Prevention of Micronutrient Deficiencies in Young Children: Consensus Statement from Infant and Young Child Feeding Chapter of Indian Academy of Pediatrics

Justification: Micronutrient deficiencies have significant impact on the overall health and well-being of society and potential targets forsupplementations. It is important to formulate a consensus statement in view of current evidence, and put in place strategies to meettargets. Objectives: To formulate by endorsement or adoption and disseminate a consensus statement for prevention of micronutrientsdeficiencies in young children for office practices from an Indian perspective. Process: A National Consultative Meeting was convenedby Infant and Young Child Feeding Chapter (IYCF) of Indian Academy of Pediatrics (IAP) on 17 December, 2016 at Mumbai. IYCF chapter,IAP, United Nations Children Fund, National Institute of Nutrition and Government of India were the participating agencies; and participantsrepresenting different parts of India were included. Conclusions: Micronutrient deficiencies are widespread. For its prevention propermaternal and infant-young child feeding strategies need to be practiced. Encourage delayed cord clamping, dietary diversification,germinated foods, soaking and fermentation processes. Existing Iron, Vitamin A, Zinc supplementation and universal salt iodizationprograms need to be scaled up, especially in high risk groups. Universal vitamin D supplementation need to be in place; though, the doseneeds more research. Vitamin B12 deficiency screening and supplementation should be practiced only in high-risk groups. Availability ofappropriately fortified foods needs to be addressed urgently.

Infant and Young Child Feeding Guidelines, 2016.

Justification: Shaping up the post-2015 development agenda is of crucial importance in the development process around the Globe as 2015 was the last year of milllionium development goals. It is the right time to asses our own progress vis-a-vis the Millennium Development Goals and these Guidelines are an attempt in that regard. Process: The Infant and Young Child Feeding (IYCF) chapter of Indian Academy of Pediatrics invited a group of experts for National Consultative Meet for discussing and contributing on latest scientific advances and developments. Various partners from WHO, UNICEF, Ministry of Child Welfare Department, Ministry of Health and Family Welfare, Ministry of Chemical and Fertilizers of Govt of India, Human Milk Banking Association (of India), Indian Medico-Legal and Ethics Association (IMLEA), non-governmental organizations and academicians from various states of India contributed to these guidelines. The guidelines were finalized during the IYCNCON 2015 at New Delhi in August 2015. Objectives: To formulate, endorse, adopt and disseminate guidelines related to Infant and Young Child feeding from an Indian perspective (including human milk banking, infant feeding in the HIV situation, and micro-nutrients). Recommendations: Early initiation of breastfeeding within first hour of birth, exclusive breastfeeding for the first six months followed by continued breastfeeding for up to two years and beyond with appropriate complementary foods after completion of 6 months is the most appropriate feeding strategy. Micro-nutrient supplementation in infants, and adequate nutrition and anemia control for adolescent girls, pregnant and lactating mothers is advocated. Concepts and need for human milk banks in India has also been incorporated.

Human Milk Banking Guidelines.

Justification: WHO and UNICEF state that the use of human milk from other sources should be the first alternative when it is not possible for the mother to breastfeed. Human milk banks should be made available in appropriate situations. The IYCF Chapter is actively concerned about the compelling use of formula feeds in the infants because of the non availability of human breast milk banks. Process: A National Consultative Meet for framing guidelines was summoned by the IYCF Chapter and the Ministry of Health and Family Welfare, Government of India on 30th June, 2013, with representations from various stakeholders. The guidelines were drafted after an extensive literature review and discussions. Though these guidelines are based on the experiences and guidelines from other countries, changes have been made to suit the Indian setup, culture and needs, without compromising scientific evidence. Objectives: To ensure quality of donated breast milk as a safe end product. Recommendations: Human Milk Banking Association should be constituted, and human milk banks should be established across the country. National coordination mechanism should be developed with a secretariat and technical support to follow-up on action in States. Budgetary provisions should be made available for the activities.

The IMS Act 1992: need for more amendments and publicity.

The IMS act was passed after a lot of thinking, discussions over pros and cons of childhood feeding practices and recommendations of WHA. We are not only legally bound by it, but it is also our moral responsibility to see that the act works. Already 9-10 years have passed but the results are not that encouraging. Most of our colleagues are unaware of the provisions and importance of this act. Making the law effective is very time consuming, costly, unaffordable and avoidable affair. We should not harp on multiplicity of legal opinions & loopholes to allow breaking the law in spirit if not in letter. We feel that most of our laws are paper tigers without any teeth, gathering dust by remaining present only in law books or journals. If we don't act now then there is every possibility that this act may also become one of the historical legal documents. Hence it is time for all of us to become an activist or counselor for BF. We should create awareness and public opinion about protection, promotion and support for BF. Be vigilant, form community watch group and report violations to the authorities. So that our country can become a proud nation of healthy, intelligent and emotionally stable children in the 21st century.