developed through collaboration of:
ENN, IBFAN, Terre des hommes, UNICEF, UNHCR, WHO, WFP.
Kent Page, UNICEF, DRC, 2003.
Mae La camp, Thailand, O. Banjong, 2001.
Guatemala/LINKAGES, Maryanne Stone-Jimenez.
M. Jakobsen, Guinea Bissau, 1987.
The development of this training material would not have been possible without the contributions of time and effort of nutrition and health professionals too numerous to mention. This document draws on existing best practice and published evidence where it exists. Where it does not it draws on extensive experience and a broad base of expert opinion.
This document is the product of interagency collaboration among the following agencies which provided resources in terms of staff time, financial support or both:
Emergency Nutrition Network
IBFAN - represented by its Regional Coordinating Office in Geneva (GIFA)
Fondation Terre des hommes, Lausanne, Suisse
This material is not a formal publication of any of the agencies mentioned above and should be considered a 'living document' for use, comment and further development, and will be updated as necessary.
Comments, additional inputs and experiences of using this material are welcome and should be sent to ENN at the address below.
The online version is available on the ENN website, http://www.ennonline.net.
Print copies will be made available and should be requested from ENN at the address below.
Emergency Nutrition Network (ENN), Unit 13, Standingford House, Oxford, OX4 1BA, UK.
Tel/fax: +44 (0)1865 722886
Feeding with breastmilk substitutes.
Breastmilk substitutes (BMS):
Any food being marketed or otherwise represented as a partial or total replacement of breastmilk, whether or not suitable for that purpose; in practical terms this includes milk or milk powder marketed for children under 2 years and complementary foods, juices and teas marketed for children under 6 months.
Complementary feeding (previously called "weaning"):
The giving of complementary foods in addition to breastmilk or infant formula.
Any food, whether commercially manufactured, or locally, or home-prepared, suitable as a complement to breastmilk or infant formula when either becomes insufficient to satisfy the nutritional requirements of the infant (from the age of 6 months). Complementary foods marketed for children under 6 months are breastmilk substitutes. Note: complementary foods should not be confused with supplementary foods which are commodities intended to supplement a general ration and used in emergency feeding programmes for the prevention and reduction of malnutrition and mortality in vulnerable groups.
Commercial baby foods (industrially-formulated complementary foods):
Branded jars or packets of semi-solid or solid foods, teas and juices.
Only breastfeeding or breastmilk feeding and no other foods or fluids (no water, no juices, no tea, no pre-lacteal feeds), with the exception of drops or syrups consisting of micronutrient supplements or medicines.
Children less than 12 months.
Infant feeding equipment:
Bottles; teats; syringes (usually in an institutional setting); or baby cups sometimes fitted with lids.
A breastmilk substitute formulated industrially in accordance with Codex Alimentarius Standards (joint FAO/WHO food standards programme) to satisfy the normal nutritional requirements of infants up to six months of age. Infant formula may also be prepared at home in which case it is described as "home-prepared".
The International Code:
The International Code of Marketing of Breast-Milk Substitutes, adopted by the World Health Assembly (WHA) in 1981 and all relevant WHA Resolutions, referred to here as "the International Code" (4). The aim of the International Code is to contribute to the provision of safe and adequate nutrition for infants by the protection and promotion of breastfeeding and by ensuring the proper use of breastmilk substitutes (see definition above) when these are necessary, on the basis of adequate information and through appropriate marketing and distribution. The Code and all relevant WHA Resolutions set out the responsibilities of the infant food industry, health workers, national governments and concerned organisations in relation to the marketing of breastmilk substitutes, bottles and teats.
Optimal infant and young child feeding:
Exclusive breastfeeding for the first six months of life, followed by continued breastfeeding with adequate complementary foods for up to two years and beyond.
Dried whole, semi-skimmed or skimmed milk; liquid whole, semi-skimmed or skimmed milk; soy milks.
The re-establishment of breastfeeding after the breastmilk supply has stopped, or is reduced.