Improving the dietary intakes and nutritional status of infants and young children through improved food security and complementary feeding (IMCF)

Importance of complementary feeding

The greatest decline in nutritional status of children is seen between the ages of six months and two years of life. This is a critical nutritional window for children, in which they should be transitioning from exclusive breastfeeding to receiving complementary foods in addition to continued adequate intake of breastmilk. The four principals of complementary feeding defined by WHO are that complementary feeding be:
  • adequate in terms of the energy and nutrient needs of the child;
  • introduced at the appropriate age and not replace but rather augment intake from breastmilk
  • safe from environmental and biological contamination
  • provided in a manner and style which is consistent with the child’s appetite and that feeding frequency and feeding methods are age-appropriate

These four principals for complementary feeding are frequently not met, due to a variety of factors, including but not limited to, poor utilization of locally available nutrient-dense foods, time constraints related to meal preparation, poor and inadequate water and food storage options and lack of knowledge and time for age-appropriate feeding by caregivers. The result is often complementary foods with inadequate energy and micronutrient density and also with risk of contamination introduced during preparation and/or storage. These factors then contribute to the overall burden of malnutrition and illness experienced amongst infants and young children.

FAO approach to developing Complementary Feeding messages

FAO recommends community-based nutrition education in combination with home-based dietary counselling with a focus on utilizing locally available nutrient dense foods with messages developed that are nutritionally and culturally appropriate. Because of the complexity of the nutritional and behavioural issues involved, careful assessment of the current constraints faced by families and means of overcoming them should be incorporated into the development of nutrition education messages. Trials of improved practices (TIPs) are a formative research technique used in programmes that promote behaviour change. (Examples).

The methodology has been well tested and validated, particularly with regard to health and hygiene behaviour, and has been used in various countries to develop nutrition behaviour change communication strategies, including on infant and young child feeding practices. Careful consideration of feasible local solutions that are developed with the participation of and tested by caregivers and local extension staff, can lead to the identification of appropriate and effective interventions to improve complementary feeding practices tailored to the specific local context.

Research initiative on the impact of Complementary Feeding interventions combined with a food security programme

Food availability, including seasonality and household constraints in accessing locally available foods, combined with insufficient nutritional knowledge, awareness and skills related to optimal infant and young child feeding practices are often cited as some of the main barriers to sustainable improvements in complementary feeding. The German Federal Ministry of Nutrition, Agriculture and Consumer Protection (BMELV) has funded a collaborative research project with FAO and the Institute of Nutrition, Justus-Liebig University in Giessen, Germany to study the impact of combining behaviour change communication for complementary feeding developed using TIPs with nutrition sensitive agriculture interventions oriented toward promoting diverse locally available, nutrient-rich and affordable foods (such as dark green leafy vegetables, orange-fleshed vegetables and fruit, nuts and legumes, fruits and small fish and livestock). The specific research questions to be answered in the study are:

  • Can nutrient needs of children 6-23 months of age be met with locally available foods if consumed in an age-appropriate manner?
  • Can TIPs generate:
    • nutrition education messages that are appropriate for the population?
    • nutritionally improved, culturally acceptable and affordable recipes?
    • recipes and messages that result in improved child feeding behaviours and improved intakes?
  • Can the prevalence of child malnutrition be decreased if messages and recipes generated from TIPs are locally available and accepted?
  • Is nutrition education combined with nutrition-sensitive agriculture interventions to improve complementary feeding practices more effective than either activity alone in reducing malnutrition among children under five years of age?
last updated:  Monday, June 9, 2014