available for students. The Chapter is accompanied by a CD-ROM with reference materials. It includes an annotated listing of references presented in the Model Chapter, PowerPoint slides to support technical seminars on infant and young child feeding, and the document Effective teaching: a guide for educating healthcare professionals that can be used to identify effective methods and approaches to introduce the content. Proposed learning objectives and core competencies for medical students and allied health professionals in the area of infant and young child feeding are also part of the CD-ROM. 1 Growth, health and development Adequate nutrition during infancy and early childhood is essential to ensure the growth, health, and development of children to their full potential. Poor nutrition increases the risk of illness, and is responsible, directly or indirectly, for one third of the estimated 9.5 million deaths that occurred in 2006 in children less than 5 years of age (1,2) (Figure 1). Inappropriate nutrition can also lead to childhood obesity which is an increasing public health problem in many countries. Early nutritional deficits are also linked to long-term impairment in growth and health. Malnutrition during the first 2 years of life causes stunting, leading to the adult being several centimetres shorter than his or her potential height (3). There is evidence that adults who were malnourished in early childhood have impaired intellectual performance (4). They may also have reduced capacity for physical work (5,6). If women were malnourished as children, their reproductive capacity is affected, their infants may have lower birth weight, and they have more complicated deliveries (7). When many children in a population are malnourished, it has implications for national development. The overall functional consequences of malnutrition are thus immense. The first two years of life provide a critical window of opportunity for ensuring children’s appropriate growth and development through optimal feeding (8). Based on evidence of the effectiveness of interventions, achievement of universal coverage of optimal breastfeeding could prevent 13% of deaths occurring in children less than 5 years of age globally, while appropriate complementary feeding practices would result in an additional 6% reduction in underfive mortality (9). 1.2 The Global Strategy for infant and young child feeding In 2002, the World Health Assembly and UNICEF adopted the Global Strategy for infant and young child feeding (10). The strategy was developed to revitalise world attention to the impact that feeding practices have on the nutritional status, growth and development, health, and survival of infants and young children (see also Session 9). This Model Chapter summarizes essential knowledge that every health professional should have in order to carry out the crucial role of protecting, promoting and supporting appropriate infant and young child feeding in accordance with the principles of the Global Strategy. 1.3 Recommended infant and young child feeding practices WHO and UNICEF’s global recommendations for optimal infant feeding as set out in the Global Strategy are: K exclusive breastfeeding for 6 months (180 days) (11); K nutritionally adequate and safe complementary feeding starting from the age of 6 months with continued breastfeeding up to 2 years of age or beyond. Exclusive breastfeeding means that an infant receives only breast milk from his or her mother or a wet nurse, or expressed breast milk, and no other liquids or solids, not even water, with the exception of oral rehydration solution, drops or syrups consisting of vitamins, minerals supplements or medicines (12). Complementary feeding is defined as the process starting when breast milk is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. The target range for complementary feeding is generally taken to be 6 to 23 months of age,1 even though breastfeeding may continue beyond two years (13). These recommendations may be adapted according to the needs of infants and young children in exceptionally difficult circumstances, such as pre-term or low-birth-weight infants, severely malnourished children, and in emergency situations (see Session 6). Specific recommendations apply to infants born to HIV-infected mothers. 1.4 Current status of infant and young child feeding globally Poor breastfeeding and complementary feeding practices are widespread. Worldwide, it is estimated that only 34.8% of infants are exclusively breastfed for the first 6 months of life, the majority receiving some other food or fluid in the early months (14). Complementary foods are often introduced too early or too late and are often nutritionally inadequate and unsafe. Data from 64 countries covering 69% of births in the developing world suggest that there have been improvements in this situation. Between 1996 and 2006 the rate of exclusive breastfeeding for the first 6 months of life increased from 33% to 37%. Significant increases were made in sub-Saharan Africa, where rates increased from 22% to 30%; and Europe, with rates increasing from 10% to 19% (Figure 2). In Latin America and the Caribbean, excluding Brazil and Mexico, the percentage of infants exclusively breastfed increased from 30% in around 1996 to 45% in around 2006 (15). 1.5 Evidence for recommended feeding practices Breastfeeding Breastfeeding confers short-term and long-term benefits on both child and mother (16), including helping to protect children against a variety of acute and chronic disorders. The long-term disadvantages of not breastfeeding are increasingly recognized as important (17,18). Reviews of studies from developing countries show that infants who are not breastfed are 6 (19) to 10 times (20) more likely to die in the first months of life than infants who are breastfed. Diarrhoea (21) and pneumonia (22) are more common and more severe in children who are artificially fed, and are responsible for many of these deaths. Diarrhoeal illness is also more common in artificially-fed infants even in situations