I NFANT AND Y OUNG C HILD F EEDING (IYCF) P RACTICES

Appropriate IYCF practices include breastfeeding through age 2, introduction of solid and semi-solid foods at age 6 months, and gradual increases in the amount of food given and frequency of feeding as the child gets older. The minimum frequencies for feeding children in developing countries are based on the energy output of complementary foods. The energy needs of children are based on age-specific total daily energy requirements plus 2 SD (to cover almost all children), minus the average energy intake from breast milk. Infants with low breast milk intake need to be fed more frequently than those with high breast milk intake. However, care should be taken that feeding frequencies do not exceed the recommended input from

Nutrition of Children and Women • 165 complementary foods because excessive feeding can result in displacement of breast milk (PAHO/WHO

2003).

According to recommendations, breastfed children age 6-23 months should receive animal-source foods and vitamin A-rich fruits and vegetables daily (PAHO/WHO 2003). Because first foods almost always include a grain- or tuber-based staple, it is unlikely that young children who eat food from less than three groups will receive both an animal-source food and a vitamin A-rich fruit or vegetable. Therefore, three food groups are considered the minimum number appropriate for breastfed children (Arimond and Ruel 2004). Breastfed infants age 6-8 months should receive complementary foods two to three times a day, with one or two snacks; breastfed children age 9-23 months should receive meals three to four times a day, with one or two snacks. Non-breastfed children age 6-23 months should receive milk or milk products two or more times a day to ensure that their calcium needs are met. In addition, they need animal-source foods and vitamin A-rich fruits and vegetables. Four food groups are considered the minimum number appropriate for non-breastfed young children. Non-breastfed children age 12-23 months should be fed meals four to five times each day, with one or two snacks (PAHO/WHO 2003; WHO 2008; and WHO 2010).

Table 11.6 shows the percentage of children under age 2 living with their mothers who are fed according to three IYCF practices¹ based on breastfeeding status, number of food groups, and number of times fed during the day or night preceding the survey. Among breastfed children, 24 percent were given foods from at least four groups and 45 percent were fed the minimum number of times during the day and night preceding the survey. Fifteen percent of the breastfed children fall into both categories, i.e., their feeding practices meet minimum standards with respect to food diversity and feeding frequency (Table 11.6 and Figure 11.4). Regional variations exist; children living in the Central region are most likely to receive the minimum acceptable diet (27 percent), and those in the Eastern region are the least likely (4 percent). Breastfed children of educated mothers (27 percent) who reside in the wealthiest households (22 percent) are most likely to receive a quality diet.

With regards to the non-breastfed children age 6-23 months, only 11 percent were given milk or milk products an adequate number of times, almost half (49 percent) received foods from at least four food groups, and 37 percent were fed the minimum number of times. However, only 5 percent of nonbreastfeeding children feeding practices qualified as being in accordance with all three IYCF practices.

Among all children age 6-23 months, only 13 percent were fed the minimum acceptable diet.

Overall, 86 percent of children received breastmilk, milk, or milk products, 28 percent received four or more food groups, and 43 percent received food the minimum number of times. Children in the 12-17 age group, those who live in urban areas and in Greater Accra, children of educated mothers, and those in the wealthiest households are most likely to receive the minimum acceptable diet. It is noteworthy that only 4 percent of children residing in the Eastern region received the minimum acceptable diet.

1 It should also be noted that there have been changes in the definition of the standard IYCF indicators since 2008.

Examples are the removal of “foods made with fats” as a food group, the requirement that breastfed children receive four instead of three food groups, the requirement that non-breastfed children receive two or more servings of milk or milk products, and the removal of cheese from the milk or milk products list in line with recent WHO IYCF feeding indicators guidelines. Thus, in certain instances comparison of related indicators with previous GDHS reports may be problematic.

Table 11.6 Infant and young child feeding (IYCF) practices

Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based on breastfeeding status, number of food groups, and times they are fed during the day or night preceding the survey, by background characteristics, Ghana 2014

Among breastfed children 6-23

Among all children 6-23 months, percentage fed:

1 Food groups: a. infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; c. vitamin A-rich fruits and vegetables; d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish, and organ meats;

g. legumes and nuts. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.

2 For breastfed children, minimum meal frequency is receiving solid or semi-solid food at least twice a day for infants 6-8 months and at least three times a day for children 9-23 months

3 Includes two or more feedings of commercial infant formula, fresh, tinned, and powdered animal milk, and yogurt

4 For non-breastfed children age 6-23 months, minimum meal frequency is receiving solid or semi-solid food or milk feeds at least four times a day

5 Non-breastfed children age 6-23 months are considered to be fed with a minimum standard of three Infant and Young Child Feeding Practices if they receive other milk or milk products at least twice a day, receive the minimum meal frequency, and receive solid or semi-solid foods from at least four food groups not including the milk or milk products food group

6 Breastfeeding, or not breastfeeding and receiving two or more feedings of commercial infant formula, fresh, tinned and powdered animal milk, and yogurt

7 Children are fed the minimum recommended number of times per day according to their age and breastfeeding status as described in footnotes 2 and 4

Nutrition of Children and Women • 167

Figure 11.5 IYCF indicators on minimum acceptable diet