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Core Commitments

for Children

are the core UNICEF policy and framework for humanitarian action

NUTRITION

Introduction

  • Children in middle childhood have access to community- and school-based package of interventions that includes at a minimum: iron supplementation, deworming prophylaxis[58], nutrition education, counselling and support, according to context

  • Adolescent girls and boys have access to community- and school-based package of interventions that includes at a minimum: iron and folic acid supplementation, deworming prophylaxis, nutrition education, counselling and support, according to context

4. Prevention of undernutrition, micronutrient deficiencies, and anaemia in middle childhood and adolescence[56]

 

Children in middle childhood (5-9 years) and adolescent girls and boys (10-19 years) benefit from diets, practices and services that protect them from undernutrition, micronutrient deficiencies and anaemia[57]

Strategic Result

Children, adolescents and women have access to diets, services and practices that improve their nutritional status[51]

Commitment

Benchmarks

  • Nutrition cluster/sector coordination and leadership functions are adequately staffed and skilled at national and sub-national levels

  • Core leadership and coordination accountabilities are delivered

1. Leadership and coordination

 

Effective leadership and coordination are established and functional 

See 2.1.2 Coordination

  • Relevant data and evidence on the type, degree, extent, determinants and drivers of maternal and child malnutrition and of the groups most at risk are available

  • Multisectoral data and evidence guide timely decision-making, support monitoring, and enable course correction of preparedness and response

2. Information systems and nutrition assessments

 

Monitoring and information systems for nutrition, including nutrition assessments, provide timely and quality data and evidence to guide policies, strategies, programmes and advocacy

  • Caregivers of children aged 0-23 months are supported to adopt recommended infant and young child feeding (IYCF) practices, including both breastfeeding and complementary feeding[55]

  • Children aged 0-59 months have improved nutritional intake and status through age-appropriate nutrient-rich diets, micronutrient supplementation, home-fortification of foods and deworming prophylaxis, according to context

 3. Prevention of stunting[52], wasting[53], micronutrient deficiencies and overweight[54] in children aged under five years

 

Children aged under five years benefit from diets, practices and services that prevent stunting, wasting, micronutrient deficiencies and overweight 

  • Pregnant women and breastfeeding mothers - with special attention to pregnant adolescent girls and other nutritionally at-risk mothers – have access to a package of interventions that includes at a minimum: iron and folic acid/multiple micronutrient supplementation, deworming prophylaxis, weight monitoring, nutrition counselling, and nutrition support through balanced energy protein supplementation, according to context

5. Prevention of undernutrition[59], micronutrient deficiencies, and anaemia in pregnant women and breastfeeding mothers

 

Pregnant women and breastfeeding mothers benefit from diets, practices and services that protect them from undernutrition, micronutrient deficiencies and anaemia

  • All children aged under five years in affected areas are screened regularly for the early detection of severe wasting and other forms of life-threatening acute malnutrition and are referred as appropriate for treatment services

  • All children aged under five years suffering from severe wasting and other forms of life-threatening acute malnutrition in affected areas benefit from facility- and community-based services that provide effective treatment assuring survival rates >90%, recovery rates >75% and default rates <15%[60]

6. Nutrition care for wasted children

 

Children aged under five years benefit from services for the early detection and treatment of severe wasting and other forms of life-threatening acute malnutrition in early childhood

  • National and sub-national systems delivering health, water and sanitation, education, child and social protection are supported to:

    • align their policies, programmes and practices with internationally agreed standards and guidance on nutrition

    • deliver evidence-based interventions with a workforce supported in their knowledge, skills and capacity in nutrition

    • procure and deliver essential nutrition supplies in a timely manner through facility- and community-based platforms

7. System strengthening for maternal and child nutrition 

 

Services to prevent and treat malnutrition in children, adolescents and women are provided through facility- and community-based delivery mechanisms in ways that strengthen national and sub-national systems

 

See 2.2.4 Linking humanitarian and development

  • Children, adolescents, caregivers and communities are aware of available nutrition services and how and where to access them

  • Children, adolescents, caregivers and communities are engaged through participatory behaviour change interventions to improve their nutritional status

  • Caregivers and communities are supported and empowered to prevent malnutrition, as well as to identify and refer children with life-threatening forms of undernutrition

8.  Community engagement for behaviour and social change

 

At-risk and affected populations have timely access to culturally appropriate, gender- and age-sensitive information and interventions that promote the uptake of diets, services and practices and contribute to improve their nutritional status

 

See 2.2.7 Community engagement for behaviour and social change

Key Considerations

Advocacy

  • Advocate for the right of every child to adequate nutrition and the fulfilment of the CCCs with every stakeholder, using the CRC, the 2030 Agenda for Sustainable Development, SDG 2  and Security Council Resolution 2417 on conflict and hunger.

  • Advocate for the inclusion of nutrition in national policies, strategies, programmes and standards, including multi-year financing for nutrition programmes, supplies and equipment.

  • Advocate for the inclusion of ready-to-use therapeutic food (RUTF) in the national Essential Medicine Lists.

  • Advocate for the protection of breastfeeding from unethical marketing practices in line with the International Code on the Marketing of Breastmilk Substitutes, and subsequent World Health Assembly resolutions and international guidance. Discourage the donation of breastmilk substitutes or feeding equipment.

​

Coordination and Partnerships 

  • As Sector/Cluster Lead Agency for Nutrition, provide leadership for nutrition and support coordination of partners at national and sub-national levels. Support and engage intersectoral coordination mechanisms in particular with Health, Food Security and WASH Sectors/Clusters.

  • Establish and support functional technical working groups in technical areas relevant to the context. This may include Infant and Young Child Feeding, Nutrition of School-Age Children, Community-Based Management of Acute Malnutrition, Nutrition Information Systems, and Accountability to Affected Populations.

  • Initiate and enhance coordination for programming to prevent and treat malnutrition among UN agencies supporting nutrition, including FAO, UNHCR, WFP and WHO.

  • Manage and mitigate risks when engaging with the private sector, including the food and beverage industry, by adhering to organizational and sectoral guidance on private sector engagement.

 

Quality Programming and Standards

  • Foster multisectoral and integrated response and geographic convergence in Nutrition, Health, WASH, Education, Child Protection, Social Policy and cross-cutting sectors[61].

  • Establish safe spaces for feeding and responsive care and promote linkages with Child Protection.

  • Design, deliver and monitor nutrition programmes according to the quality standards described in the most up to date UNICEF guidance à See Annex 2 – References

  • Place a deliberate focus on the most marginalized children and women to reduce inequities (right in principle) and improve impact on the most vulnerable groups (right in practice). All forms of malnutrition are increasingly concentrated among the poorest and most marginalized children, adolescents, women and households.

  • Procure ready-to-use infant formula for infants who cannot be breastfed, or are mixed fed, with priority given to infants under six months old in line with UNICEF Guidance on the provision and use of breastmilk substitutes in humanitarian settings.

  • Systematically engage with communities to implement preparedness, preventive and response activities at community level, including the promotion of positive practices such as optimal infant and young child feeding, access to and adoption of healthy diets, routine immunization and micronutrient supplementation, and early detection and treatment of severe wasting and other forms of life-threatening acute malnutrition.

  • Work with GBV actors to reduce risks of GBV related to nutrition programmes. If there are no GBV actors available, train nutrition staff on the GBV Pocket Guide.

  • Include the needs of children with disabilities and their caregivers in assessments and the design of preparedness and response actions for nutrition.

  • Using safe and confidential feedback and reporting mechanisms based on affected populations’ preferred methods of communication, systematically use their views to review, inform and correct nutrition interventions.

  • Ensure that children, adolescents, caregivers and communities participate in decisions that affect their lives and have access to safe and confidential complaints mechanisms.

​

Linking Humanitarian and Development

  • Establish, strengthen and invest in information and monitoring systems, including policies, tools and databases for sex-, age- and disability-disaggregated data for nutrition, and end-user monitoring.

  • Embed emergency preparedness and response actions in development coordination platforms, including the Scaling Up Nutrition movement.

  • Develop risk-informed systems and programmes and support government and partner capacity at national and sub-national levels through skill transfer.

  • Strengthen nutrition supply chains to improve integrated forecasting, costing, procurement, storage (including contingency stocks), delivery and end-user monitoring of nutrition commodities.[62] 

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Footnotes

[51] The nutrition situation of children, adolescents and women is determined by their diets (e.g. breastfeeding and age-appropriate nutrient-rich foods, with safe drinking water and household food security at all times), the quality of the nutrition services they benefit from (e.g. services that protect, promote and support good nutrition) and their nutrition practices (e.g. age-appropriate feeding, dietary and hygiene practices). 

[52] Stunting in children 0-59 months is defined as a height-for-age below -2 SD (standard deviation) from the WHO Child Growth Standards median for a child of the same age and sex. Moderate stunting is defined as below -2 SD and greater than or equal to -3 SD. Severe stunting is defined as below -3 SD.

[53] Wasting in children 0-59 months is defined as a weight-for-height below -2 SD from the WHO Child Growth Standards median for a child of the same height and sex. Moderate acute malnutrition (MAM) is defined by moderate wasting (weight-for-height below -2 and above or equal

to -3 SD) and/or (in the case of children 6-59 months) mid-upper-arm-circumference (MUAC) of less than 125mm and above or equal to 115mm. Severe acute malnutrition (SAM) is defined by the presence of severe wasting (weight-for-height below -3 SD) bilateral pitting oedema (kwashiorkor) and/or (in the case of children 6-59 months) a MUAC of less than 115mm.

[54] Overweight in children aged 0-59 months is defined as a weight-for-height above +2 SD from the WHO Child Growth Standards median for a

child of the same height and sex. Severe overweight (above +3 SD) is referred to as obesity. 

[55] Infant and Young Child Feeding (IYCF) refers to the feeding of infants and young children aged 0-23 months. IYCF programmes focus on the

protection, promotion and support of early initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months of life, timely introduction of diverse complementary foods and age appropriate complementary feeding practices along with continued breastfeeding for two years or beyond.

[56] Undernutrition among adolescents includes stunting and underweight or thinness. In adolescence, underweight or thinness is defined as Body Mass Index (BMI)-for-age Z-score below –2 SD from the 2007 WHO Growth Reference Standard for Children and Adolescents (5-19 years). Severe thinness is defined as BMI-for-age Z-score below –3 SD. Stunting is defined as height-for-age below -2 SD. Severe acute malnutrition in adolescents aged 10–14 years is defined by a MUAC of less than 160 mm and signs of severe visible wasting or bilateral pitting oedema.

[57] Anaemia classified on the basis of the WHO recommended cut-offs for haemoglobin concentrations as follows: haemoglobin levels g/l:

children 5–11 years ≥115 (no anaemia) 110–114 (mild) 80–109 (moderate) <80 (severe); children 12–14 years ≥120 (no anaemia), 110–119 (mild) 80–109 (moderate), <80 (severe); non-pregnant women 15 years and above ≥120 (no anaemia), 110–119 (mild) 80–109 (moderate), <80 (severe). In settings where anaemia prevalence among children 5-12 years is 20% or higher, iron supplementation should be provided.

Similarly, in settings where anaemia prevalence among menstruating adolescent girls 10-19 years is 20% or higher, iron and folic acid supplementation should be provided to adolescents.

[58] In areas where the baseline prevalence of any soil-transmitted helminth infection is 20% or higher among children 5-12 years childhood and non-pregnant adolescent girls 10-19 years.

[59] For the purpose of this document, undernutrition in non-pregnant women of reproductive age is referred to as “thinness” and defined as having a BMI below 18.5 kg/m2. For girls (15-19 years), refer to footnote 56 on adolescents.

[60] Sphere standards state that the population of discharged individuals from treatment of severe acute malnutrition is made up of those who have recovered, died, defaulted or not recovered. The survival rate in this document refers to the total number of individuals who recover, default or do not recover divided by the total number discharged x 100. Recovery rate is calculated using the total number of individuals recovered divided by the total number discharged x 100. The default rate is calculated using the total number of individuals who defaulted divided by the total number discharged x 100.

[61] For example: Improving the diversity of children’s diets requires a food system that can produce a range of nutritious foods that are accessible and acceptable to families; a health system with well-trained staff at facility and community level to counsel caregivers on the benefits of consuming a diverse diet; a water and sanitation system that provides clean drinking water as part of a healthy diet and for the safe preparation of foods; and a social protection system that helps make nutritious foods affordable for the most vulnerable children and families.

[62] Including RUTF, supplies for therapeutic feeding centers, micronutrient supplements, deworming tablets, multiple micronutrient powders, height boards and weighing scales.

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