Feeding in exceptionally difficult circumstances

WHO recommends exclusive breastfeeding for six months, and sustained breastfeeding with appropriate complementary foods up to two years or beyond. Families in difficult circumstances require specially attention and practical support to be able to feed their children adequately. In such cases, the likelihood of not breastfeeding increases, due to the dangers of artificial feeding and inappropriate complementary feeding. Where-ever possible, mothers and babies should remain together and be provided the support they need to exercise the most appropriate feeding option under the circumstances.

Difficult circumstances refer to situations faced by particularly vulnerable groups such as:

  • HIV-infected mothers and their infants
  • People suffering the consequences of complex emergencies, including natural or human-induced disasters such as floods, drought, earthquakes, war, civil unrest and severe political and economic living conditions.
  • Low birth-weight or premature infants
  • Infants and young children who are malnourished
  • Adolescent mothers and their infants
  • Children living in special circumstances such as foster care, or with mothers who have physical or mental disabilities, or children whose mothers are in prison or are affected by drug or alcohol abuse.

WHO is working on technical guidelines and materials for infant and young child feeding for vulnerable groups, in particular as it relates to HIV and infant feeding, infant feeding in emergency situations, feeding of malnourished children and feeding low-birth weight and premature infants.

The contribution of breastfeeding to mother-to-child transmission of HIV is an area of considerable concern. Evidence shows that up to 20% of infant born to HIV-infected mothers may acquire HIV through breastfeeding, depending on duration and other risk factors. Recent studies indicate a heightened risk of transmission during the early months. However, evidence from one study shows that exclusive breastfeeding in the first three months of life may carry a lower risk of HIV transmission than mixed feeding does. WHO is supporting research to estimate risks of transmission associated with exclusive breastfeeding and early cessation, as well as to develop interventions to ensure safe replacement feeding. Pending new information, the UNICEF/UNAIDS/WHO guidelines issued in 1998 remain valid. For more information on available guidelines and tools, please refer to the page on HIV and Infant Feeding.

Two training modules on Infant feeding in emergencies are being developed as a joint effort by WHO, UNICEF, UNHCR, WFP and international NGOs. A working draft of Module 1, intended for all emergency relief staff, is available. A more detailed module for relief workers caring for mothers and children is under development.

Children who are malnourished are often found in environments where improving the quality and quantity of food intake is particularly problematic. They need extra attention both during early rehabilitation and over the longer term. For infants and young children, continued frequent breastfeeding and, when necessary, relactation are important measures. Guidelines on the management of malnutrition are part of the manual Management of the Child with a serious infection or severe malnutrition, which can be used for improving the quality of care in first-referral level facilities.

Related documents

HIV and Infant feeding

Infant feeding in emergencies

More information