Infant and Child Feeding Index is useful tool for reflecting nutritional status of young children

Introduction

In India, the NFHS-3 survey reported that 46% of children aged three years were underweight, 19% were wasted, and 38% were stunted. Infants and children up to the age of two are the most vulnerable section because they have higher requirements for energy- and nutrient- dense foods for proper growth, physical, and mental development. 

Faulty breastfeeding and poor feeding practices can result in undernutrition. Infant and young child feeding practices are age-specific and multidimensional. Researchers have developed an appropriate tool to determine overall child feeding practices. The Infant and Child Feeding Index are based on a scoring system which is age-specific.

Infant and Child Feeding Index Scoring

The components of Infant and Child Feeding Index are breastfeeding, no to bottle feeding, dietary diversity score, food group frequency score and feeding frequency score.

For breastfeeding, a score of 2 is given when infants in the age group 6 to 8 months and 9 to 11 months are breastfed and a score of 0 if they are not breastfed. For children aged between 12 to 17 months a score of 1 for breastfed children and 0 for non-breastfed children. Bottle feeding is a negative behavior, so a score of 1 is given if the child is not bottle fed and a score of 0 is given when the child is bottle fed. 24 – hour dietary recall was used for calculating Dietary diversity scores. The food group frequency score was assessed separately by using food frequency questionnaire, each food group was given a score of 0 when consumption during the past 7 days was nil, a score of 1 was given if consumed for less than 3 days and a score of 2 was given if consumed for more than equal to 4 days.

The scores were then summed up into a scale of 0 - 14 and new scores were then assigned. The score of 0 was given when less than two food groups were consumed for 6 - 8 months, and less than three food groups consumed for infants >9 months. A score of +1 was given to children who consumed 3 to 4 food groups for 6 - 8 months, four food groups for infants >9 months and a score of 2 was given to children who were fed more than equal to 5 food groups irrespective of children from different age groups. 

Feeding frequency scores were assessed for children from different age groups, +1 to children who were fed 2 times for 6 to 8 months old, 3 times for children above 9 months of age, and +2 was to children who were fed more than equal to 3 times for 6 to 8 months old and more than equal to 4 times for children above 9 months. For older children, an exception was for those who were given meal for more than equal to 5 times was given + 3. The Infant and Child Feeding Index score were then calculated by doing the addition of the scores.

Infant and Child Feeding Index and Nutritional Status 

Studies have confirmed that Infant and Child Feeding Index might reflect chronic and acute malnutrition among infants, but, the sensitivity is relatively low. Sensitivity is defined as the ability of the index to correctly identify the children as wasted, stunted and underweight when the score is less than 5. 

The Infant and Child Feeding Index reflects the quality of the complementary foods that is fed to children from urban slums using its components such as food frequency scores and dietary diversity scores. Among the components of Infant and Child Feeding Index, dietary diversity or variety scores and frequency of feeding meals or snacks were found to be positively associated with anthropometric indices. Infant and child feeding index was significantly associated with both weight-for-age and weight-for-length but was not associated with length-for-age. 

Other determinants that were associated with the nutritional status of children are identified as poor quality and low frequency of complementary foods that are fed to young children. Thus, improvement in components of Infant and Child Feeding Index including the quality of complementary foods needs attention mainly through appropriate interventions to improve infant complementary feeding practices and thus, nutritional status of the children aged less than two years.  

Conclusion

The Infant and Child Feeding Index tool is useful for collecting information on infant and young child feeding practices. It is the useful and important tool for public health programs to address the issues of complementary feeding and it can be used for monitoring purpose of bringing about change in infant feeding practices. Further, the impact of feeding practices on young children’s nutritional status can be determined by the Infant and Child Feeding Index tool.