Invisible pursuit: A scoping review of global policy guidance on care of vulnerable infants under 6 months and their mothers
Authors: McGrath Marie , Wrottesley Stephanie V. , Deconinck Hedwig 
Published: December 2024

ABSTRACTIntroductionMillions of infants worldwide are born vulnerable or become so in the first six months of life. These infants are at risk of poor growth and development, immediate and long-term ill-health, and increased mortality. The wellbeing of infants is intimately connected with the nutrition and health of their mothers, necessitating combined care.MethodsWe conducted a scoping review to investigate the nature and coherence of global policy guidance on the care of vulnerable infants u6m and their mothers, using the MAMI Care Pathway as a framework. Our iterative methodology identified 83 global policy documents, of which 34 (13 guidelines and 21 guidance documents) addressed vulnerable infants under 6 months and their mothers.ResultsWe first summarized common characteristics of policy guidance documents. Next, we identified 28 key vulnerability factors (descriptors) and grouped them into small and sick newborns, nutritional status of the infant, infant (breast)feeding difficulties and illness, and maternal lactation difficulties and illness. Finally, we identified 11 care dimensions whose coverage varied across the policies. Congenital illness was the most frequently identified vulnerability marker, followed by low birth weight, preterm birth, breastfeeding problems, maternal physical health, and maternal absence or death. The markers least often identified were the mother’s adolescent and anthropometry status and infant mental health. Infant growth was included in only three of 13 priority guidelines. Continuity of care was implied but lacked detail. Policies often focused on specific infant conditions rather than combined individual needs, and few addressed maternal aspects.DiscussionVulnerable infants under 6 months come in many forms. Multiple descriptors obscure what exists and what is missing in global policy guidance that impedes care continuity and cross-sector collaboration. Resourceful and innovative amalgamation of global guidance is needed at country level for feasible, efficient, and coherent person-centred delivery of care.KEY MESSAGESWhat is already known on this topic.Extensive global policy guidance exists for managing vulnerable infants under 6 months of age. However, the lack of clear coherence across policies and implementation strategies risk duplicating efforts and missing opportunities. The focus often remains on infants rather than mothers, and on specific conditions rather than personal needs. Diverse descriptors of vulnerability and unpredictable content make it challenging to navigate and apply policy guidance effectively.What this study adds.This scoping review unearthed consequential gaps. Guidance on vulnerable newborns lacks details on follow-up care beyond the early postnatal period. Infant growth as a marker of vulnerability is missing in key guidance. Maternal health is poorly covered.How this study might affect research, practice, or policy.Identified common ground in policy guidance present opportunities to align efforts to implement them using a person-centred lens. Policy coherence requires institutional commitment and accountability, connecting disciplines and country leadership to demystify and contextualise existing practices.