Infants should be exclusively breastfed – i.e. receive only breast milk – for the first six months of life to achieve optimal growth, development and health. “Exclusive breastfeeding” is defined as giving no other food or drink – not even water – except breast milk. It does, however, allow the infant to receive oral rehydration salts (ORS), drops and syrups (vitamins, minerals and medicines). Breast milk is the ideal food for the healthy growth and development of infants; breastfeeding is also an integral part of the reproductive process with important implications for the health of mothers.

WHO recommends that infants start receiving complementary foods at six months (180 days) of age in addition to breast milk. Foods should be adequate, meaning that they provide sufficient energy, protein and micronutrients to meet a growing child’s nutritional needs. Foods should be prepared and given in a safe manner to minimize the risk of contamination. Feeding young infants requires active care and stimulation to encourage the child to eat.

The transition from exclusive breastfeeding to full use of family foods is a very vulnerable period. It is the time when many infants become malnourished, contributing significantly to the high prevalence of malnutrition in children under five years of age worldwide. It is essential therefore that infants receive appropriate, adequate and safe complementary foods to ensure the right transition from the breastfeeding period to the full use of family foods.

 

Breastfeeding is an unequaled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Review of evidence has shown that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.

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

  • Initiation of breastfeeding within the first hour of life
  • Exclusive breastfeeding – that is the infant only receives breast milk without any additional food or drink, not even water
  • Breastfeeding on demand – that is as often as the child wants, day and night
  • No use of bottles, teats or pacifiers

Breast milk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half 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 due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness. These effects can be measured in resource-poor and affluent societies (Kramer M et al Promotion of Breastfeeding Intervention Trial (PROBIT): A randomized trial in the Republic of Belarus. Journal of the American Medical Association, 2001, 285(4): 413-420)

Breastfeeding contributes to the health and well-being of mothers; it helps to space children, reduces the risk of ovarian cancer and breast cancer, increases family and national resources, is a secure way of feeding and is safe for the environment.

While breastfeeding is a natural act, it is also a learned behaviour. An extensive body of research has demonstrated that mothers and other caregivers require active support for establishing and sustaining appropriate breastfeeding practices. WHO and UNICEF launched the Baby-friendly Hospital Initiative in 1992, to strengthen maternity practices to support breastfeeding. The foundation for the BFHI are the Ten Steps to Successful Breastfeeding described in Protecting, Promoting and Supporting Breastfeeding: a Joint WHO/UNICEF Statement. The evidence for the effectiveness of the Ten Steps has been summarized in a scientific review document.

The BFHI has been implemented in about 16.000 hospitals in 171 countries and it has contributed to improving the establishment of exclusive breastfeeding world-wide. While improved maternity services help to increase the initiation of exclusive breastfeeding, support throughout the health system is required to help mothers sustain exclusive breastfeeding.

WHO WHO and UNICEF developed the 40-hour Breastfeeding Counselling: A training course to train a cadre of health workers that can provide skilled support to breastfeeding mothers and help them overcome problems, both institutions have also developed a 5-day course on Infant and Young Child Feeding Counselling, to train health workers so they become competent and able to promote appropriate breastfeeding, complementary feeding and feeding of infants in the context of HIV.

Basic breastfeeding support skills are also part of the 11-day Integrated Management of Childhood Illness training course for first-level health workers, which combines skills for adequate case management with preventive care. Evaluation of breastfeeding counselling delivered by trained health professionals as well as community workers has shown that this is an effective intervention to improve exclusive breastfeeding rates.

The Global Strategy for Infant and Young Child Feeding describes the essential interventions to promote, protect and support exclusive breastfeeding.


Amounts of foods to offer

Age Texture Frequency Amount at each meala
6–8 months Start with thick porridge, well mashed foods
Continue with mashed family foods
2–3 meals per day, plus frequent breastfeeds
Depending on the child’s appetite, 1–2 snacks may be offered
Start with 2–3 tablespoonfuls per feed, increasing gradually to ½ of a 250 ml cup
9–11 months Finely chopped or mashed foods, and foods that baby can pick up 3–4 meals per day, plus breastfeeds
Depending on the child’s appetite, 1–2 snacks may be offered
½ of a 250 ml cup/bowl
12–23 months Family foods, chopped or mashed if necessary 3–4 meals per day, plus breastfeeds
Depending on the child’s appetite, 1–2 snacks may be offered
¾ to full 250 ml cup/bowl
a Note: If baby is not breastfed, give in addition: 1–2 cups of milk per day, and 1–2 extra meals per day