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 for supplementations. It is important to formulate a consensus statement in view of current evidence, and put in place strategies to meet targets. OBJECTIVE: To formulate by endorsement or adoption and disseminate a consensus statement for prevention of micronutrients deficiencies in young children for office practices from an Indian perspective. PROCESS: A National Consultative Meeting was convened by 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 participants representing different parts of India were included. CONCLUSIONS: Micronutrient deficiencies are widespread. For its prevention proper maternal 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 iodization programs need to be scaled up, especially in high risk groups. Universal vitamin D supplementation need to be in place; though, the dose needs more research. Vitamin B12 deficiency screening and supplementation should be practiced only in high-risk groups. Availability of appropriately 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.

Initiation of lactation and establishing relactation in outpatients.

The present study was conducted to evaluate whether mothers with babies less than 6 weeks of age can be helped to initiate or establish lactation in outpatient department. One thousand mothers with babies less than 6 weeks of age who completed 10 days of follow-up in outpatient have been analyzed. Mothers who had either stopped breastfeeding or were not able to initiate breastfeeding were helped with establishing lactation at outpatient clinic. Sick babies and mothers having breast problem and systemic illness were excluded. 91.6% of mothers succeeded in establishing lactation within 10 days. 83.4% mothers achieved complete lactation and 8.2% of mothers achieved partial lactation in 10 days. However, 8.4% of mothers could not be helped in this study. They had to be hospitalized because of various reasons. It is possible to help majority of mothers with lactation difficulties at the outpatient when the baby is less than 6 weeks of age. Helping mothers with proper attachment at the breast appears to be crucial for success.

Chediak-Higashi syndrome.

A case of Chediak-Higashi syndrome is reported in a four-year-old boy who presented with recurrent chest infection, partial albinism, hyperpigmentation of the extremities and presence of giant granules in leucocytes and melanocytes in the skin. Parental consanguinity was present. Though uncommon, hyperpigmentation of sun exposed areas may be the initial symptom in Chediak-Higashi syndrome.

Follow-up study of survivors of severe protein energy manlnutrition.

OBJECTIVE: To evaluate the nutritional profile of survivors of severe protein energy malnutrition on follow-up at 1-3 years and 5-7 years. DESIGN: Prospective and Cross-sectional point prevalence. METHODS: Group I comprised 50 severely malnourished children dischared 5-7 years from nutritional rehabilitation center and Group II comprised 50 children discharged 1-3 years ago. The nutritional status of these 100 children was compared to the nutritional status of 35 siblings who had not suffered from severe malnutrition in their earlier life (Group III). RESULTS: All the malnourished children showed significant improvement in weight for age. More children in Group I had better height for age compared to Group II(p>0.05). Analysis of weight for height showed that study children has better nutritional status than their siblings who had not suffered from significant malnutrition. CONCLUSION: Significant improvement in nutritional status occurs with nutritional rehabilitation. However, improvement in height for age is more difficult to obtain. Interestingly, rehabilitated malnourished children on follow up had better nutritional status as compared to their siblings.

Breastfeeding practices in villages of central Karnataka.

OBJECTIVE: To asses the prevailing breastfeeding and infant feeding practices in rural areas. DESIGN: Stratified sampling method in a community based study. SUBJECTS: 1050 infants from 0-24 months of age. RESULTS: The timely first suckling rate was 0.3%. All the infants received prelacteal feeds. Colostrum was rejected by 29% of mothers. Delayed initiation of breastfeeding was common; 35% of babies were not breast-fed even at 48 h of birth. Exclusive breastfeeding was noted in 94% at 1 mo, 83.5% at 2 mo, 72.5% at 3 mo, 61.2% at 4 mo, 43.4% at 5 mo and 26.8% at 6 mo age. Timely complementary feeding rate was 57.3% among infants from 6 to 10 mo age. Continued breastfeeding rate was 99.7% at 1 year and 87.2% at 2 years. The bottle feeding rate was 49.4% among infants below 1 year age. The ever breast-fed rate was 97.0% and the median duration of breastfeeding was beyond 24 months. CONCLUSIONS: Bottle feeding is quite prevalent even in rural areas and the infant feeding practices are far from satisfactory.

PIP: In Central Karnataka in India, a community-based study was conducted on 1050 mothers with infants younger than 24 months to examine breast feeding and infant feeding practices in rural areas. Only 3 infants (0.3%) were offered breastfeeding within 1 hour after delivery. By 72 hours post-delivery, 90.9% of infants had begun breast feeding. All infants had received prelacteal feeds. 28.6% of mothers discarded the colostrum. The exclusive breast feeding rate was 94% at 1 month, 83.5% at 2 months, 72.5% at 3 months, and 61.2% at 4 months. 97% of infants ever breast fed. Among infants younger than 1, 49.4% were bottle fed. Major reasons for introducing bottle feeding were not enough milk (58.1%), subsequent pregnancy (35.8%), and ill health of mother (20.7%). Among infants 6-10 months old, 57.3% had received timely supplementary feedings. 94.7% of mothers used home made weaning foods. 5.3% used commercial foods. These findings show that rural mothers in Central Karnataka delay initiation of breast feeding, reject the colostrum, and use prelacteal foods and that bottle feeding and commercial weaning foods have an influence on infant feeding practices in rural areas.