Infant and young child feeding

To enable mothers to establish and sustain exclusive breastfeeding for 6 moths, WHO and UNICEF recommend:

• initiation of breastfeeding within the first hour of life;
• exclusive breastfeeding (i.e. only breast milk with no additional food or drink, not even water);
• breastfeeding on demand, as often the child wants, day and night; and
• no use of bottles, teats or pacifiers.

The recommendations for feeding infants and young children (6-23 months) include:

• continued breastfeeding;
• introduction of solid, semisolid or soft foods at 6 months;
• appropriate food diversity (at least five food groups per day);
• appropriate frequency of meals: two to three times a day between 6 and 8 months, increasing to three to four times a day between 9 and 23 months, with nutritious snacks offered once or twice a day as desired;
• safe preparation of foods; and
• feeding infants in response to their cues.

The caring practice indicators for feeding infants and young children that are available on the NLiS country profiles include:

• proportion of children aged 0-23 months who were put to the breast within 1 hour of birth;
• proportion of infants under 6 months who are exclusively breastfed;
• proportion of children who are continued breastfed at 12-15 months;
• proportion of children who are continued breastfed at 20-23 months;
• proportion of infants aged 6-8 months who receive solid, semisolid or soft foods;
• proportion of children aged 6-23 months who receive a minimum dietary diversity; and
• proportion of children aged 6-23 months who receive a minimum acceptable diet.

Early initiation of breastfeeding

What does this indicator tell us?

This indicator is the percentage of infants who are put to the breast within 1 hour of birth.

How is this indicator defined?

Early initiation of breastfeeding is defined as the proportion of children born in the previous 24 months who were put to the breast within 1 hour of birth.

What are the consequences and implications?

Breastfeeding improves child health, and there is evidence that delayed initiation of breastfeeding increases a child’s risk for mortality

Infants under 6 months who are exclusively breastfed

What does this indicator tell us?

This indicator is the percentage of infants aged 0-5 months who are exclusively breastfed.

How is it defined?

This is the proportion of infants aged 0-5 months who are fed exclusively on breast milk, with no other food or drink, including water. The infant is, however, allowed to receive oral rehydration solution (ORS) and drops or syrups containing vitamins, minerals and medicine.

What are the consequences and implications?

Exclusive breastfeeding is an unequalled way of providing the ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process, with important health benefits for mothers. An expert review of evidence showed that, on a population basis, exclusive breastfeeding for the first 6 months is the optimal way of feeding infants.

Breast milk is the natural first food for infants, providing all the energy and nutrients that the infant needs for the first months of life. It continues to provide one half or more of a child’s nutritional needs during the second 6 months of the first year, and up to one third during the second year of life.

Breast milk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality from common childhood illnesses, such as diarrhoea and pneumonia, and means that the child is likely to recover more quickly from illness.

Breastfeeding contributes to the health and well-being of mothers, by helping to space children, reducing their risks for ovarian and breast cancers, and saving family and national resources. It is a secure way of feeding and is safe for the environment.

Continued breastfeeding at 1 year in children 12-15 months (%).

What does this indicator tell us?

This indicator is the percentage of children between 12-15 months of age who received breast milk during the previous day.

How is this indicator defined?

This indicator is defined as the proportion of children aged 12-15 months who received breast milk during the previous day. It includes breastfeeding by a wet nurse and feeding expressed breast milk.

What are the consequences and implications?

Breast milk is a significant source of energy and nutrients in children 6-23 months of age. It provides one half or more of a child's energy needs between 6 and 12 months of age, and one third of energy between 12 and 24 months.

Continued breastfeeding at 2 years in children 20-23 months (%) 

What does this indicator tell us?

This indicator is the percentage of children between 20-23 months of age who receive breast milk during the previous day.

How is this indicator defined?

This indicator is defined as the proportion of children aged 20-23 months who received breast milk during the previous day. It includes breastfeeding by a wet nurse and feeding expressed breast milk.

What are the consequences and implications?

Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, in order to meet their evolving nutritional requirements, children should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.

Infants aged 6-8 months who receive solid, semisolid or soft foods

What does this indicator tell us?

The indicator is the percentage of infants who start solid, semisolid or soft foods at between 6 and 8 months of age. WHO recommends starting complementary feeding at 6 months of age.

How is it defined?

It is defined as the proportion of infants aged 6-8 months who receive solid, semisolid or soft foods.

What are the consequences and implications?

When breast milk alone no longer meets the nutritional needs of the infant, complementary foods should be added. The transition from exclusive breastfeeding to family foods, referred to as "complementary feeding", typically occurs between 6 and 18-24 months of age. This is a very vulnerable period, and it is the time when malnutrition often starts, contributing significantly to the high prevalence of malnutrition among children under 5 worldwide.

Children aged 6-23 months who receive a minimum dietary diversity (MDD)

What does this indicator tell us?

This indicator is the percentage of children aged 6-23 months who receive a minimum dietary diversity.

The indicator “proportion of children aged 6-23 months who receive a minimum dietary diversity” is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework.

How is it defined?

In June 2017, the WHO-UNICEF Technical Expert Advisory group on nutrition Monitoring (TEAM) recommended a revision of the minimum dietary diversity (MDD) indicator as defined by WHO (2008), to make it feasible and meaningful for Member State reporting. The revision concerned adding "breast milk" as an eighth food group and shifting the criterion for MDD accordingly, from four of seven groups to five of eight groups. Thus, dietary diversity is present when the diet contains five or more of the following food groups:

• breast milk;
• grains, roots and tubers;
• legumes and nuts;
• dairy products (milk, yogurt, cheese);
• flesh foods (meat, fish, poultry, liver or other organs);
• eggs;
• vitamin A-rich fruits and vegetables; and
• other fruits and vegetables.

Children aged 6-23 months who receive a minimum acceptable diet (MAD)

What does this indicator tell us?

This indicator is the percentage of children aged 6-23 months who receive a minimum acceptable diet.

How is it defined?

The composite indicator of a minimum acceptable diet is calculated from:

• the proportion of breastfed children aged 6-23 months who had at least the MDD and minimum meal frequency during the previous day; and
• the proportion of non-breastfed children aged 6-23 months who received at least two milk feedings and had at least the MDD, not including milk feeds, and minimum meal frequency during the previous day.

Dietary diversity is present when the diet contained four or more of the following food groups:

• breast milk
• grains, roots and tubers
• legumes and nuts
• dairy products (e.g. milk, yogurt and cheese)
• flesh foods (e.g. meat, fish, poultry, liver or other organs)
• eggs
• vitamin A-rich fruits and vegetables
• other fruits and vegetables.

The minimum daily meal frequency is defined as:

• twice for breastfed infants aged 6-8 months,
• three times for breastfed children aged 9-23 months
• four times for non-breastfed children aged 6-23 months.

What are the consequences and implications?

A minimum acceptable diet is essential to ensure appropriate growth and development for feeding infants and children aged 6-23 months. Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality.

Source of data

UNICEF global databases - Infant and Young Child Feeding. http://data.unicef.org/nutrition/iycf

WHO. Global Health Observatory (GHO) data repository. Exclusive breastfeeding under 6 months. Data by country (http://apps.who.int/gho/data/view.main.NUT1730).

UNICEF data: monitoring the situation of children and women. Infant and young child feeding (https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/ ).

Further reading

WHO, UNICEF. Global Nutrition Monitoring Framework: operational guidance for tracking progress in meeting targets for 2025. Geneva: World Health Organization; 2017 (http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/ ).

WHO, UNICEF, USAID, AED, UCDAVIS, IFPRI. Indicators for assessing infant and young child feeding practices. Part I: Definitions. Conclusions of a consensus meeting held 6-8 November 2007 in Washington, DC, USA. Geneva: World Health Organization; 2008

WHO, UNICEF, USAID, AED, UCDAVIS, IFPRI. Indicators for assessing infant and young child feeding practices. Part 2: Measurement. Geneva: World Health Organization; 2010

WHO, UNICEF, USAID, AED, UCDAVIS, IFPRI. Indicators for assessing infant and young child feeding practices. Part 3: Country profiles. Geneva: World Health Organization; 2010

WHO, UNICEF. Global strategy for infant and young child feeding. Geneva: World Health Organization; 2003 (http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/ ).

Internet resources

WHO. Infant and young child feeding list of publications. (http://www.who.int/nutrition/publications/infantfeeding/en/index.html ).

WHO. Global targets 2025 to improve maternal, infant and young child nutrition. (http://who.int/nutrition/global-target-2025/en/ ).

WHO global data bank on infant and young child feeding. (http://www.who.int/nutrition/databases/infantfeeding/en/index.html).

WHO. e-Library of Evidence for Nutrition Actions (eLENA):

Early initiation of breastfeeding to promote exclusive breastfeeding (http://www.who.int/entity/elena/titles/early_breastfeeding/en/index.html ).

Exclusive breastfeeding for optimal growth, development and health of infants (http://www.who.int/entity/elena/titles/exclusive_breastfeeding/en/index.html ).

Continued breastfeeding for healthy growth and development of children (http://www.who.int/entity/elena/titles/continued_breastfeeding/en/index.html ).

Appropriate complementary feeding (http://www.who.int/entity/elena/titles/complementary_feeding/en/index.html ).