micronutrient supplementation guideline

for infants 0-11 months old
4. Iron supplements for low birth weight (LBW) infants
at 2 months
5. Therapeutic vitamin A dose for infants diagnosed
with high-risk conditions
measles, severe pneumonia, severely underweight,
persistent diarrhea, xerophthalmia
6. Treat 0-11 month-old infants with diarrhea with
reformulated ORS and zinc
7. Do not give iodine supplements to infants. Use
iodized salt in the preparation of complementary
food.
 5/47

Micronutrient supplementation guideline

for infants 1-<5 years old

1. Prioritize 12-23 month-old children for iron and

vitamin A supplement
2. Iron for those who are clinically diagnosed with
anemia
3. Children 12-59 months old receive 2 doses of
vitamin A each year (every 6 months)
4. Therapeutic vitamin A dose for children
diagnosed with high-risk conditions
1. xerophthalmia, severe pneumonia, measles,
persistent diarrhea, severely underweight
 5/48

Micronutrient supplementation guideline

for infants 1-<5 years old

5. Treat 12-59 month old children with diarrhea

with reformulated ORS and zinc
6. Encourage the use of iodized salt and
consumption of other fortified foods with
Sangkap Pinoy Seal
 5/49

Sources of contamination of
complementary foods
Food handler (e.g.
Human and animal contaminated hands) Flies and pets
Source of contamination

excreta Contaminated
Infected food animal household water
Polluted environment
Night soil FOOD (soil, dust)
(Raw/Cooked)
Irrigation and waste Dirty pots and
water cooking utensils
Domestic animals
Cross-contamination
Survival & Growth

Time-Temperature
Abuse

Contaminated Complementary Food

Source: Motarjemi, Y. Research Priorities on Safety of Complementary Feeding. Pediatrics. 2000:106;1304-1305
 5/50

Good hygiene practices prevent disease

The peak incidence of diarrheal disease is

during the second half year of infancy, as the
intake of complementary foods increases
Attention to hygienic practices during food
preparation and feeding is critical for prevention
of diarrhea and other illnesses
 5/51

Handwashing
Wash hands with soap and water before
preparing foods and feeding baby
Wash hands and babys hands before eating
Wash hands with
soap and water
after using the
toilet and
washing or
cleaning babys
bottom.
 5/52

5 keys to safer food

Keep clean
Separate raw
and cooked
foods
Cook
thoroughly
Keep food at
safe
temperatures
Use safe water
and raw
materials

Adapted from WHO Complementary Feeding Counselling Training Course

 5/53

#1 key to safer food: Keep clean

Wash hands before handling food and often during
food preparation.
Wash hands after going to the toilet, changing the
baby or coming in contact with animals.
Wash very clean all surfaces and equipment used
for food preparation or serving.
Use a clean spoon or cup to give foods or liquids to
the baby.
Do not use bottles, teats or spouted cups that are
difficult to clean.
Protect kitchen areas and food from insects, pests
and other animals.
 5/54

#2 key to safer food: Separate raw and

cooked foods

Separate raw meat, poultry and seafood from other

foods.
Use separate equipment and utensils such as
knives and cutting boards for handling raw foods.
Store foods in covered containers to avoid contact
between raw and prepared foods.
 5/55

#3 key to safer food: Use fresh foods and

cook thoroughly

Use fresh foods.

Cook food thoroughly, especially meat, poultry, eggs
and seafood.
Bring foods like soups and stews to boiling point.
For meat and poultry, make sure juices are clear not
pink.
Reheat cooked food thoroughly. Bring to the boil or
heat until too hot to touch. Stir while re-heating.
 5/56

#4 key to safer food: Keep food at safe

temperatures

Do not leave cooked food at room temperature for

more than 2 hours.
Do not store food too long, even in a refrigerator.
Do not thaw frozen food at room temperature.
Food for infants and young children should ideally
be freshly prepared and not stored at all after
cooking.
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#5 key to safer food: Use safe water and

raw materials

Use safe water or treat it to make it safe.

Choose fresh and wholesome foods.
Use pasteurized milk.
Wash fruits and vegetables in safe water, especially
if eaten raw.
Do not use food beyond its expiry date.
 5/58

Other sanitary and hygienic practices

Keep food covered to protect it from flies and other

insects.
Proper use of toilet and sanitary disposal of human
excreta.
Use of safe storage system for drinking water and
making sure that it is covered.
 6/1

Session 6

Management and Support of Infant

Feeding in Maternity Facilities