Breastfeeding is the natural way to feed infants and young children. Exclusive breastfeeding for the first six months of life ensures optimal growth, development and health. After that, breastfeeding, with appropriate complementary foods, continues to contribute to the infant’s and young child’s growth, development and health. Low rates and early cessation of breastfeeding have important adverse health, social and economic implications for women, children, the community and the environment, result in greater expenditure on national health care provision, and may increase inequalities in health. Despite difficulties in interpreting available data, it is clear that current initiation, exclusivity and duration rates of breastfeeding in virtually every country worldwide, including EU countries, fall short of recommended levels. In some EU countries, initiation rates are very low, but even in countries where they are high, there is a marked fall-off in the first six months and throughout most of Europe the exclusive breastfeeding rate at six months is low. The most common identified barriers to the initiation and continuation of breastfeeding include:
- insufficient coverage and quality of prenatal education on infant and young child feeding;
- suboptimal maternity hospital policies and practices;
- lack of timely follow-up and competent support;
- misinformation and lack of guidance and encouragement from health workers;
- lack of or poor implementation of the International Code of Marketing of Breastmilk Substitutes;
- early return to work in the absence of workplace facilities and support for breastfeeding;
- lack of family and broad societal support; and, in some countries,
- media portrayal of formula feeding as the norm.
Appropriate complementary feeding and transition towards a well balanced diet of nourishing family foods are also important for the growth, development and health of young children. The Green Paper recently issued by the European Commission recognises that “important lifestyle choices pre-determining health risks at adult age are made during childhood and adolescence; it is therefore vital that children be guided towards healthy behaviours”.Promoting healthy eating behaviours in young children is acknowledged, with the promotion of physical activity, as one of the main interventions for the control of the current epidemic of obesity.
The aim of this document is to provide recommendations that will inform all health workers – whether in primary health care, in hospitals or other community health care settings – caring for parents and children during pregnancy, childbirth and in the first three years of life, of the best evidence-based practices to protect, promote and support optimal feeding of infants and young children in their different work settings. The document concentrates on what health workers should do rather than detailing how the recommendations should be implemented, as the latter will depend on local structures, capacities and circumstances. In addition to the standard practice guidelines, the document includes four annexes. These present a supportive standard policy and details on situations where breastfeeding may be contraindicated, on the risks of a decision not to breastfeed, and on safe alternative feeding.
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