Infant and Young Child Feedingin Emergencies. Operational Guidance.
VERSION 3.0 – UPDATEThe Operational Guidance on IFE
AimTo provide concise, practical guidance on how to ensure appropriate infant
and young child feeding in emergencies (IFE)

ScopeApplies to emergency preparedness, response and recovery worldwide

Target Groups

Infants and young children aged 0-23 months and pregnant and lactating
women (PLW)Intended for

Policy-makers, decision-makers and programmers working in emergency
preparedness, response and recovery across sectors and disciplines.

Version 3
Updated by:
Co-led:Coordinated by:Funded by:

The IFE Core Group
ENN and UNICEF
ENN
USAID/OFDA (ENN)

2001

2006

2007

2010

2017

Version 1.0

Version 2.0

Version 2.1

Addendum

Version 3.0

V 3.0 Process
March 2016

• IFE Core Group
Meeting:
Interviewfindings shared,
gaps in contentand processagreedFeb 16 – Sept 17

Dec 2017• Consultation

IFE CoreGroup

Experts

Experiences &resources
SPHERE• IFE Core Group
Meeting:
Dissemination& roll out
action planV 3.0 What has stayed the same?
• Layout• Headings• Most of existingguidance• Terminology of IFE• Availability in English,
French and Arabic

KEY POINTSPRACTICAL STEPS (1 – 6)
1. Endorse or develop policies
2. Train staff
3. Co-ordinate operations
4. Assess and monitor
5. Protect, promote and support optimal IYCF with integrated
multi-sector interventions
6. Minimise the risks of artificial feeding

EMERGENCY PREPAREDNESS ACTIONS  New
KEY CONTACTSREFERENCES  Expanded
DEFINITIONS  Expanded
ANNEX 1: Multi-sectoral content  New
ACRONYMS  New

V 3.0 Revisions - Programming• Updated to reflect latest global guidance (published and upcoming)• Greater programmatic detail in all sections• Greater and more balanced content to address needs of non-breastfed infants• More comprehensive content on complementary feeding• Introduction of new concepts e.g. human milk banks• Considers situations where OG-IFE recommendations cannot be immediately met• More content on emergency preparedness• Summary key points updated

V 3.0 Revisions – Roles & Responsibilities• Greater emphasis on the lead role of government in preparedness and response• Greater clarity on the respective roles and responsibilities of UN agencies• Greater coverage of sectors beyond nutrition and more explicit actions to take
• Incorporated accountability to affected populations• Reflects significantly evolved operational environmentV 3.0 Revisions – References, Resources, Terminology• More extensive list of supporting references and resources• Greater referencing of recommendations and definitions• More extensive list of definitions• Changes, and additions, to terminology• Optimal IYCF → Recommended IYCF
• HIV Risk Assessment• Donor Human Milk
• Human Milk Bank
• Cluster Lead Agency• Lipid-based nutrient supplement (LNS)1: Endorse or develop policies
Key provisions regarding IFE should be reflected in government, multi-sector and agency
policies and should guide emergency responses.

2: Train staff
Sensitisation and training on IFE is necessary at multiple levels and across sectors.

3: Coordinate operations
Capacity to coordinate IFE should be established in the coordination mechanism for every
emergency response. Government is the lead IFE coordination authority. Where this is notpossible or support is needed, IFE coordination is the mandated responsibility of UNICEF
or UNHCR, depending on context, in close collaboration with government, other UN
agencies and operational partners.
Where all provisions of OG-IFE cannot be immediately met, context-specific guidance on
appropriate actions and acceptable ‘compromises’ should be provided by the IFE
coordination authority and mandated UN agencies.
Timely, accurate and harmonised communication to the affected population, emergency
responders and the media is essential

4: Assess & Monitor
Needs assessment and critical analysis should determine a context specific IFE response▪ Pre-crisis data
▪ Rapid decision-making and action▪ Early needs assessment▪ In depth assessment▪ Monitoring
It is essential to monitor the impact of humanitarian actions and inaction on IYCF
practices, child nutrition and health; to consult with the affected population in planningand implementation; and to document experiences to inform preparedness and future
response.

5: Protect, promote and support optimal IYCF with integrated multi-sector interventions
Immediate action to protect recommended infant and young child feeding (IYCF) practices
and minimise risks is necessary in the early stages of an emergency, with targeted support
to higher risk infants and children▪ General▪ Breastfeeding support▪ Infants who are not breastfed – incl. relactation, wet nursing, donor human milk, BMS▪ Complementary feeding▪ Micronutrient supplementation▪ HIV and infant feeding▪ Infectious disease outbreaks

5: Protect, promote and support optimal IYCF with integrated multi-sector interventions

In every emergency, it is necessary to assess and act to protect and support the nutritionneeds and care of both breastfed and non-breastfed infants and young children. It is
important to consider prevalent practices, the infectious disease environment, culturalsensitivities and expressed needs and concerns of mothers/caregivers when determining
interventions

In every emergency, it is important to ensure access to adequate amounts of appropriate,
safe, complementary foods and associated support for children and to guarantee
nutritional adequacy for pregnant and lactating women.

5: Protect, promote and support optimal IYCF with integrated multi-sector interventions
Multi-sector collaboration is essential in an emergency to facilitate and complement
direct infant and young child feeding (IYCF) interventions. Actions are included for:HealthAdolescentServices

WASH

FSLChildProtection

ECD

Disability

ShelterCashSocialProtection

Agriculture

Logistics

WASH: Water, Sanitation and Hygiene, FSL: Food Security and Livelihoods, ECD: Early Childhood Development

6: Minimise the risks of artificial feeding
In emergencies, the use of breastmilk substitutes (BMS) requires a context-specific,
coordinated package of care and skilled support to ensure the nutritional needs of nonbreastfed children are met and to minimise risks to all children through inappropriate use▪ Donations in emergencies▪ Artificial feeding management▪ BMS supplies▪ BMS specification▪ Procurement of BMS supplies, feeding equipment and support▪ Distribution of BMS
Donations of BMS, complementary foods and feeding equipment should not be sought or
accepted in emergencies; supplies should be purchased based on assessed need. BMS,
other milk products, bottles and teats should never be included in a general distribution.

Emergency preparedness…is critical to a timely, efficient and appropriate IFE response
Examples from Box 1: Emergency Preparedness Actions
POLICYTRAINING

COORDINATION

Develop preparedness plans on IFE Prepare orientation material foruse in early emergency response

Develop terms of reference for IFE
coordination in a response

ASSESS AND MONITORARTIFICIAL FEEDING

MULTI-SECTOR INTERVENTIONS

Prepare key questions to include in Examine national legislation
early needs assessment
related to food and drugs,
particularly importation

Communicate government
position on not seeking or
accepting donations

**INSTRUCTION SLIDE**
The following slides cover implications of the revisions in the Operational Guidance on
IFE for stakeholders involved with HEALTH in emergencies.
Slides on HIV and Mental Health and Psychosocial Support (MHPSS) are available
separately.
Please delete slides that are not applicable to your audience and cross reference tointernal documents and processes where relevant.

Implications for…Health
Health is a key sector to sensitise and work with on IYCF.
5.30 Key sectors and disciplines to sensitise and work with on IYCF include health(reproductive health; MNCH; MHPSS; HIV; infectious disease management); adolescentservices; WASH; FSL; child protection; ECD; disability; shelter; cash transfer programmes;
social protection; agriculture; camp coordination and camp management; and logistics.
5.31 Sector programme entry points for IYCF include: antenatal and postnatal care;immunisation; growth monitoring; prevention of mother-to-child transmission (PMTCT)
programmes; HIV prevention and treatment services, acute malnutrition treatment;
community health; psychosocial counselling services; hygiene promotion; child protection
screening; ECD activities; places of employment; and agriculture extension work.

Implications for…Health5.32 Examples of two-way multi-sector collaboration include:• Enable access of pregnant women to skilled antenatal care and other necessary
health services, including MHPSS.
• Integrate IYCF support and/or establish referral systems with reproductive, MNCH
and adolescent health services; curative health services; acute malnutrition
treatment; HIV; and child protection services. Include minimum/initial service
packages offered by different sectors.
• Work with HIV prevention and treatment services to support access and adherence
to ART

Implications for…HealthPolicy
1.1 Governments and agencies should have up-to-date policies which adequately
address all of the following elements in the context of an emergency: protection,promotion and support of breastfeeding; the management of artificial feeding;complementary feeding; the nutrition needs of PLW; compliance with theInternational Code of Marketing of Breastmilk Substitutes (BMS) and subsequent
relevant World Health Assembly (WHA) Resolutions (the Code); prevention andmanagement of donations of BMS; and infant feeding in the context of public healthemergencies and infectious disease outbreaks. Additional context-specific provisions
may be necessary, such as for refugees or internally displaced persons (IDP).
Provisions may exist as a standalone policy and/or may be integrated into otherrelevant policies. UNICEF and WHO have key responsibilities in supporting
national/sub-national policy preparedness.

Implications for…HealthTrain Staff
2.3 Adapt and prioritise training content to address identified needs, cultural
expectations and personal experiences of mothers and staff; capacity gaps; thetarget audience; and time available. More specialist capacity to counsel mothers
and infants with heightened needs, such as stressed or traumatised mothers,
malnourished infants and mothers, low birth weight (LBW) infants and disabled
infants with feeding difficulties, may be needed. At a minimum, staff in contact withmothers and children aged under two years should be trained to be sensitive to
psychosocial issues, on nutrition screening, and on referral pathways to more
specialist support.

Implications for…Health
Coordinate Operations
3.4 The level of coordination, including whether a dedicated IFE coordinator isnecessary, will depend on the context. Wherever possible, support government tofulfil their IFE coordination responsibility and work with existing country-levelstructures and mechanisms. Identify or locate IFE coordination capacity within themost relevant sector coordination mechanism, such as nutrition, health or foodsecurity.
3.6 Coordinate with other sectors to identify opportunities for multi-sector
collaboration in needs assessment and programming and to inform sector policies,
actions plans and risk management regarding IFE. Actively participate in relevant
sector or cluster co-ordination meetings.

Implications for…Health
4.2 Explore opportunities to include IYCF questions in other sector needs
assessments and draw on relevant multi-sector data.

Pre-crisis data and early needs assessment
4.6.1 Key information to consider includes contextual data:
Health environment, including support offered by providers of antenatal,delivery and postnatal services; age and morbidity profile of admissions toacute malnutrition treatment programmes; infectious disease morbidity rates;
crude mortality rate (CMR), infant mortality rate (IMR) and under-five mortalityrate (U5MR); coverage of antiretroviral treatment (ART); and support offered bysocial services and social protection mechanisms.

Implications for…HealthProtect, promote and support optimal infant and young child feeding withintegrated multi-sector interventions
5.4 Establish accessible IYCF support services to provide for higher risk infants, young
children and mothers, such as orphans, unaccompanied children, infants who are notbreastfed; children with disabilities that affect feeding or whose caregivers aredisabled; mothers in detention; children whose mothers are ill; adolescent mothers;premature infants; LBW infants; and children and/or mothers who are acutelymalnourished.

Implications for…Health
Breastfeeding support
5.7 Protect, promote and support early initiation of exclusive breastfeeding in all
newborn infants. Integrate the Ten Steps to Successful Breastfeeding of theWHO/UNICEF Baby-friendly Hospital Initiative in maternity services. Key newborn
health interventions include:• skin-to-skin contact• kangaroo mother care• ‘rooming in’ (keeping mothers and infants together)• delayed umbilical cord clamping.
Limit supplementation with BMS to medical needs.

Implications for…Health
Breastfeeding support
5.7 Target support to mothers of premature and LBW infants, adolescent mothers andfirst-time mothers.
Ensure access to HIV services as appropriate, including nutritional support whenindicated.
Ensure birth registration of newborns within two weeks of delivery and coordinate
with other sectors (such as health, food security and social protection) to facilitate
access to support services.
Use and build existing capacity (such as traditional birth attendants, midwives andpeers) to provide skilled breastfeeding support.

Implications for…Health
Infants who are not breastfed
5.10 In all emergencies, intervene to protect and support infants and children
who are not breastfed to meet nutritional needs and minimise risks. The
consequences of not breastfeeding are influenced by the age of the child (theyoungest are most vulnerable); the infectious disease environment; access toassured supplies of appropriate BMS, fuel and feeding/cooking equipment; andWASH conditions.

Implications for…Health
Infants who are not breastfed
5.16 BMS requirement may be temporary or longer term. Temporary BMS indications
include: during relactation; transition from mixed feeding to exclusive breastfeeding;short-term separation of infant and mother; short-term waiting period until wet nurse
or donor human milk is available. Longer-term BMS indications include: infant notbreastfed pre-crisis; mother not wishing or unable to relactate; infant established onreplacement feeding in the context of HIV; orphaned infant; infant whose mother isabsent long-term; specific infant or maternal medical conditions; very ill mother;
infant rejected by mother; a rape survivor not wishing to breastfeed.

Implications for…Health
Micronutrient Supplementation
5.29 For children aged 6-59 months, multiple-micronutrient supplements may be necessary to meet
nutrition requirements where fortified foods are not being provided, in conjunction with otherinterventions to improve complementary foods and feeding practices.
In malaria-endemic areas, the provision of iron in any form, including MNPs, should be implemented inconjunction with measures to prevent, diagnose and treat malaria. Provision of iron through theseinterventions should not be made to children who do not have access to malaria prevention strategies;
prompt diagnosis of malaria illness; and treatment with effective antimalarial drug therapy.
Vitamin A supplementation is recommended for children aged 6-59 months.

For PLW, iron and folic acid or multiple-micronutrient supplementation should be provided inaccordance with the latest guidance.

Implications for…Health
Infectious disease outbreaks
5.40 Anticipate and assess the impact of human and animal infectious disease
outbreaks on IYCF, such as interrupted access to health and feeding support services;
deterioration in household food security and livelihoods; transmission risks via
breastfeeding; and maternal illness and death. Take actions to mitigate risks. Interim
guidance may be necessary to address unanticipated IYCF consequences in outbreaks,
such as Ebola virus and Zika virus. Consult WHO for up-to-date advice.

Implications for…HealthProtect, promote and support optimal infant and young child feeding withintegrated multi-sector interventions
For more information on how to work together to jointly achieve shared objectives:
1. Go to: Operational Guidance on IFE V3.0 Resources – Health
2. Watch:
IYCF Framework

**INSTRUCTION SLIDE**
The following slides cover implications of the revisions in the Operational Guidance onIFE for stakeholders involved with Early Childhood Development in emergencies.
Please delete slides that are not applicable to your audience and cross reference tointernal documents and processes where relevant.

Implications for…Early Childhood Development
ECD is a key discipline to sensitise and work with on IYCF.
5.31 Sector programme entry points for IYCF include: antenatal and postnatal care;immunisation; growth monitoring; prevention of mother-to-child transmission(PMTCT) programmes; HIV prevention and treatment services, acute malnutrition
treatment; community health; psychosocial counselling services; hygiene promotion;
child protection screening; ECD activities; places of employment; and agriculture
extension work.

Implications for…Early Childhood Development
5.32 Examples of two-way multi-sector collaboration include:
Integrate ECD into IYCF support at facility and community levels andexplore opportunities to incorporate IYCF elements into ECD

See References Section 8.6 Multi-sector Interventions – Early Childhood Development

INSTRUCTION SLIDE
You may find it useful to have a discussion on how the revised guidance can be dissemination withinyour working group / cluster / agency etc.
Suggestions have been made for roll out at:
1.

Individual agency level

2.

National level3.

Regional level

Select the appropriate slide. Suggested roll out actions will have to be contextualised prior topresenting. Following the discussion, it is recommended to set SMART objectives and work out atimeline to implement the recommended roll-out actions. Consider what resources are required tosupport the roll-out.

Recommendations for dissemination (Agency)• Wide dissemination of Ops Guidance on IFE within <agency>• What does this mean for you and your agency? Roles, responsibilities, agency activities,
programming, strategies, position papers etc.

• Training for technical staff from health, nutrition and other sectors• Sensitisation for all staff including senior management and communication, logistics,resource mobilization, rapid response and volunteer teams• Inclusion of V 3.0 in induction reading materials, agency resource libraries, training
materials etc.
• Dissemination and roll out to regional, country and field offices• Update training materials

Recommendations for dissemination(National/Cluster)• Wide dissemination to <NiEWG / nutrition cluster members, all other sectors, intercluster,
relevant government agencies and authorities, advocacy groups, policymakers>• What does this mean for you? Preparedness and response plans, roles and responsibilities etc.
• Dissemination of / sensitisation on update• Translation of Operational Guidance on IFE text into local language• Adaptation of Operational Guidance on IFE to local context• Incorporation of V 3.0 revisions into national guidance & policy• Inclusion into background reading materials

Recommendations for dissemination (Regional)• Wide dissemination of Ops Guidance on IFE at <regional level>• What does this mean for you? Preparedness and response plans, roles and responsibilities etc.
• Training and sensitisation for regional offices• Translation into regional languages• Dissemination to country offices• Incorporation of V3.0 updates into regional strategies, funding etc.

Appropriate and timely support of infant and young child feedingin emergencies (IFE) saves lives, protects child nutrition, healthand development and benefits mothers.