Nutrition in the First 1,000 Days - Save the Children

24 SaviNg liveS aND BUilDiNg a Better FUtUre: loW-coSt SolUtioNS that WorK
Promoting and supporting
early initiation of
Breastfeeding
Despite its benefits, many women delay
initiation of breastfeeding. Only 43 percent
of newborns in developing countries are
put to the breast within one hour of birth.
Establishing good breastfeeding practices
in the first days is critical to the health of
the infant and to breastfeeding success.
Initiating breastfeeding is easiest and most
successful when a mother is physically
and psychologically prepared for birth and
breastfeeding and when she is informed,
supported, and confident of her ability to
care for her newborn. The following actions
can increase rates of early initiation of
breastfeeding:
• Identify the practices, beliefs, concerns
and constraints to early and exclusive
breastfeeding and address them through
appropriate messages and changes in
delivery and postnatal procedures
• Counsel women during prenatal care on
early initiation and exclusive breastfeeding
• Upgrade the skills of birth attendants to
support early and exclusive breastfeeding
• Make skin-to-skin contact and initiation
of breastfeeding the first routine after
delivery
• Praise the mother for giving colostrum
(the “first milk”), provide ongoing
encouragement, and assist with position-
ing and attachment
Breastfeeding – Human breast milk provides all the nutrients newborns
need for healthy development and also provides important antibodies against
common childhood illnesses. Exclusive breastfeeding prevents babies from
ingesting contaminated water that could be mixed with infant formula. The
protective benefits of breastfeeding have been shown to be most significant with
6 months of exclusive breastfeeding and with continuation after 6 months, in
combination with nutritious complementary foods (solids), up to age 2. In
conditions that normally exist in developing countries, breastfed children are
at least 6 times more likely to survive in the early months than non-breastfed
children.65
Complementary feeding – When breast milk alone is no longer sufficient
to meet a child’s nutritional needs, other foods and liquids must be added
to a child’s diet in addition to breast milk. Optimal complementary feeding
involves factors such as the quantity and quality of food, frequency and
timeliness of feeding, food hygiene, and feeding during/after illnesses. The
target range for complementary feeding is 6-23 months.66 WHO notes that
breastfeeding should not be decreased when starting complementary feeding;
complementary foods should be given with a spoon or a cup, not in a bottle;
foods should be clean, safe and locally available; and ample time should be given
for young children to learn to eat solid foods.67 Rates of malnutrition among
children usually peak during the time of complementary feeding. Growth
faltering is most evident between 6-12 months, when foods of low nutrient
density begin to replace breast milk and rates of diarrheal illness due to food
contamination are at their highest.68 During the past decade, there has been
considerable improvement in breastfeeding practices in many countries; however,
similar progress has not been made in the area of complementary feeding.
Complementary feeding is a proven intervention that can significantly reduce
stunting during the first two years of life.69 If all children in the developing
world received adequate complementary feeding, stunting rates at 12 months
could be cut by 20 percent.70
Vitamin A supplements – Roughly a third of all preschool-age children
(190 million)71 and 15 percent of pregnant women (19 million)72 do not have
enough vitamin A in their daily diet. Vitamin A deficiency is a contributing
factor in the 1.3 million deaths each year from diarrhea among children and the
nearly 118,000 deaths from measles.73 Severe deficiency can also cause irreversible
corneal damage, leading to partial or total blindness. Vitamin A capsules
given to children twice a year can prevent blindness and lower a child’s risk of
death from common childhood diseases – at a cost of only 2 cents per capsule.74
It is estimated that at least 2 percent of child deaths could be prevented if all
children under age 5 received two doses of vitamin A each year.75
Zinc for diarrhea – Diarrhea causes the death of 1.3 million children76 each
year, most of them between the ages of 6 months and 2 years.77 Young children
are especially vulnerable because a smaller amount of fluid loss causes significant
dehydration, because they have fewer internal resources, and because
their energy requirements are higher. Children in developing nations suffer an
average of three cases of diarrhea a year.78 Diarrhea robs a child’s body of vital
nutrients, causing malnutrition. Malnutrition, in turn, decreases the ability
of the immune system to fight further infections, making diarrheal episodes
more frequent. Repeated bouts of diarrhea stunt children’s growth and keep
them out of school, which further limits their chances for a successful future.