Facts for life_en_010810

• Safe Motherhood and Newborn Health
• Child Development and Early Learning
• Breastfeeding
• Nutrition and Growth
• Immunization
With advice on:
• Diarrhoea
• Malaria
• HIV
• Child Protection
and more...
Facts for LifeFourth Edition

Produced by UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and the World Bank,
Facts for Life can be found at www.factsforlifeglobal.org. The website will be updated
regularly and links to an interactive site for posting comments, sharing experiences and
materials and discussions on relevant issues.
First edition published in 1989 by UNICEF, WHO and UNESCO.
Second edition published in 1993 by UNICEF, WHO, UNESCO and UNFPA.
Third edition published in 2002 by UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and
the World Bank.
Fourth edition published in 2010 by UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP
and the World Bank.
Cover photo credits (from left to right):
© UNICEF/NYHQ2006-0081/Noorani
© UNICEF/NYHQ2006-2405/Markisz
© UNICEF/NYHQ2009-0716/Nesbitt
© UNICEF/NYHQ2004-1260/Pirozzi
© UNICEF/NYHQ2008-1512/Holtz
© UNICEF/NYHQ1993–0112/LeMoyne
© UNICEF/NYHQ2008-1279/Estey
© UNICEF/NYHQ2009-0690/Ramoneda
© United Nations Children’s Fund, NewYork, 2010
This publication may be reproduced for educational or non-proﬁt purposes without
permission from the copyright holder, providing acknowledgement of the source is made.
UNICEF would appreciate receiving a copy of any publication that uses FFL as a source.
Permission in writing is required to use FFL for any commercial purposes.
For permission, please contact:
UNICEF Division of Communication, Permissions
3 UN Plaza, NY, NY 10017, USA
Email: nyhqdoc.permit@unicef.org
ISBN: 978-92-806-4466-1
Sales number: No.: E.09.XX.24
Price: $15.00
United Nations Children’s Fund
3 United Nations Plaza
NewYork, NY 10017, USA
www.unicef.org
For any queries, please email fﬂ@unicef.org

ii Facts for Life
Facts for Life
CONTENTS
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii
Essential Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Guide for Using Facts for Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x
Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
The topics:
Timing Births . . . . . 1
Hygiene. . . . . . . . 109Diarrhoea . . . . . . . 89
Safe Motherhood
and Newborn
Health . . . . . . . . . .11
Malaria . . . . . . . . 121Coughs, Colds
and More Serious
Illnesses . . . . . . . .101

Facts for Life iii
Child Development
and Early
Learning . . . . . . . . 29
HIV . . . . . . . . . . . 129
Breastfeeding. . . . 47
Child
Protection. . . . . . 149
Nutrition
and Growth . . . . . 61
Injury
Prevention . . . . . 163
Immunization. . . . 77
Emergencies:
Preparedness and
Response . . . . . . 179

iv Facts for Life
Facts for Life
FOREWORD
Nearly 9 million children died in 2008 from preventable illnesses before reaching their fifth
birthday – more than two thirds of them during the first year of life. Millions more survive
only to face diminished lives, unable to develop to their full potential.
Five diseases – pneumonia, diarrhoea, malaria, measles and AIDS – together account for
half of all deaths of children under 5 years old. Undernutrition is a contributing cause of
more than one third of these deaths.
It is possible to save lives and greatly reduce human suffering by expanding low-cost
prevention, treatment and protection measures.The challenge is to ensure that this
knowledge is shared with parents, caregivers and communities, who are the first line of
defence in protecting children from illness and harm.
Facts for Life has been developed as a vital resource for those who need it most. It delivers
essential information on how to prevent child and maternal deaths, diseases, injuries
and violence.
Since Facts for Life was first released in 1989, countless families and communities around
the world have put its messages and guidance into practice.These efforts over the
years have contributed significantly to progress on key global indicators such as health,
education, life expectancy, and infant and maternal morbidity and mortality. Much can be
achieved by empowering families and communities to adopt behaviours that improve child
survival, growth, learning, development and protection, while also promoting children’s and
women’s rights.
The fourth edition of Facts for Life expands on previous editions and contains several
significant changes. For example, because of the inextricable link between the health of
the mother and the health of the child, a Newborn Health section has been included in the
Safe Motherhood chapter.
A chapter on Child Protection has also been added, which focuses on the vulnerabilities of
children and the actions needed to ensure that they grow up in supportive environments in
the home, school and community.

Facts for Life v
Facts for Life provides information to help save, improve and protect children’s lives, and
should be shared widely with families, health workers, teachers, youth groups, women’s
groups, community organizations, government officials, employers, trade unions, media,
and non-governmental and faith-based organizations.
Facts for Life is designed to educate those who have influence over the safety and well-
being of children.Through simple messages, it aims to bring life-saving knowledge to every
corner of the world.
Ann Veneman
Executive Director
Koïchiro Matsuura
Director-General
United Nations Educational, Scientific and Cultural
Organization
Helen Clark
Administrator
United Nations Development Programme
Josette Sheeran
Executive Director
World Food Programme
Margaret Chan
Director-General
World Health Organization
Thoraya Ahmed Obaid
Executive Director
United Nations Population Fund
Michel Sidibé
Executive Director
Joint United Nations Programme on HIV/AIDS
Graeme Wheeler
Managing Director
The World Bank

vi Facts for Life
Facts for Life aims to provide families and communities with the information they need to
save and improve the lives of children. Parents, grandparents, other caregivers and young
people can refer to this practical source of information for answers to their questions related
to childbearing and getting children off to the best start in life.The challenge is to ensure that
everyone knows and understands these facts and is motivated to put them into practice.
The messages contained in Facts for Life are based on the latest scientific findings by
medical and child development experts around the world.These facts are presented in
simple language so they can be understood and acted upon easily by people without a
scientific background. Doing so can save lives.
The Facts for Life messages are also based on human rights, particularly the Convention on
the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination
against Women.
The messages empower people to fulfil the rights of their children.They also are aimed
at enabling women, young people and children to exercise and speak out in favour of
their rights.
Everyone can help communicate the Facts for Life messages — health workers, teachers,
social workers, government officials, broadcasters, journalists, community workers,
religious and political leaders, mothers, fathers, grandparents, other family members,
friends, neighbours, students and people in all walks of life — young and old, men and
women, and girls and boys.
The Purpose of
FACTS FOR LIFE

Facts for Life vii
Facts for Life consists of 14 chapters ﬁlled with practical information about how to ensure
children’s rights to survival, growth, development and well-being.The topics address
pregnancy, childbirth, major childhood illnesses, child development, early learning,
parenting, protection, and care and support of children.
Each chapter has three parts: an introduction, key messages and supporting information.
THE INTRODUCTION is a brief ‘call to action’. It summarizes the extent of the problem and
the importance of taking action.The introduction aims to inspire people to get involved
and share this information widely. It can be used to motivate political leaders and the
mass media.
THE KEY MESSAGES, addressed to parents and other caregivers, are the essence of
Facts for Life. They contain the essential information that people need to protect their
children.The key messages are clear, brief and practical, so people can easily understand
them and take the recommended action.These messages are meant to be communicated
often and in various ways through multiple channels of communication.
THE SUPPORTING INFORMATION elaborates on each key message, providing additional
details and advice.This information is particularly useful for community-based workers,
health workers, social workers, teachers and families – anyone who wants to know more
about the survival, growth, development and protection of infants and children. It can be
used to answer questions from parents and other caregivers.
The Structure of
FACTS FOR LIFE

viii Facts for Life
1. The health of women1
and children can be significantly improved when births are
spaced at least two years between the birth of the last child and the beginning of the
next pregnancy. Health risks increase for both the mother and the child when pregnancy
occurs before age 18 or after age 35. Both men and women, including adolescents,
need to know about the health benefits of family planning so they can make
informed choices.
2. All pregnant women should visit a trained health worker for prenatal and post-natal
care, and all births should be assisted by a skilled birth attendant. All pregnant women
and their families need to know the warning signs of problems during and after
pregnancy and the options for seeking assistance.They also need to have plans and
resources for obtaining skilled care for the birth and immediate help if problems arise.
3. Children learn from the moment of birth.They grow and learn best when they receive
attention, affection and stimulation, in addition to good nutrition and proper health care.
Encouraging girls and boys equally to observe and express themselves and to play and
explore helps them learn and develop socially, physically, emotionally and intellectually.
4. Breastmilk alone is the best food and drink for an infant for the first six months of life.
After six months, infants need other nutritious foods, in addition to breastfeeding up to
two years and beyond, to meet their growth and development needs.
5. Poor nutrition during the mother’s pregnancy or the child’s first two years can slow a
child’s mental and physical development for life. Children need a well-balanced diet that
includes protein and energy foods as well as vitamins and minerals, such as iron and
vitamin A, to ensure good health and development. From birth to age 1, children should
be weighed every month and from age 1 to age 2, at least every three months. If a child
does not appear to be growing, the child should be seen by a trained health worker.
6. Every child should complete the recommended series of immunizations. Immunizations
during a child’s first year of life and into the second year are especially important for
early protection against diseases that can cause poor growth, disability or death. All
women of childbearing age, including adolescent girls, need to be protected against
tetanus for their own benefit and for their future babies. Over time, five doses of tetanus
vaccine are recommended for lifelong protection. A booster should be given during
pregnancy if the woman has not yet received five doses.
7. A child with diarrhoea needs plenty of the right liquids — breastmilk and ORS (oral
rehydration salts) solution – and, if older than 6 months, other nutritious liquids and
foods should be added. Zinc should be given to reduce the severity of the diarrhoea.
1 Throughout this publication, references to pregnant women include pregnant adolescents.
Facts for Life
ESSENTIAL MESSAGES

Facts for Life ix
If the diarrhoea is mixed with blood or is frequent and watery, the child is in danger and
should be taken to a trained health worker for immediate treatment.
8. Most children with coughs or colds will get better on their own. But if a child with a
cough and fever is breathing rapidly or with difficulty, the child is in danger and needs
to be taken to a trained health worker for immediate treatment.
9. Many illnesses can be prevented by good hygienic practices: washing hands with soap
and water (or a substitute, such as ash and water) after defecating or cleaning a child
who has defecated, using clean toilets or latrines, disposing of faeces away from play
and living areas and water sources, washing hands before handling food, using water
from a safe source, disinfecting drinking water if its safety is in question, and keeping
food and water clean.
10. Malaria, which is transmitted through mosquito bites, can be fatal. Wherever malaria is
present, people should sleep under insecticide-treated mosquito nets; any child with a
fever should be examined by a trained health worker for treatment and sponged gently
with cool (not cold) water; and pregnant women should take antimalarial tablets as
recommended by a trained health worker.
11. HIV (human immunodeficiency virus), the virus that causes AIDS (acquired
immunodeficiency syndrome), is preventable and treatable, but incurable. HIV is
transmitted through unprotected sex with an HIV-infected person; transmission from
an HIV-infected mother to her child during pregnancy, childbirth or breastfeeding;
and blood from HIV-contaminated syringes, needles or other sharp instruments
and transfusion with HIV-contaminated blood. Educating all people on HIV and
reducing stigma and discrimination should be part of the information, education and
communication on HIV prevention, testing and care. Early diagnosis and treatment
of children and adults can better ensure their survival and a longer and healthier life.
Children and families affected by HIV should have access to child-friendly health and
nutritional care and social welfare services. All people living with HIV should know
their rights.
12. Girls and boys should be equally protected within their family, school and community.
If these protective environments are lacking, children are more vulnerable to
violence, abuse, sexual exploitation, trafficking, child labour, harmful practices and
discrimination. Living with family, birth registration, access to basic services, protection
from violence, a child-friendly justice system based on child rights, and children’s
active engagement in developing their knowledge and skills to protect themselves are
important building blocks in constructing protective environments in which children can
develop and fulfil their potential.
13. Many serious injuries that can result in disabilities or death can be prevented if parents
or other caregivers watch young children carefully, keep their environment safe and
teach them how to avoid accidents and injuries.
14. Families and communities must prepare for emergencies. In disasters, conflicts,
epidemics or pandemics, children and women must be the first to receive attention,
including essential health care, adequate nutrition, support for breastfeeding and
protection from violence, abuse and exploitation. Children should have access to
recreation and learning opportunities in safe, child-friendly schools and spaces that give
them a sense of normalcy and stability. Children should be cared for by their parents or
other familiar adults, so that they feel secure.

x Facts for Life
Using Facts for Life can increase people’s knowledge and change their practices and
behaviour to improve and save children’s lives.This can lead to positive changes in social
beliefs and norms (what is considered normal by society) concerning the survival, growth,
learning, development, protection, care and support of children.
Facts for Life is both a practical source of information for individuals and an essential tool
for empowering individuals, young people, families and communities. Its messages and
information can promote dialogue, learning and communication among children, youth,
families, communities and social networks.
People from all walks of life can drive social change in favour of children’s rights. Working
together can make it possible to ﬁnd diverse, relevant, interesting and constructive ways of
using and communicating Facts for Life messages far and wide.
This guide for using Facts for Life provides:
● some conceptual thinking on the process of behavioural and social change
● information on using formative research and assessment to measure behaviour change
— research determines ‘baseline’ behaviours for use in helping to design and plan an
intervention or campaign aimed at changing behaviours
— assessment measures behaviour changes against the ‘baseline’ behaviours during or
following implementation of an intervention or campaign
● practical guidance on how to use Facts for Life to promote behaviour and social change
that favours children’s right to survive, grow, learn, develop and achieve their full
potential in life.
Guide for Using
FACTS FOR LIFE

Facts for Life xi
Changing behaviours
Knowledge alone is insufficient for behaviour change
It is often assumed that if people are provided with information, products (such as vaccines
or handpumps) and services (such as health or education), they will adopt healthier
behaviours.
However, information, products and services are often not enough to ensure adoption of
new behaviours.
It is important to go beyond giving people information. Facts for Life should be used in
consultation with children, families, communities and social networks.Their participation is
vital to influencing behavioural and social change in favour of children’s rights. Using Facts
for Life as a tool in communication and development interventions involves:
● listening to the concerns of children, families and communities about the topics in Facts
for Life
● communicating the messages and supporting information in Facts for Life in interesting
and constructive ways that are relevant to a particular context
● stimulating dialogue among all concerned
● supporting actions with children, families and communities that improve behaviours
related to the topics in Facts for Life
● assessing the actions to determine behaviour change and outcomes.
Stages of behaviour change
As individuals, we go through different stages in changing our behaviour.These stages
include:
● not being aware
● becoming aware
● becoming motivated to try something new
● adopting a new behaviour
● sustaining and ‘internalizing’ a new behaviour so that it becomes part of our normal
everyday practice.
First, we have to become aware that a particular behaviour may not be healthy for us or our
children. We then learn that there are other choices or alternative behaviours. We decide
to try a new behaviour. If we are satisfied that the new behaviour is beneficial we may
repeat it. Ultimately, we may adopt it.Then we may advocate or promote it with others,
encouraging them to adopt it too.
Learning a new behaviour takes place in this continual cycle of awareness, experimentation
and repetition. For example, a father may be persuaded through talking with the local
religious leader to have his children sleep under insecticide-treated mosquito nets. He
then sees that the nets prevent mosquito bites and that his children do not get malaria.
He becomes an advocate for sleeping under insecticide-treated mosquito nets, sharing his
experience with friends and urging them to use the nets.

xii Facts for Life
Sometimes people who appear to have adopted a new behaviour eventually reject it
and return to their former behaviour. For example, the father who was promoting use
of mosquito nets may start to feel that they are too much trouble, so he and his family
members stop using them. Returning to this old behaviour can harm the health of
his family.
Ensuring the adoption of a new behaviour that benefits children and families requires an
integrated and sustained communication and development strategy.This involves using
different messages and methods to support the ‘change continuum’ of adopting the new
behaviour by individuals and families.The new behaviour may gradually be adopted by the
whole community so that, for example, everyone is using insecticide-treated mosquito nets.
Behaviour change creates a dynamic that may result in social change
Individuals rarely change all by themselves.Their behaviour often depends on and is
influenced by the views and practices of their families, friends and communities. Sometimes
these are positive, as when everybody washes their hands with soap and water after using
the toilet or latrine. Other times they may be harmful, as when parents have their daughters
undergo genital cutting or refuse to have their children vaccinated.
To change social behaviour means changing the
everyday views and practices of families and
communities. What parents, other caregivers,
children and adolescents decide to do is often
influenced by what others are doing around them.
Resistance can be expected when social norms are
challenged.This is because change involves shifting
the dynamics of a group on fundamental issues
related to gender roles, power relations and many
other factors within the family or community.
But acceptance can become contagious when
society begins to see the economic and social
benefits of adopting a new behaviour. An example
is when families using mosquito nets no longer
have to cope with sickness or death caused
by malaria.Their energies can be directed to
sustain their children’s learning and the family’s
productivity. People begin to see and hear about the
change, and interest spreads, prompting others to
adopt the new behaviour that can benefit their lives.
Eventually, the behaviour is considered normal practice by everyone.
The Malawi Interfaith AIDS
Association has integrated
verses and teachings from
the Holy Bible and the
Holy Quran into Facts for
Life booklets used during
sermons in churches
and mosques.
Facts for Life is also used by
community radio stations
and television stations, and
in Boma Lathu, a newsletter
in the local language.The
village heads use Facts
for Life for community
reading sessions.

Facts for Life xiii
Knowing the ‘baseline’ behaviours
Conduct formative research to establish the ‘baseline’ behaviour(s)
Formative research is important in the design and planning stages of programming. It
helps to clarify the current situation and develop the objectives and baseline behaviour
information needed for subsequent measurement of behaviour change following
intervention(s). In so doing, it helps those involved and participating in the programming
identify and understand interests and concerns, reasons for specific behaviours, and what
particular needs and areas of child rights are inadequately addressed.
Conducting formative research involves the
gathering, review, analysis and synthesis of
available demographic, health, education,
sociocultural, political, economic, and media and
communication-related data and information using
a range of qualitative and quantitative research
methods. Research outcomes are best when the
data and information are gender disaggregated and
related to child rights/human rights. Using a gender
lens and a human rights approach can increase
awareness and improve and deepen understanding
of practices and behaviours affecting girls and boys
and their families and communities.
It is important that the research involve the
participation of children, families, communities
and researchers in order to collectively determine
the actions necessary to change behaviours to realize children’s rights. Research can be
organized and conducted by local academic institutions or research firms.
Use formative assessment to measure behavioural change
Formative assessment during and following implementation of interventions provides
updates on changes in the behaviours of individuals and families and even entire
communities.The behavioural changes can be measured against the baseline behaviours.
Simple research methods, such as surveys and focus group discussions, are an important
part of formative research and assessment.They can help ensure that local behaviour is well
understood and that chosen actions are supported collectively. Extra attention should be
given to ensure inclusion of the opinions of girls and boys, young people and women.
Establishing the baseline behaviours can make it easier to systematically and effectively
monitor and evaluate interventions and desired behaviour changes and outcomes.The
findings can help to produce constructive conclusions and recommendations for making
timely and strategic changes in programming.
In Cameroon, Facts for Life
messages, translated into
Foufoulde, Gwaya, Haoussa
and Pidgin and
accompanied by related
images, are used in the
schools by the local
communication groups
(Cellules locales de
communication) and
Mothers’ Associations
(Associations des
mères d’élèves).

xiv Facts for Life
Communicating Facts for Life messages
Examine the messages and supporting information in Facts for Life, and, if
necessary, adapt them to the local situation.Translate them where necessary.
Effectively communicate the messages and facilitate dialogue.
The text in Facts for Life should be examined and, if necessary, adapted in collaboration
with authorities (health, education, social services and so forth) to take into account locally
relevant issues.This should be done in consultation with family and community members.
In facilitating communication and dialogue with participant groups on the messages, give
attention to the following:
● Ensure consideration of gender issues. In some settings, women may not be
empowered to make decisions about their children’s care or their own, or men may not
be encouraged to participate in child care and household chores.
● Raise attention on children’s rights to help the
participant group identify and become aware of
behaviours related to children’s health, nutrition,
development, education and protection that may
have been overlooked.
● Involve children and young people in the dialogue
on the messages and information as well as the
planning and use of Facts for Life. Support peer-to-
peer approaches and different methods to increase
child participation.
● When adapting or translating the messages
and information, use simple language and
illustrations that people understand. Do not
overload the messages with too many actions or
technical details.
● Make sure the participant group understands the
messages and information and knows how to put
them into practice. If materials have been developed in a participatory manner, this will
be more easily done.
● Always pretest the messages and illustrations with groups of people for whom they
are intended.This can be done by asking the test groups open-ended questions and
encouraging discussion to determine whether each message is clearly understood.
● Repetition is vital! Most people do not learn or change behaviour after only one
discussion or exposure to a new behaviour.
● Select communication channels that are most effective in reaching the participant
groups. Use existing channels and do not rely on a single means of communication.
Use a mix of interpersonal; community, traditional and ‘mid’ media; and mass
media so that people receive and discuss the messages repeatedly and in many
variations and circumstances. (Refer to the following section entitled Use a mix of
communication channels.)
In Honduras, a radio
broadcast about a new
ORS (oral rehydration
salts) product neglected
to mention that it was
for children suffering
from diarrhoea (locally
called empacho).
Mothers and fathers
did not understand it
was a treatment for
empacho because the
word was not used.This
underlines the necessity
of pretesting messages.

Facts for Life xv
Give people the opportunity to discuss, shape
and absorb new information for themselves and
their communities
People are more likely to trust information and to act
on it to change behaviours if:
● they are encouraged to discuss it among
themselves and to ask questions to clarify their
understanding
● they understand how they and their families and
communities will beneﬁt
● the language is familiar and compatible with
the local culture and social norms, avoiding
judgemental or prescriptive-sounding ‘orders’
● the person presenting it or the source of
information (such as radio or television) is well
known and trusted
● they hear repeated, simple and consistent messages from different sources
● they are given time to change, especially if the change carries a cost, such as installation
of latrines.
Use a mix of communication channels: interpersonal; community, traditional
and ‘mid’ media; and mass media
Interpersonal: person-to-person
Most people are not comfortable using new information seen or heard in the mass media
without having an opportunity to discuss it with someone they trust. Person-to-person
communication, supplemented by mass and traditional and/or ‘mid’ media campaigns and
ongoing programming activities, are most effective in encouraging people to adopt, sustain
and internalize new behaviours.
Using Facts for Life effectively requires facilitating participant groups, especially the most
marginalized, to become engaged in meaningful dialogue. It is important to reach remote
communities, children with disabilities and minority or indigenous children and families. It is
also vital that women and girls participate as fully as men and boys.
To facilitate an interpersonal discussion:
● Use simple examples of problems that are important to the people involved. Start
with what is already known and focus on major concerns. Avoid technical or scientiﬁc
language. Use illustrations to stimulate discussion.
● Encourage people to ask questions and express concerns. Guide the discussion to
explore the causes of the problem and possible solutions. Remember to listen, which is
as important to communication as speaking.The participation of children, families and
other community members is key to identifying barriers or unforeseen problems that
prevent people from acting on the message.They can articulate local solutions.
In Senegal, Facts for
Life messages have
been used to promote
exclusive breastfeeding,
curb the spread of
cholera, advocate for the
abandonment of female
genital cutting and
encourage skin-to-skin
contact between mothers
and newborns (especially
for premature babies), in
addition to other baby-
care practices.

xvi Facts for Life
● Show respect for people’s opinions, knowledge and
ability to change. People learn best in situations
that build their confidence, and they take action
when they feel understood and respected. Be a
role model for the behaviour you would like to
see adopted.
● Support people in taking action. Recognize that
they may want to change but may not be able to
act alone. Help them mobilize existing networks
or create new ones that will encourage more
individuals and families to adopt and sustain
new behaviours.
Community, traditional and ‘mid’ media
This type of communication refers to materials or
communication methods that are in between the
person-to-person approach and the mass audience
approach. Some examples include:
● Street theatre: Used to deliver key messages by a
small group of actors for groups ranging from a
few dozen to hundreds of people.
● Cell phone messages: Used to urge parents or
other caregivers to take their children for their
vaccinations, etc.
● Internet: Used for communication and as a source
of information.The internet is expanding rapidly
and is particularly familiar to adolescents and
young people, from urban areas to remote villages;
websites such asYouTube are especially popular.
● Posters, leaflets and badges or buttons: Often used
to reinforce information communicated through
interpersonal contact or social mobilization efforts.
● Videos and audio cassettes: Used to effectively broadcast messages through mobile
vans and communityTV viewing groups.
● Poetry, song and puppetry: Especially used to engage children and youth.
● Slide sets and flip charts: Often used in community centres and schools.
Bangladesh has been
using messages from
Facts for Life for nearly
20 years. Known as
ShasthyoTothyo in
Bengali, it has become
a household name over
the years.
The messages
communicated through
many materials and
media have been widely
disseminated by and
among government
officials, NGOs, teachers,
community workers,
medical students, child
rights committees,
women’s organizations,
local authorities, health
workers, nurses, artists
and theatre groups.
Facts for Life messages
have even shaped
curriculum content – once
a week, many primary
schools have one class
dedicated to information
from Facts for Life.

Facts for Life xvii
Mass media
Mass media (radio, newspapers and television)
are excellent tools for reaching large numbers
of people to introduce and reinforce new
information and promote a particular social
change. Some steps include:
● Assist participant groups in identifying their
primary mass media channels. What is the
source of their information and news? If
community radio is as important to them as
national radio, ﬁnd ways to work with local
radio networks.
● Publicize the same message in various media.
Repetition reinforces behaviour change,
strengthens memory and enhances learning.
This helps people retain the message and
encourages them to act on it. Examples of
media channels include interviews, news
articles, round-table discussions, radio or
television dramas, soap operas, puppet
shows, comics, jingles or songs, quizzes,
contests and call-in shows.
● Understand who in the household makes
decisions about what to listen to or watch,
and make sure the message targets them.
● If the messages are aired on radio or
television, make sure they are broadcast at a time when families are listening or
watching. Do not rely only on free public service announcements aired during
off-peak hours.
● Broadcast messages during popular programmes so they reach a wide audience. Ask
popular disc jockeys and television show hosts to discuss the messages on radio call-in
programmes orTV shows with live audiences.
Use of mixed communication methods produces the best results
To achieve behaviour change that favours the rights of all children, it is key to use a mix of
communication channels, combining short-term, campaign-style actions with long-term and
interactive communication.
Refer to the Facts for Life website, www.factsforlifeglobal.com, for further information on
communication for development and a collection of supplementary resources related to
each of the chapters.
India’s number one television
drama series, Kyunki Jeena Issi
Ka Naam Hai, is based on Facts
for Life. Launched in 2008,
the series reaches 56 million
viewers who are mostly
women between 15 and 34
years old.
The show communicates Facts
for Life messages through
engaging stories. Viewers
relate the experiences of the
characters to their own lives.
Assessments in some states
have revealed that midwives
have been so inspired by the
show’s popular nurse character
that they feel more motivated
in their work. Facts for Life
messages have also reinforced
the midwives’ knowledge, for
example, regarding prenatal
check-ups.

©UNICEF/NYHQ2005-1228/LeMoyne
Why it is important to share
and act on information about
TIMING BIRTHS

Introduction 1
TIMINGBIRTHS
T
oo many births, births too close together
and births to adolescent girls under 18 and
women over 35 endanger the lives of women
and adolescents and their infants.
Family planning is one of the most effective ways
to improve women’s and children’s health and
survival. Family planning services provide women
and men with information, education and the
means to plan when to begin having children,
how many to have, how far apart to have them
and when to stop. However, millions of women
of childbearing age, including adolescent girls, do
not have control over limiting pregnancies or spacing births, nor do they have access to
effective family planning methods.
Both women and men have the right to choose how many children to have and when to
have them. With family planning services they are enabled to make informed decisions on
pregnancy by taking into account the beneﬁts and risks, including those related to age and
level of access to health services.
Ensuring access to family planning services for women and men, and to education for all
children would help prevent many maternal and child deaths and disabilities, particularly
in countries where marriage occurs early in life.Together these measures can contribute to
women’s, adolescent girls’ and children’s right to survival, health and well-being.
BREASTFEEDINGNUTRITIONANDGROWTH
CHILDDEVELOPMENT
ANDEARLYLEARNINGSAFEMOTHERHOOD
TIMINGBIRTHS

2 Facts for Life
KEY MESSAGES:
What every family and community
has a right to know about
TIMING BIRTHS
1. Pregnancy before the age of 18 or after the age of 35 increases the health
risks for the mother and her baby.
2. For the health of both mothers and children, a woman should wait until her
last child is at least 2 years old before becoming pregnant again.
3. The health risks of pregnancy and childbirth increase if a woman has had
many pregnancies.

Key Messages 3
4. Family planning services provide men and women of childbearing age
with the knowledge and the means to plan when to begin having children,
how many to have, how far apart to have them and when to stop.There
are many safe, effective and acceptable methods of planning for and
avoiding pregnancy.
5. Both men and women, including adolescents, are responsible for family
planning. Both partners need to know about the health beneﬁts of family
planning and the available options.
CHILDDEVELOPMENT
TIMINGBIRTHS

4 Facts for Life
Supporting Information
TIMING BIRTHS
KEY MESSAGE
1. Pregnancy before the age of 18 or after the age of 35 increases the health
risks for the mother and her baby.
SUPPORTING INFORMATION
Every year over 500,000 women die from pregnancy and childbirth
complications. For every woman who dies, approximately 20 more develop
infections and severe disabling problems – adding up to more than 10 million
women affected each year. Access to and use of family planning services
could prevent many of these deaths and disabilities.
Delaying a first pregnancy until a girl is at least 18 years of age helps to
ensure a safer pregnancy and childbirth. It reduces the risk of her baby being
born prematurely and/or underweight.This is especially important where
early marriage is the custom and married adolescents face pressure to
become pregnant.
Childbirth is more likely to be difficult and dangerous for an adolescent than
for an adult. Babies born to very young mothers are much more likely to die
in the first year of life.Young adolescents do not yet have a fully developed
pelvis. Pregnancy for them can result in serious consequences, such as
eclampsia, premature labour, prolonged labour, obstructed labour, fistula,
anaemia (thin blood) or infant and/or maternal death.

Supporting Information 5
The younger the mother is, the greater the risk to her and her baby.The risk
of maternal death related to pregnancy and childbirth for adolescent girls
between 15 and 19 years of age accounts for some 70,000 deaths each year.
For adolescents under 15 years of age these risks increase substantially. Girls
who give birth before age 15 are five times more likely to die in childbirth
than women in their twenties.
Adolescent girls and
young women, married or
unmarried, need special help
to delay pregnancy. All who
might be involved with an
early pregnancy – adolescent
girls and young women and
adolescent boys and men as
well as their families – should
be aware of the risks involved
and how to avoid them.This
should include information
on how to prevent sexually
transmitted infections (STIs),
including HIV.
After the age of 35, the
health risks associated with
pregnancy and childbirth
begin to increase again.
The risks may include
hypertension (high blood
pressure), haemorrhage (loss of blood), miscarriage and gestational diabetes
(diabetes during pregnancy) for the woman and congenital anomalies (birth
defects) for the child.
KEY MESSAGE
2. For the health of both mothers and children, a woman should wait until her
last child is at least 2 years old before becoming pregnant again.
The risk of death for newborns and infants increases significantly if the births
are not spaced.There is a higher chance that the new baby will be born too
early and weigh too little. Babies born underweight are less likely to grow
well, more likely to become ill and four times more likely to die in the first
year of life than babies of normal weight.
Throughout this publication,
references to pregnant women
include pregnant adolescents.
It is important to note that the
pregnant adolescent is at increased
risk of pregnancy complications
such as eclampsia, premature
labour, prolonged labour,
obstructed labour, fistula, anaemia
and death.
For her baby, there is a greater risk
of premature birth, low birthweight,
health problems and death.
For the pregnant adolescent under
15 years of age, these risks increase
substantially.
CHILDDEVELOPMENT
TIMINGBIRTHS
©UNICEF/NYHQ2006-0951/Noorani

6 Facts for Life
One of the threats to the health and growth of a child under age 2 is the birth
of a sibling. For the older child, breastfeeding may stop, and the mother
has less time to prepare the foods and provide the care and attention the
child needs.
Whenever a new baby comes into the family, it is important for the father to
help the mother with the new baby and the other children. Both mothers and
fathers and other caregivers should give equal attention and care to both girls
and boys.
A mother’s body needs time to recover fully from pregnancy and childbirth.
She needs to regain her health, nutritional status and energy before she
becomes pregnant again.
If a woman has a miscarriage or abortion, she should wait at least six months
before becoming pregnant again in order to reduce the risk to herself and
her baby.
To protect the health of their families, men as well as women need to be
aware of the importance of (1) a two-year space between the birth of the last
child and the beginning of the next pregnancy and (2) the need to limit the
number of pregnancies.
KEY MESSAGE
3. The health risks of pregnancy and childbirth increase if a woman has had
many pregnancies.
A woman’s body can easily become exhausted by repeated pregnancies,
childbirth and caring for small children. After many pregnancies, she faces an
increased risk of serious health problems such as anaemia and haemorrhage.

KEY MESSAGE
4. Family planning services provide men and women of childbearing age
with the knowledge and the means to plan when to begin having children,
how many to have, how far apart to have them and when to stop.There
are many safe, effective and acceptable methods of planning for and
avoiding pregnancy.
Trained health workers and clinics should offer information and advice to
empower women to make decisions about family planning and to help
women and men choose a family planning method that is acceptable, safe,
convenient, effective and affordable.
Trained health workers and clinics should also provide adolescent girls and
boys with reproductive health information and family planning services that
are (1) sensitive to adolescents and (2) geared to help them develop their
skills to make healthy and responsible life decisions.
Special channels to reach out to adolescent girls and pregnant adolescents
need to be developed to provide them with support which may include
counselling, contraceptives, and prenatal and post-natal services. Pregnant
adolescents require special attention and more frequent visits to the health
clinic for prenatal and post-natal care.
Adolescent boys and men can play a key role in preventing unplanned
(unintended) pregnancies. It is important that they have access to information
and services related to sexual and reproductive health.
The more formal education an adolescent girl or woman has, the more
likely she is to use reliable family planning methods, delay marriage and
childbearing, be better off economically and have fewer and healthier babies.
Enrolling and keeping girls in school is therefore extremely important for
maternal and child health, in addition to all the other beneﬁts of education.
Of the various contraceptive methods, only condoms protect against both
pregnancy and sexually transmitted infections, including HIV.
CHILDDEVELOPMENT
TIMINGBIRTHS

8 Facts for Life
It is critical to educate adolescent boys, young men and men on their
responsibility regarding condom use. Adolescent girls and boys, married or
unmarried, need to know about the dual protection of a condom and another
kind of contraception (using two methods of contraception at the same time)
to help avoid pregnancy and prevent sexually transmitted infections (STIs),
including HIV.
In some countries, deaths related to abortion are high among adolescent
girls. Adolescent girls, young women and their partners should be provided
with information on pregnancy prevention and the risks associated with
abortion.
A mother who feeds her baby only with breastmilk, on demand day and
night during the baby’s ﬁrst six months, can delay the return of menstruation
and help prevent pregnancy.There is a small chance that she can become
pregnant before her periods return.The risk is less than 2 per cent, which is
similar to that of other family planning methods. However, this risk increases
after six months.

KEY MESSAGE
5. Both men and women, including adolescents, are responsible for family
planning. Both partners need to know about the health beneﬁts of family
planning and the available options.
Men and women, including adolescents, must take responsibility for
preventing unplanned pregnancies.They should seek advice and have access
to information from a trained health worker on the various methods and
beneﬁts of family planning.
Information can be obtained from a doctor, nurse, midwife, maternity centre
or family planning clinic. In some places, a teacher, a youth organization or a
women’s organization may also be able to provide this information.
CHILDDEVELOPMENT
TIMINGBIRTHS

©UNICEF/NYHQ2008-1500/Kamber
SAFE MOTHERHOOD
AND NEWBORN HEALTH

Introduction 11
E
very pregnant woman hopes for a healthy
baby and an uncomplicated pregnancy.
However, every day, about 1,500 women
and adolescent girls die from problems related
to pregnancy and childbirth. Every year, some
10 million women and adolescent girls experience
complications during pregnancy, many of which
leave them and/or their children with infections and
severe disabilities.
Each year, about 3 million babies are stillborn, and
3.7 million babies (latest data available, 2004) die
very soon after birth or within the first month.The
poor health of the mother, including diseases that
were not adequately treated before or during pregnancy, is often a factor contributing to
newborn deaths or to babies born too early and/or with low birthweight, which can cause
future complications.
The risks of childbearing for the mother and her baby can be greatly reduced if: (1) a woman
is healthy and well nourished before becoming pregnant; (2) she has regular maternity
care by a trained health worker at least four times during every pregnancy; (3) the birth
is assisted by a skilled birth attendant, such as a doctor, nurse or midwife; (4) she and her
baby have access to specialized care if there are complications; and (5) she and her baby are
checked regularly during the 24 hours after childbirth, in the first week, and again six weeks
after giving birth.
Pregnant women and their partners who are HIV-positive or think they may be infected should
consult a trained health worker for counselling on reducing the risk of infecting the baby during
pregnancy, childbirth and breastfeeding, and caring for themselves and their baby.
Governments have a responsibility to ensure that every woman has access to quality
maternity care, including prenatal and post-natal services; a skilled birth attendant to assist
at childbirth; special care and referral services in the event serious problems arise; and
maternity protection in the workplace.
Most governments have ratified the Convention on the Elimination of All Forms of
Discrimination against Women. Some countries have ratified the international agreements
on maternity protection, and most have enacted legislation on maternity protection.
These international agreements in defence of women’s rights include a legally binding
commitment to provide pregnant women and mothers with health services and protection
in the workplace.
Many women, including adolescents, have difficulty accessing quality health care due to
poverty, distance, lack of information, inadequate services or cultural practices. Governments
and local authorities, with support from non-governmental and community-based organizations,
have a responsibility to address these issues to ensure that women receive the quality health
care they need and that they and their newborns have a right to receive.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

12 Facts for Life
KEY MESSAGES:
SAFE MOTHERHOOD
AND NEWBORN HEALTH
1. Girls who are educated and healthy and who have a nutritious diet
throughout their childhood and teenage years are more likely to have
healthy babies and go through pregnancy and childbirth safely if
childbearing begins after they are 18 years old.
2. The risks associated with childbearing for the mother and her baby can be
greatly reduced if a woman is healthy and well nourished before becoming
pregnant. During pregnancy and while breastfeeding, all women need more
nutritious meals, increased quantities of food, more rest than usual, iron-folic
acid or multiple micronutrient supplements, even if they are consuming fortified
foods, and iodized salt to ensure the proper mental development of their babies.
3. Every pregnancy is special. All pregnant women need at least four prenatal
care visits to help ensure a safe and healthy pregnancy. Pregnant women
and their families need to be able to recognize the signs of labour and the
warning signs of pregnancy complications.They need to have plans and
resources for obtaining skilled care for the birth and immediate help if
problems arise.
4. Childbirth is the most critical period for the mother and her baby. Every
pregnant woman must have a skilled birth attendant, such as a midwife,
doctor or nurse, assisting her during childbirth, and she must also have
timely access to specialized care if complications should occur.
5. Post-natal care for the mother and child reduces the risk of complications
and supports mothers and fathers or other caregivers to help their new
baby get a healthy start in life.The mother and child should be checked
regularly during the first 24 hours after childbirth, in the first week, and
again six weeks after birth. If there are complications, more frequent check-
ups are necessary.

Key Messages 13
6. A healthy mother, a safe birth, essential newborn care and attention, a
loving family and a clean home environment contribute greatly to newborn
health and survival.
7. Smoking, alcohol, drugs, poisons and pollutants are particularly harmful to
pregnant women, the developing fetus, babies and young children.
8. Violence against women is a serious public health problem in most
communities. When a woman is pregnant, violence is very dangerous to
both the woman and her pregnancy. It increases the risk of miscarriage,
premature labour and having a low-birthweight baby.
9. In the workplace, pregnant women and mothers should be protected
from discrimination and exposure to health risks and granted time to
breastfeed or express breastmilk.They should be entitled to maternity
leave, employment protection, medical beneﬁts and, where applicable,
cash support.
10. Every woman has the right to quality health care, especially a pregnant
woman or a new mother. Health workers should be technically competent
and sensitive to cultural practices and should treat all women, including
adolescent girls, with respect.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

14 Facts for Life
KEY MESSAGE
1. Girls who are educated and healthy and who have a nutritious diet
throughout their childhood and teenage years are more likely to have healthy
babies and go through pregnancy and childbirth safely if childbearing begins
after they are 18 years old.
Girls with more formal education are better equipped to fulﬁl their potential
in life.They tend to know about health-care practices and are less likely to
become pregnant at a very young age.They are more likely to marry later,
have fewer and better-spaced pregnancies, and seek prenatal and post-natal
care. It is estimated that two maternal deaths can be prevented for every
additional year of school attendance per 1,000 women.
The healthy growth and development of a girl through adolescence helps to
prepare her for healthy pregnancies during her childbearing years.
In addition to education and health care, girls need a nutritious diet during
childhood and adolescence to reduce problems later in pregnancy and
childbirth. A nutritious diet includes iodized salt and foods rich in essential
minerals and vitamins such as beans and other pulses, grains, green leafy
vegetables, and red, yellow and orange vegetables and fruits. Whenever
possible, milk or other dairy products, eggs, ﬁsh, chicken and meat should be
included in the diet.
SAFE MOTHERHOOD
AND NEWBORN HEALTH

Girls who stay in school are more likely to delay marriage and childbirth.
Early pregnancy can have serious consequences for adolescents under 18
years old, particularly for those under 15 years old. Adolescent girls and their
babies are at much higher risk of complications and death.
It is important to empower girls to avoid early pregnancy and inform
both girls and boys about the risks of early pregnancy as well as sexually
transmitted infections, including HIV. They both need to develop the
skills to make healthy life choices that also support equality and respect
in relationships.
Genital cutting of girls and women can cause severe vaginal and urinary
infections that can result in sterility or death. It can also cause dangerous
complications during childbirth.
Health workers and community outreach programmes can help raise
awareness of harmful practices and the importance for adolescents to delay
marriage and pregnancy for their health and well-being.
Families need to understand the high risks of early pregnancy. If an
adolescent girl marries early and/or becomes pregnant, her family should
provide her with support and ensure she obtains the health services
she needs.
KEY MESSAGE
2. The risks associated with childbearing for the mother and her baby can be
greatly reduced if a woman is healthy and well nourished before becoming
pregnant. During pregnancy and while breastfeeding, all women need more
nutritious meals, increased quantities of food, more rest than usual, iron-folic
acid or multiple micronutrient supplements, even if they are consuming fortified
foods, and iodized salt to ensure the proper mental development of their babies.
Adolescent girls, women, pregnant women and new mothers need the best
foods available: milk, fresh fruit and vegetables, meat, fish, eggs, grains,
peas and beans. All of these foods are safe to eat during pregnancy and
while breastfeeding.
Women will feel stronger and be healthier during pregnancy if they eat nutritious
meals, consume greater quantities of nutritious food and get more rest than
usual. Nutritious foods rich in iron, vitamin A and folic acid include meat, fish,
eggs, green leafy vegetables, and orange or yellow fruits and vegetables.
After childbirth, women also need nutritious meals and a greater quantity of
food and rest. Breastfeeding mothers need about 500 extra calories per day,
the equivalent of an additional meal.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

16 Facts for Life
During prenatal visits, a trained health worker can provide the pregnant
woman with iron-folic acid or multiple micronutrient supplements to prevent
or treat anaemia. Malaria or hookworm infection can be treated if needed.The
health worker can also screen the pregnant woman for night blindness and,
as necessary, prescribe an adequate dosage of vitamin A to treat the woman
and contribute to the healthy development of the fetus.
If the pregnant woman thinks she has anaemia, malaria or hookworms, she
should consult a trained health worker.
Salt consumed by families should be iodized. Iodine in a pregnant woman’s
and young child’s diet is especially critical for the healthy development of the
child’s brain. Goitre, a swelling at the front of the neck, is a clear sign that the
body is not getting enough iodine. A diet low in iodine is especially damaging
during the early stages of pregnancy and in early childhood. Women who do
not have enough iodine in their diet are more likely to have an infant who is
mentally or physically disabled. Severe iodine deficiency can cause cretinism
(stunted physical and mental growth), stillbirth, miscarriage and increased
risk of infant mortality.
KEY MESSAGE
3. Every pregnancy is special. All pregnant women need at least four prenatal
care visits to help ensure a safe and healthy pregnancy. Pregnant women
and their families need to be able to recognize the signs of labour and the
warning signs of pregnancy complications.They need to have plans and
resources for obtaining skilled care for the birth and immediate help if
problems arise.
When a young woman begins to be sexually active, she needs information
about pregnancy and the risks of sexually transmitted infections (STIs),
including HIV. She should be able to recognize the early signs of pregnancy.
If she becomes pregnant, she should be supported to receive prenatal care
early in the pregnancy from a trained health worker. She should learn about
the normal phases of pregnancy and how to keep herself and her baby
healthy during the pregnancy. She needs to know the warning signs of
serious pregnancy complications.
A pregnant woman needs at least four prenatal visits with a trained health
worker during every pregnancy.The first prenatal visit should take place
as early as possible, ideally in the first three months (the first trimester)
of pregnancy, and the other three visits can be scheduled to take place at
predetermined times during the remainder of the pregnancy.

To help ensure a safe and healthy pregnancy, a trained health worker or
skilled birth attendant should:
● provide the pregnant woman with information on the changes occurring
in her body
● check for high blood pressure, which can be dangerous to both mother
and child
● check for anaemia and provide iron-folic acid supplements, ensure that
the woman understands the importance of taking the supplements and
explain the normal side effects, including constipation and nausea
● screen for night blindness to determine if the woman needs to be treated
with vitamin A and, if necessary, prescribe vitamin A to protect the mother
and promote the healthy development of the fetus
● review the mother’s tetanus immunization status and give the dose(s)
needed to protect her and her newborn baby
● encourage all pregnant women to use only iodized salt in food
preparation to help protect their children from mental and physical
disabilities and to protect themselves from goitre
● encourage all pregnant women to have more nutritious meals, increased
quantities of food and more rest than usual
● prescribe antimalarial tablets and recommend use of an insecticide-
treated mosquito net where needed
● prescribe deworming medication, as necessary, from the second trimester
onward to help reduce low birthweight
● prepare the mother and father for the experience of childbirth and caring
for their newborn, give the mother advice on breastfeeding and caring for
herself, and provide the father with guidance on how he can assist
● advise the pregnant woman and her family on where the birth should
take place and how to get help if complications arise before and during
childbirth or immediately after delivery
● provide referrals when needed to groups in the community that provide
support and protect pregnant women living with violence
● advise on how to avoid STIs, including HIV
● check for infections during pregnancy, especially urinary tract infections
and STIs, including HIV, and treat them with appropriate medications
● provide voluntary and conﬁdential HIV testing and counselling.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

18 Facts for Life
A pregnant woman who is HIV-positive should consult a trained health
worker for counselling on how to reduce the risk of infecting her baby during
pregnancy, childbirth and breastfeeding and how to care for herself and her
baby. A pregnant woman who thinks she may be infected with HIV should be
supported to get tested and receive counselling.The father-to-be should also
be tested and counselled (refer to the HIV chapter for more information).
Every pregnant woman and her family need to know that pregnancy and
childbearing can have risks.They should be able to recognize the warning signs.
It is generally recommended that women give birth in a facility and with a
skilled birth attendant, since complications cannot be predicted. For some
women, this is even more important because the possibility of complications
increases if they:
● are under 18 or over 35 years of age
● gave birth less than two years ago
● have had several previous pregnancies
● have had a previous premature birth or a baby weighing less than
2 kilograms at birth
● have had a previous difﬁcult birth or Caesarean birth
● have had a miscarriage or stillbirth
● weigh less than 38 kilograms
● are less than 1.5 metres tall
● have been through inﬁbulation or genital cutting
● have HIV or other STIs.
A pregnant woman should be supported to recognize the signs of labour and
know when it is time to seek a skilled birth attendant to assist with the birth.
The signs of labour include any one of the following:
● painful contractions every 20 minutes or less
● the water breaks
● bloody, sticky discharge.
Warning signs during pregnancy include:
● anaemia (symptoms include paleness of the tongue and inside the
eyelids, fatigue and shortness of breath)
● unusual swelling of legs, arms or face
● little or no movement of the fetus.

Signs that mean help is needed immediately include:
● spotting or bleeding from the vagina
● severe headaches, blurred vision
● convulsions (fits)
● severe abdominal pain
● fever and weakness
● fast or difficult breathing
● labour pains for more than 12 hours.
During the prenatal visits, the pregnant woman and her family should
be supported in preparing for the birth and possible complications by
developing a plan that specifies:
● where the woman will give birth and where she will go if complications
arise
● who will accompany her
● how she will get there
● what supplies she needs to take for herself and her baby
● what costs are involved and how they will be covered
● who will help take care of her family while she is away
● who can donate blood if it is needed.
Because conditions may change, the plan for the birth and possible
complications should be updated during every prenatal care visit as the
pregnancy progresses.
The plan for emergency care in case of complications should include the
location of the nearest maternity clinic or hospital and the resources needed
to quickly get the woman there at any time of the day or night.
All pregnant women should have access to a maternity clinic or hospital
when they give birth.This is particularly important if the woman and her
family are aware that the birth is likely to be difficult. In some cases, where
distance and/or an expected risky birth are factors, it may be preferable to
have the mother-to-be move closer to the clinic or hospital as her due date
approaches so she is within quick reach of health services.
Health workers, families and communities need to give special attention
to pregnant adolescents because they are at higher risk of pregnancy
complications and in some cases they may lack the influence to make family
decisions or ask for assistance.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

20 Facts for Life
KEY MESSAGE
4. Childbirth is the most critical period for the mother and her baby. Every
pregnant woman must have a skilled birth attendant, such as a midwife,
doctor or nurse, assisting her during childbirth, and she must also have
timely access to specialized care if complications should occur.
Every pregnancy deserves attention because there is always a risk of something
going wrong with the mother, baby or both. Many dangers, illnesses or even
death can be avoided if the woman plans to give birth attended by a skilled birth
attendant, such as a doctor, nurse or midwife, and makes at least four prenatal
visits to a trained health worker during the pregnancy.
The likelihood of the mother or the baby becoming ill or dying is reduced
when childbirth takes place in a properly equipped health facility with the
assistance of a skilled birth attendant, who also checks regularly on the
mother and baby in the 24 hours after delivery.
When the pregnant woman is ready to give birth, she should be encouraged
to have a companion of her choice accompany her to provide her with
continuous support during childbirth and after birth. In particular, the
companion can support the woman in labour to eat and drink, use breathing
techniques for different stages of childbirth, and arrange for pain and
discomfort relief as needed and advised by the skilled birth attendant.
During and immediately following childbirth, the skilled birth attendant will:
● assess and follow the progress of labour and pay attention to danger
signs that indicate help is needed immediately
● advise the woman and her family if specialized care is needed and if a
transfer to a hospital or maternity centre is necessary
● reduce the risk of infection by keeping hands, instruments and the
delivery area clean, and by using gloves at appropriate times
● encourage the woman to walk during the ﬁrst stage of labour and support
her choice of position for childbirth
● assist the different stages of labour and the birth of the baby
● cut the umbilical cord at the appropriate moment and care for it
● care for the baby and keep her or him warm after birth
● guide the mother to put her baby on her chest for immediate skin-to-skin
contact and initiation of breastfeeding soon after birth
● deliver the afterbirth (placenta) safely and care for the mother after the
baby is born

● examine and weigh the baby and put recommended drops in the baby’s
eyes to prevent blindness and infection
● manage newborn health problems and refer or transfer the baby with the
mother to an appropriate health provider or health facility, if necessary.
KEY MESSAGE
5. Post-natal care for the mother and child reduces the risk of complications and
supports mothers and fathers or other caregivers to help their new baby get a
healthy start in life.The mother and child should be checked regularly during the
first 24 hours after childbirth, in the first week, and again six weeks after birth.
If there are complications, more frequent check-ups are necessary.
Post-natal care assisted by a skilled birth attendant is important to help
ensure the survival and health of the mother and her newborn. During the
first hours after childbirth and the first week and month of life, newborn
babies are particularly vulnerable.
After childbirth the skilled birth attendant will:
● check the mother’s and baby’s health regularly during the 24 hours after
birth, during the first week, and again six weeks after birth
● advise and support the mother on how to continue breastfeeding the baby
● advise the new parents on how to prevent or delay another birth
● advise the mother on nutrition, rest, hygiene, immunizations, sleeping
under an insecticide-treated mosquito net in malarial areas, regular health
check-ups and how to care for herself and her baby; advise the father to
be supportive of these needs of the mother and child
● explain potential danger signs for the mother and her baby
● support the mother, father and family in preparing an emergency plan in
the event complications arise
● advise mothers and fathers on STIs, including HIV, and if they are infected
with HIV, how to care for themselves and their child and how to practise
breastfeeding in a way that reduces the risk of infecting the child
● counsel the mother who is HIV-positive and her partner to help them
make informed decisions on future pregnancies and contraceptive
methods (refer to the HIV chapter for more information)
● schedule the next follow-up visit for the mother and her baby.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

22 Facts for Life
For the mother and/or child with complications, the skilled birth attendant
will:
● explain to the mother any complications she or her baby had and the
treatment received and how she should continue to care for herself and
her baby at home
● provide the mother with medications if necessary and instructions on
how, when, and for how long to administer them
● identify and administer missing immunizations to the mother, including
tetanus toxoid
● advise the mother and father or other caregivers on how to best care for
their baby if born too soon or too small, or with other special needs
● schedule frequent follow-up visits to assess the health of the mother and
her baby.
The ﬁrst days and weeks are especially risky for low-birthweight babies.The
majority of newborn deaths occur in low-birthweight babies. Many of these
babies could be saved with post-natal care provided by a skilled birth attendant
who will:
● identify and address the danger signs in a timely manner
● provide extra support for breastfeeding, including expressing milk and
cup feeding
● ensure the baby is warm by helping the mother or other caregiver use
skin-to-skin care, also known as the ‘Kangaroo Mother Care’ method
● refer the baby for emergency care if the infant is unable to breastfeed or
accept expressed milk.
KEY MESSAGE
6. A healthy mother, a safe birth, essential newborn care and attention, a loving
family and a clean home environment contribute greatly to newborn health
and survival.
Newborns need to be carefully cared for around the clock, loved, kept clean
and warm, and fed. Mothers and fathers or other primary caregivers who
meet their basic needs contribute to building the foundation of the babies’
future health, happiness, growth, learning and development.

A newborn thrives when she or he is:
● kept close to and frequently held and cuddled by the mother, father or
other primary caregiver
● exclusively breastfed from birth through the first six months on demand
and at least eight times in a 24-hour period, contributing to bonding
between the infant and the mother and giving the baby immunity against
infections
● loved and given affection, attention, encouragement and stimulation from
her or his family members, helping the baby to grow and learn rapidly
● kept warm, clean, comfortable and safe, and changed regularly and
burped after feeding
● cared for in a clean environment that helps to prevent infections
● provided with quality health care, including regular check-ups with timely
immunizations and weighing to monitor growth.
A skilled birth attendant will:
● respond to new parents’ questions on caring for their newborn that may
relate to breastfeeding, formula feeding, immunizations, bathing the
baby, interacting with the baby, language development, sleeping patterns
and more
● inform the new parents of danger signs in an infant that require
immediate medical attention
● help mothers and fathers develop their emergency plan in case
complications should arise with their baby
● provide the mother and father with a record of essential information
about the baby at birth (weight, height, time of birth)
● issue the baby’s birth certificate for parents to report the birth to the
civil registrar.
Babies born early or with low birthweight or babies with other special needs
require special care, love and attention to ensure their survival and optimal
growth and development.
A skilled birth attendant can play a critical role in instructing the mother and
father on how to care for their baby with special needs.
Some babies may need extra care at a special care unit of a hospital until they
are sufficiently developed or well enough to go home with the parents. If a baby
is not yet able to breastfeed, the mother can express her milk and safely store it
so it can be fed to the baby using a sterilized feeding tube, spoon or cup.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

24 Facts for Life
Caring for a newborn brings joy to the mother and father as well as anxiety
and fatigue as they adjust to having full-time care of the new baby in their
lives. Since newborns are generally dependent on their parents to provide for
their every need, mothers and fathers need to take good care of themselves.
Breastfeeding mothers especially need to eat more nutritious food, and all
mothers should get more rest. A father can support the mother while she
breastfeeds by caring for the household and other children or by caring for
the newborn while she rests.
KEY MESSAGE
7. Smoking, alcohol, drugs, poisons and pollutants are particularly harmful to
pregnant women, the developing fetus, babies and young children.
If a pregnant woman smokes, her child is more likely to be born underweight.
Her child is also more likely to have coughs, colds, croup, pneumonia or other
breathing problems.
A pregnant woman can damage her own health and the health of the fetus
by drinking alcohol or using narcotics.These substances can severely affect
a child’s physical and mental development.The mother-to-be should stop
drinking alcohol and/or taking drugs as soon as she plans a pregnancy or
suspects she is pregnant. If she has difﬁculty stopping, she should seek
medical advice and support from a trained health worker, a health centre or a
substance-abuse organization.
A pregnant woman should not take medicines during pregnancy unless they
are absolutely necessary and prescribed by a trained health worker.
To ensure proper physical growth and mental development of the child, women
of childbearing age, pregnant women, mothers and young children need to be
protected from smoke from tobacco or cooking ﬁres; from pesticides, herbicides
and other poisons; and from pollutants such as lead found in water transported
by lead pipes, in vehicle exhaust and in some paints.
Families and communities can especially help pregnant women, mothers and
their children by supporting smoke-free environments so they do not inhale
damaging secondary tobacco smoke.
Workplaces should protect women of childbearing age, pregnant women and
mothers from exposure to harmful smoke, poisons and pollutants that can
affect their health and that of their children.

KEY MESSAGE
8. Violence against women is a serious public health problem in most
communities.When a woman is pregnant, violence is very dangerous to both
the woman and her pregnancy. It increases the risk of miscarriage, premature
labour and having a low-birthweight baby.
Violence and abuse are unacceptable at any time. Women who are abused
during pregnancy may suffer from early labour and could lose their babies
as a result. Babies can be born with low birthweight, which can affect their
health and survival.
Health workers, families and communities should be aware of these dangers,
provide protection, and work to prevent and eliminate violence against
women. Local authorities, with support from organizations and community
leaders, have the responsibility to: (1) take action to prevent violence against
women and challenge social norms that increase women’s risk for violence
and abuse; (2) enforce laws protecting women from violence and abuse; and
(3) provide accessible protection and support services for abused women.
KEY MESSAGE
9. In the workplace, pregnant women and mothers should be protected from
discrimination and exposure to health risks and granted time to breastfeed or
express breastmilk.They should be entitled to maternity leave, employment
protection, medical beneﬁts and, where applicable, cash support.
Worldwide, nearly 60 per cent of women of childbearing age were in the
labour force as of 2006. Many women work in the informal economy, where
their work is not recorded, regulated or protected by public authorities.
Whether women work in the formal or informal economy, it is important that
protective measures are put in place in communities, with support from the
government and civil society, to safeguard the health and economic security
of women, children and families.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

26 Facts for Life
Protective measures can include:
Maternity leave: A mother has the right to a period of rest when her child is
born, means to support herself and her family, and a guarantee that she can
return to work when her leave is finished.
Employment protection: This is a guarantee that pregnant women and
new mothers will not be discriminated against and lose their job or job
entitlements (pension, paid holiday leave, etc.) due to pregnancy, maternity
leave or time off for childbirth
Cash (income) support and medical benefits: Working pregnant women
and mothers and their newborns and families generally need cash support
and medical care benefits. Cash support replaces a portion of lost income
caused by the interruption of the women’s work due to pregnancy, childbirth
and newborn care. Medical benefits are needed by pregnant women, new
mothers and newborns for prenatal, childbirth and post-natal services, and
hospitalization when necessary.
Health protection: The pregnant or nursing woman should not be obliged to
perform work that can affect her health or that of her child.Where there is a risk,
changes in her work conditions should be made to reduce workplace health
risks.The woman should return to her job when it is safe for her to do so, or she
should be provided with an equivalent job with the same remuneration.
Breastfeeding: Mothers should have the right to breastfeed a child after
returning to work, because breastfeeding has major benefits for the health
of the mother and her child. Mothers should be entitled to take one or more
breaks, or a reduction in work hours for breastfeeding, which should not be
subtracted from her paid work time.
KEY MESSAGE
10. Every woman has the right to quality health care, especially a pregnant
woman or a new mother. Health workers should be technically competent
and sensitive to cultural practices and should treat all women, including
adolescent girls, with respect.
Many dangers of pregnancy and childbirth can be avoided if women
have access to quality health care during pregnancy and childbirth and
after childbirth.
All women have the right to the services of a skilled birth attendant, such as a
doctor, nurse or midwife, and to emergency care if complications should arise.

Quality health care that offers information and counselling enables women
and men to make informed decisions about their reproductive health. A
woman in need of maternal care should be supported by her husband or
partner and family to take good care of herself and her baby and to reach a
health facility when needed, including for prenatal care, childbirth, post-natal
care and emergency care.
Governments, with support from communities, should make sure that the
cost of health services does not prevent women, including adolescent girls,
from using them. Other barriers such as the cost of transport, long distances,
difﬁcult roads and cultural practices also need to be addressed to ensure
access to health services.
Health-care providers should be supported through regular training to
maintain and improve their technical and communication skills needed to
provide quality health care. They should be trained to treat all women with
respect, to be sensitive to cultural norms and practices, and to respect a
person’s right to conﬁdentiality and privacy. They need to be sensitive and
understanding of the particular needs of adolescents, and know how to
support and counsel them in caring for themselves and their babies.
CHILDDEVELOPMENT
ANDEARLYLEARNING
SAFEMOTHERHOOD
ANDNEWBORNHEALTH

28 Facts for Life
©UNICEF/NYHQ2006-1378/Pirozzi
CHILD DEVELOPMENT
AND EARLY LEARNING

Introduction 29
C
hild development refers to the changes
that occur as a child grows and develops in
relation to being physically healthy, mentally
alert, emotionally sound, socially competent and
ready to learn.
The first five years of a child’s life are fundamentally
important.They are the foundation that shapes
children’s future health, happiness, growth,
development and learning achievement at school,
in the family and community, and in life in general.
Recent research confirms that the first five years
are particularly important for the development of
the child’s brain, and the first three years are the
most critical in shaping the child’s brain architecture. Early experiences provide the base for
the brain’s organizational development and functioning throughout life.They have a direct
impact on how children develop learning skills as well as social and emotional abilities.
Children learn more quickly during their early years than at any other time in life.They need
love and nurturing to develop a sense of trust and security that turns into confidence as
they grow.
Babies and young children grow, learn and develop rapidly when they receive love and
affection, attention, encouragement and mental stimulation, as well as nutritious meals and
good health care.
Understanding the stages of child development helps parents know what to expect and how
to best support the child as she or he grows and develops.
In many settings, early childhood programmes support parents and their children from
infancy through age 8, which includes the important transition from home to school.
All children have the right to be raised in a family and to have access to quality health
care, good nutrition, education, play and protection from harm, abuse and discrimination.
Children have the right to grow up in an environment in which they are enabled to reach
their full potential in life.
It is the duty of parents, other caregivers and family members, communities, civil society
and governments to ensure that these rights are respected, protected and fulfilled.
CHILDDEVELOPMENT

30 Facts for Life
KEY MESSAGES:
CHILD DEVELOPMENT
AND EARLY LEARNING
1. The early years, especially the ﬁrst three years of life, are very important for
building the baby’s brain. Everything she or he sees, touches, tastes, smells
or hears helps to shape the brain for thinking, feeling, moving and learning.
2. Babies learn rapidly from the moment of birth.They grow and learn best
when responsive and caring parents and other caregivers give them
affection, attention and stimulation in addition to good nutrition, proper
health care and protection.
3. Encouraging children to play and explore helps them learn and develop
socially, emotionally, physically and intellectually.This helps children get
ready for school.

Key Messages 31
4. Children learn how to behave (socially and emotionally) by imitating the
behaviour of those closest to them.
5. Entering primary school on time is critical to ensure the continuity of a child’s
development. Support from parents, other caregivers, teachers and the
community is very important.
6. All children grow and develop in similar patterns, but each child develops at
her or his own pace. Every child has her or his own interests, temperament,
style of social interaction and approach to learning.
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32 Facts for Life
CHILD DEVELOPMENT
AND EARLY LEARNING
KEY MESSAGE
1. The early years, especially the first three years of life, are very important for
building the baby’s brain. Everything she or he sees, touches, tastes, smells
or hears helps to shape the brain for thinking, feeling, moving and learning.
A child’s brain develops rapidly during the first five years of life, especially
the first three years. It is a time of rapid cognitive, linguistic, social, emotional
and motor development. For example, a child learns many words starting
at around 15–18 months. Rapid language learning continues into the
preschool years.
The child’s brain grows as she or he sees, feels, tastes, smells and hears.
Each time the child uses one of the senses, a neural connection is made in
the child’s brain. New experiences repeated many times help make new
connections, which shape the way the child thinks, feels, behaves and learns
now and in the future.
A close relationship between the child and the caregiver is the best way to
nourish the child’s growing brain. When a caregiver plays with and sings,
speaks, reads or tells a story to the child and nurtures her or him with healthy
food, love and affection, the child’s brain grows. Being healthy, interacting
with caregivers and living in a safe and clean environment can make a big
difference in a child’s growth, development and future potential.
Babies need lots of care and affection in the early years. Holding, cuddling
and talking to the child stimulate brain growth and promote emotional
development. Being kept close to the mother and breastfed on demand

provide the infant with a sense of emotional security.The baby suckles for
both nutrition and comfort.
For young children, crying is a way of communicating. Responding to
the child’s cry by holding and/or talking soothingly to her or him will help
establish a sense of trust and security.
This kind of early bonding and attachment to the mother, father or other close
caregiver helps a child develop a broad range of abilities to use and build
upon throughout life.These include the ability to:
● learn
● be self-conﬁdent and have high self-esteem
● have positive social skills
● have successful relationships at later ages
● develop a sense of empathy.
As children’s brains develop, so do their emotions, which are real and
powerful. Children may become frustrated if they are unable to do something
or have something they want.They are often frightened of strangers,
new situations or the dark. Children whose reactions are laughed at,
punished or ignored may grow up shy and unable to express emotions
normally. If caregivers are patient and sympathetic when a child expresses
strong emotions, the child is more likely to grow up happy, secure and
well balanced.
Boys and girls have the same physical, mental, emotional and social needs.
Both have the same capacity for learning. Both have the same need for
affection, attention and approval.
Young children can experience excessive stress if they are physically or
emotionally punished, are exposed to violence, are neglected or abused, or
live in families with mental illness, such as depression or substance abuse.
These stresses interfere with the developing brain and can lead to cognitive,
social and emotional delays and behaviour problems in childhood and later
in life.
Children who are physically or mentally punished in anger are more likely
to become violent themselves. More positive and effective ways to address
children’s behaviour can include:
● providing a child with clear explanations about what to do and what not
to do
● responding consistently to certain behaviours
● praising good behaviour.
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34 Facts for Life
These responses by parents and other caregivers encourage children so they
become well-adjusted and productive members of the family and community.
Both parents, as well as other family members, need to be involved in caring
and nurturing the growth, learning and development of children.They should
make both girls and boys feel equally valued as they encourage them to learn
and explore – this is important preparation for school.
Mothers around the world generally take on the primary role of addressing
their children’s rights and needs.They love, feed, console, teach, play with and
care for their children.
A father’s role is as vital as the mother’s in nurturing and caring for their
children and protecting their rights. A father should make daughters and
sons feel they are equally important. Just like the mother, the father can help
meet their child’s needs for love, affection, approval, encouragement and
stimulation.Together, the mother and father can ensure that the child receives
a quality education and good nutrition and health care.
KEY MESSAGE
2. Babies learn rapidly from the moment of birth.They grow and learn best
when responsive and caring parents and other caregivers give them affection,
attention and stimulation in addition to good nutrition, proper health
care and protection.
Touch, hearing, smell, sight and taste are learning tools the child uses to
explore and understand her or his world.
Affection, attention and stimulation
Children’s minds develop rapidly when they are talked to, touched and
cuddled; when they see and hear familiar faces and voices; and when they
handle different objects.
Children learn quickly when they feel loved and secure from birth and when
they play and interact with family members and other people close to them.
The more often mothers, fathers and other caregivers play with, talk to and
respond to the child, the faster she or he learns.
Parents and other caregivers should consistently talk, read and sing to infants
and young children. Even if the child is not yet able to understand the words,
these early ‘conversations’ help to develop social and language skills and
learning capacities.

Parents and other caregivers can help children learn and grow by giving them
new, interesting and safe things to look at, listen to, smell, hold and play with.
Children who feel secure and loved usually do better in school, are more
self-confident, have good self-esteem and are able to cope more easily with
life’s challenges.
Good nutrition
Exclusive breastfeeding on demand for the first six months, timely
introduction of safe and nutritious foods at the age of 6 months and
continued breastfeeding for two years or beyond provide the child with
optimal nutrition and health benefits. Feeding time is also an opportunity
for the child to receive affection and have contact with the mother, father or
other caregiver.
Good nutrition is vital for a child’s growth and development.The diet of a
pregnant woman and that of a young child should be varied and nutritious. It
should include essential nutrients such as proteins and essential fats to help
a child’s body grow and have energy, vitamin A to help a child resist illness,
iodine to help ensure the healthy development of a child’s brain, and iron to
protect a child’s mental and physical abilities.
While the mother has the primary role of breastfeeding the child, the father
can support her by making sure she has nutritious food, helping with
household and childcare responsibilities, and being emotionally supportive of
her, the baby, the older children and other family members.
Proper health care
The health worker should inform parents and other caregivers about:
● necessary immunizations and the schedule to follow
● how to avoid anaemia and parasitic diseases in children over 6 months
of age
● why deworming is important
● how to ensure that the child gets enough nutrients, such as iron and
vitamin A, for her or his healthy mental and physical development.
Children who are anaemic, malnourished or frequently sick may become
fearful and upset more easily than healthy children.They will also lack the
drive to play, explore and interact with others.These children need special
attention, care and encouragement to eat, play and interact with others in
order to become healthy.
Infants who have completed their immunizations on time and are receiving
proper nutrition, health care, love and affection have an increased chance of
CHILDDEVELOPMENT

36 Facts for Life
survival.They are able to concentrate on exploring, learning and developing
cognitive, language, social, emotional and motor skills.
Protection and care from responsive and caring parents and/or other
caregivers
Babies and small children should not be left alone for long periods of time.
This delays their physical and mental development. It also puts them at risk
of accidents.
Girls need the same amount of food, attention, affection and care that boys
need. All babies and young children need to be encouraged and praised when
they learn to do something new and say new words.
All girls and boys should have their birth registered in order to help ensure
their right to access basic services, such as health care, education and legal
and social services.
KEY MESSAGE
3. Encouraging children to play and explore helps them learn and develop
socially, emotionally, physically and intellectually.This helps children get
ready for school.
Children play because it is fun. Play is also key to their learning and
development. Playing, both structured and unstructured, lays the foundation
for a child’s development of future learning and life skills. It helps children:
● develop their knowledge, experience, curiosity and conﬁdence
● learn by trying things, comparing results, asking questions and meeting
challenges
● develop the skills of language, thinking, planning, organizing and
decision-making.
Stimulation, play and being included in play with other children and adults
are very important for children with disabilities or chronic illnesses, such as
children with HIV.
When parents and other caregivers talk and interact with children in their
ﬁrst language, it helps children develop the ability to think and express
themselves. Children learn language quickly and easily through hearing and
singing songs, having stories told or read to them, repeating rhymes and
playing games.
Girls and boys need the same opportunities for play and interaction with
all family members, including siblings and grandparents, and in activities

outside the home. Play and interaction with the mother and the father help
strengthen the bond between the child and both parents.
Family members and other caregivers can help children learn by giving
them simple tasks with clear instructions, providing objects to play with and
suggesting new activities.They should not dominate the child’s play.
All children need a variety of simple play materials that are suitable for their
stage of development and learning. Water, sand, cardboard boxes, wooden
building blocks, and pots and lids are just as good for facilitating a child’s play
and learning as toys bought from a shop.
Parents and caregivers need to be patient when a very young child insists
on trying to do something without help. Children learn by trying until they
succeed. As long as the child is protected from danger, struggling to do
something new and difﬁcult is a positive step in the child’s development.
Children are constantly changing and developing new abilities. Caregivers
should notice these changes and follow the child’s lead. Responding to and
encouraging children helps them develop more quickly.
As young children grow older they need opportunities to learn and socialize
with other children of their age. Group learning activities, run by a trained
caregiver or teacher at home or in a nursery school or kindergarten, are
important in helping children get ready for school.
KEY MESSAGE
4. Children learn how to behave (socially and emotionally) by imitating the
behaviour of those closest to them.
By watching and imitating others, young children learn how to interact
socially.They learn acceptable and unacceptable kinds of behaviour.
The examples set by adults, older siblings and children are the most powerful
inﬂuences shaping a child’s behaviour and personality. One way children
learn is by copying what others do. If men and women do not treat each other
equally, the child will observe, learn and probably copy this behaviour. If
adults shout, behave violently, exclude or discriminate, children will learn this
type of behaviour. If adults treat others with kindness, respect and patience,
children will follow their example. If mothers and fathers treat each other with
love and respect, this is what their children will learn and most likely ‘replay’
in their adult relationships.
CHILDDEVELOPMENT

38 Facts for Life
Children like to pretend.This should be encouraged, as it develops their
imagination and creativity. It also helps the child understand different ways
people behave.
KEY MESSAGE
5. Entering primary school on time is critical to ensure the continuity of a child’s
development. Support from parents, other caregivers, teachers and the
community is very important.
In most countries, children start primary school at around 6 or 7 years of age.
Starting school is a critical stage in a child’s development.
Both girls and boys should start school at the appropriate age (in accordance
with their country’s policy). By the time they enter school, they should
have basic cognitive and language skills and sufﬁcient social competency
and emotional development to allow them to enjoy learning in the formal
school setting.
The support of parents and other caregivers is very important for children’s
successful transition to school. Parents and other caregivers should equally
and fully support both girls and boys in attending school regularly and
being well prepared.They should also be involved in school activities.This
helps children adapt to the school setting, settle more quickly into the school
learning environment and attend school regularly.
Teachers should be prepared to support young children who are still
developing their basic potential for learning.Teachers have a key role in
building the conﬁdence of both girls and boys so that they can equally enjoy
and succeed at learning. Play continues to be a basic medium of teaching and
learning in the early school years. A child-friendly school that supports active
learning and promotes participation offers the best learning environment
for children.
Along with families and the school, the community – both local authorities
and civil society – can contribute to:
● making school a priority within the community
● making sure the school is a safe and welcoming place for all children
● making sure the school has the resources it needs, including community
members involved in school management and parent-teacher
associations.

KEY MESSAGE
6. All children grow and develop in similar patterns, but each child develops at
her or his own pace. Every child has her or his own interests, temperament,
style of social interaction and approach to learning.
Understanding the ages and stages of child development helps parents
understand the changes to expect as a child grows and develops (refer to the
the following chart). Parents or other caregivers should be able to seek help
when they feel their child is not developing as expected.
By observing how young children respond to touch, sound and sight, parents
can identify signs of possible developmental problems or disabilities. If a
young child is developing slowly, parents and other caregivers can help by
spending extra time with the child, playing and talking with the child, and
massaging the child’s body.
If the child does not respond to attention and stimulation, parents and other
caregivers need to seek help from a trained health worker. Taking early
action is very important in helping children who have delays and disabilities
reach their full potential. Parents and other caregivers need to encourage the
greatest possible development of the child’s abilities.
A girl or boy with a disability needs lots of love and extra protection. She
or he needs all the same attention, care and support every other child
needs: birth registration, breastfeeding, immunizations, nutritious food, and
protection from abuse and violence. Like all children, children with disabilities
should be encouraged to play and interact with other children.
A child who is unhappy or experiencing emotional difﬁculties may exhibit
unusual behaviour. Examples include:
● suddenly becoming emotional, unfriendly, sad, lazy or unhelpful
● consistently acting out or misbehaving
● crying often
● having sleep difﬁculties
● becoming violent with other children
● sitting alone instead of playing with family or friends
● suddenly having no interest in usual activities or schoolwork
● losing appetite.
CHILDDEVELOPMENT

40 Facts for Life
The child’s parents or other caregivers should be encouraged to talk with
and listen to the child. If the problem persists, they should seek help from a
trained health worker or teacher.
If a child has mental or emotional difﬁculties or has been abused, she or he
needs mental health or counselling services.The child should be assessed to
determine what support and treatment are needed.
The following chart gives parents an idea of how young children develop. Each stage of
development is part of a continuum, building on the previous stage and affecting the next.
Not all children grow and develop at the same pace. Slow progress may be normal or may
be due to inadequate nutrition, poor health, lack of stimulation or a more serious problem.
Parents may wish to discuss their child’s progress with a trained health worker or a teacher.
HOW CHILDREN DEVELOP
By the age of 1 MONTH
A baby should
be able to:
● turn her or his head towards a hand that is stroking the child’s cheek or
mouth
● bring both hands towards her or his mouth
● turn towards familiar voices and sounds
● suckle the breast and touch it with her or his hands.
Advice for
parents
and other
caregivers:
● make skin-to-skin contact and breastfeed within one hour of birth
● support the baby’s head when you hold the baby upright
● massage and cuddle the baby often
● always handle the baby gently, even when you are tired or upset
● breastfeed frequently and on demand
● always safely dispose of the baby’s faeces and wash hands with
soap and water or a substitute, such as ash and water, after changing
the baby
● talk, read and sing to the child as much as possible
● give consistent love and affection
● visit a trained health worker with the infant during the ﬁrst week and
again six weeks after birth.

By the age of 1 MONTH continued
Warning signs
to watch for:
● poor suckling at the breast or refusing to suckle
● little movement of arms and legs
● little or no reaction to loud sounds or bright lights
● crying for long periods for no apparent reason
● vomiting and diarrhoea, which can lead to dehydration.
By the age of 6 MONTHS
A baby should
be able to:
● raise the head and chest when lying on her or his stomach
● reach for dangling objects
● grasp and shake objects
● roll both ways
● sit with support
● explore objects with hands and mouth
● begin to imitate sounds and facial expressions
● respond to her or his own name and to familiar faces.
Advice for
parents
and other
caregivers:
● lay the baby on a clean, ﬂat, safe surface so she or he can move freely
and reach for objects
● continue to hold and cuddle the baby every day, giving consistent love
and affection
● prop or hold the baby in a secure position so she or he can see what is
happening nearby
● continue to breastfeed on demand day and night, and start adding
other foods (two to three meals a day starting at 6 months; three to four
meals a day from 9 months)
● talk, read or sing to the child as often as possible, not only when she or
he is hungry or getting ready to sleep.
Warning signs
to watch for:
● stiffness or difﬁculty moving limbs
● constant moving of the head (this might indicate an ear infection, which
could lead to deafness if not treated)
● little or no response to sounds, familiar faces or the breast
● refusing the breast or other foods.
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42 Facts for Life
By the age of 12 MONTHS
A baby should
be able to:
● sit without support
● crawl on hands and knees and pull herself or himself up to stand
● take steps holding on to support
● try to imitate words and sounds and respond to simple requests
● enjoy playing and clapping
● repeat sounds and gestures for attention
● pick things up with thumb and one ﬁnger
● start holding objects such as a spoon and cup and attempt self-feeding.
Advice for
parents
and other
caregivers:
● point to objects and name them; play with, talk, sing and read to the
child frequently
● use mealtimes and other family activities to encourage interaction with
all family members
● give consistent affection and be responsive both when the child is
happy and when upset
● if the child is developing slowly or has a physical disability, focus on the
child’s abilities and give extra stimulation and interaction
● do not leave a child in one position for many hours
● make the area as safe as possible to prevent accidents, and keep
dangerous objects, such as sharp objects, plastic bags and small items a
child can choke on, out of the child’s reach
● continue to breastfeed and ensure that the child has enough food and a
variety of family foods
● help the child experiment with spoon and cup feeding
● make sure the child’s immunizations are up to date and that she or he
receives all recommended doses of nutrient supplements
● keep the child’s hands clean and begin teaching the child to wash them
with soap.
Warning signs
to watch for:
● does not make sounds in response to others
● does not look at objects that move
● listlessness and lack of response to the caregiver
● lack of appetite or refusal of food.
By the age of 2YEARS
A child should
be able to
● walk, climb and run
● point to objects or pictures when they are named (e.g., nose, eyes, ears)
● say several words together (from about 15 months)
● follow simple instructions
● scribble if given a pencil or crayon
● enjoy simple stories and songs
● imitate the behaviour of others
● begin to eat by herself or himself.

By the age of 2YEARS continued
Advice for
parents
and other
caregivers:
● read to and sing or play games with the child
● teach the child to avoid dangerous objects
● talk to the child normally – do not use baby talk
● continue to breastfeed and ensure the child has enough food and a
variety of family foods
● make sure the child is fully immunized
● encourage, but do not force, the child to eat
● provide simple rules and set reasonable expectations
● praise the child’s achievements, provide reassurance when the child is
afraid and continue to give consistent affection every day.
Warning signs
to watch for:
● lack of response to others
● difﬁculty keeping balance while walking
● injuries and unexplained changes in behaviour (especially if the child
has been cared for by others)
● lack of appetite.
A child should
be able to:
● walk, run, climb, kick and jump easily
● recognize and identify common objects and pictures by pointing
● make sentences of two or three words
● say her or his own name and age
● name colours
● understand numbers
● use make-believe objects in play
● feed herself or himself
● express affection.
Advice for
parents
and other
caregivers:
● read and look at books with the child and talk about the pictures
● tell the child stories and teach rhymes and songs
● give the child her or his own bowl or plate of food
● continue to encourage the child to eat, giving the child as much time as
she or he needs
● help the child learn to dress, use the toilet or latrine and wash her or his
hands with soap and water or a substitute, such as ash and water, after
defecating and before touching food and eating
● listen to and answer all the child’s questions
● encourage creative play, building and drawing
● give the child simple tasks, such as putting toys back in their place, to
build responsibility
● limit television watching and ensure that violent shows are not viewed
● acknowledge and encourage positive behaviour and set clear limits
● provide consistent affection every day
● if available, enrol the child in an early learning (play) activity with other
children.
CHILDDEVELOPMENT

44 Facts for Life
By the age of 3YEARS continued
Warning signs
to watch for:
● loss of interest in playing
● frequent falling
● difﬁculty manipulating small objects
● failure to understand simple messages
● inability to speak using several words
● little or no interest in food.
A child should
be able to:
● move in a coordinated way
● speak in sentences and use many different words
● understand opposites (e.g., fat and thin, tall and short)
● play with other children
● dress without help
● answer simple questions
● count 5–10 objects
● wash her or his own hands.
Advice for
parents
and other
caregivers:
● listen to the child
● interact frequently with the child
● read and tell stories
● encourage the child (both girls and boys) to play and explore
● listen to and answer all the child’s questions, have conversations (with
both girls and boys)
● encourage creative play, building and drawing
● limit television watching and ensure that violent shows are not viewed
● acknowledge and encourage positive behaviour and set clear and
consistent limits
● provide consistent affection every day
● enrol the child (both girls and boys) in an early learning (play)
programme that helps to prepare the child for school.
Warning signs
to watch for:
● fear, anger or violence when playing with other children, which could be
signs of emotional problems or abuse.

A child’s: ● physical development proceeds more gradually and steadily than in the
early years
● muscle mass increases, and small and large motor skills improve
● ability to understand and communicate abstract concepts and complex
ideas has begun to develop
● span of attention increases, and she or he can focus on the past and
future as well as the present
● learning capacity is expanding, and she or he is learning to read, write
and do problem solving in a school environment
● friends and interactions with her or his peer group are increasingly
important
● interest in friendships includes enjoying time with her or his peer group
and turning to peers for information
● self-control improves, and understanding of more complex emotions
increases.
Advice for
parents
and other
caregivers:
● be a good role model, equally for girls and boys
● encourage your child to express feelings and beliefs and to solve
problems
● recognize and support your child’s strengths and skills as well as
limitations
● spend time with your child, and talk and listen to her or him
● find activities you can do together that will make your child feel
successful, secure and loved
● facilitate and support your child’s playtime with friends and in
extra-curricular school activities
● acknowledge and encourage positive behaviour and set clear and
consistent limits
● show interest and become involved in your child’s school – remember
that the mother, father and/or other caregiver(s) are a child’s first and
most important teachers.
Warning signs
to watch for:
● difficulties making and keeping friends and participating in group
activities
● avoiding a task or challenge without trying, or showing signs of
helplessness
● trouble communicating needs, thoughts and emotions
● trouble focusing on tasks, understanding and completing schoolwork
● excessive aggression or shyness with friends and family. BREASTFEEDINGNUTRITIONANDGROWTH
CHILDDEVELOPMENT

©UNICEF/NYHQ2006-2405/Markisz
Why it is important to share and
act on information about
BREASTFEEDING

Introduction 47
B
abies who are breastfed are generally
healthier and achieve optimal growth and
development compared to those who are fed
formula milk.
If the vast majority of babies were exclusively fed
breastmilk in their first six months of life – meaning
only breastmilk and no other liquids or solids, not
even water – it is estimated that the lives of at least
1.2 million children would be saved every year. If
children continue to be breastfed up to two years
and beyond, the health and development of
millions of children would be greatly improved.
Infants who are not breastfed are at an increased risk of illness that can compromise their
growth and raise the risk of death or disability. Breastfed babies receive protection from
illnesses through the mother’s milk.
Breastfeeding is the natural and recommended way of feeding all infants, even when
artificial feeding is affordable, clean water is available, and good hygienic conditions for
preparing and feeding infant formula exist.
If a mother is HIV-positive, there is a risk that she can transmit HIV to her baby through
breastfeeding. Counselling can help her carefully weigh the risks and make an informed
decision on which feeding option is best for her baby and most manageable for her.
Almost every mother can breastfeed successfully. All mothers, particularly those who might
lack the confidence to breastfeed, need the encouragement and practical support of the
baby’s father and their families, friends and relatives. Health workers, community workers,
women’s organizations and employers can also provide support.
Everyone has the right to information about the benefits of breastfeeding and the risks
of artificial feeding. Governments have a responsibility to provide this information.
Communities as well as media and other channels of communication can play a key role in
promoting breastfeeding.
CHILDDEVELOPMENT

48 Facts for Life
KEY MESSAGES:
BREASTFEEDING
1. Breastmilk alone is the best food and drink for an infant for the ﬁrst six
months of life. No other food or drink, not even water, is usually needed
during this period.
2. Newborn babies should be given to the mother to hold immediately after
delivery.They should have skin-to-skin contact with the mother and begin
breastfeeding within one hour of birth.
3. Almost every mother can breastfeed successfully. Breastfeeding the baby
frequently causes production of more milk.The baby should breastfeed at
least eight times daily, day and night, and on demand.
4. Breastfeeding helps protect babies and young children against dangerous
illnesses. It also creates a special bond between mother and child.
5. Bottle feeding and giving a baby breastmilk substitutes such as infant
formula or animal milk can threaten the baby’s health and survival. If
a woman cannot breastfeed her infant, the baby can be fed expressed
breastmilk or, if necessary, a quality breastmilk substitute from an ordinary
clean cup.

Key Messages 49
6. If a woman is infected with HIV, there is a risk that she can pass the infection
to her infant through breastfeeding. In the ﬁrst six months, this risk is much
greater if the infant is fed both breastmilk and other liquids and foods than
if fed breastmilk alone.Therefore, it is recommended that the baby receives
breastmilk alone for the ﬁrst six months, unless it is acceptable, feasible,
affordable, sustainable and safe to give breastmilk substitutes (infant
formula) exclusively.
7. A woman employed away from her home can continue to breastfeed her
child. She should breastfeed as often as possible when she is with the infant
and express her breastmilk when they are apart so that another caregiver
can feed it to the baby in a clean and safe way.
8. After 6 months of age, when babies begin to eat foods, breastfeeding should
continue for up to two years and beyond because it is an important source of
nutrition, energy and protection from illness.
CHILDDEVELOPMENT

50 Facts for Life
KEY MESSAGE
1. Breastmilk alone is the best food and drink for an infant for the first six
months of life. No other food or drink, not even water, is usually needed
during this period.
Breastmilk is the best food a young child can have. It promotes optimal
growth and development and protects against illness. Breastmilk contains the
perfect balance of nutrients for a baby, unlike infant formula, powdered milk
or animal milk.
The baby does not need water or other drinks or foods (such as tea, juice,
sugar water, gripe water, rice water, other milks, formula or porridge) during
the first six months. Even in hot, dry climates, breastmilk fully meets a baby’s
need for fluids.
Breastmilk is easy for the baby to digest. A baby has difficulty digesting
animal milks, and formula is digested much more slowly than breastmilk.
Compared to other options, breastmilk nourishes the baby more efficiently.
Breastmilk protects against illness because it contains antibodies that transfer
the mother’s immunity or resistance to disease to the child. No other milks
contain these antibodies.
Giving a baby under 6 months of age any liquids or foods other than
breastmilk increases the risk of diarrhoea and other illnesses. Water and other
liquids or foods may be contaminated, which can cause diarrhoea.
BREASTFEEDING

A baby who takes water or other liquids or foods in the first six months
suckles less on the breast.This slows down breastmilk production.
If regular weighing shows that a breastfed baby under 6 months of age is not
growing well:
● The mother may need help to improve the way the baby takes the
breast into the mouth to ensure good attachment so the baby can suckle
effectively.
● The baby may need more opportunities to breastfeed. The baby should
breastfeed on demand, day and night, at least eight times during a
24-hour period.The baby should be allowed to breastfeed until she or he
releases the breast and looks satisfied and sleepy. This shows that the
baby has had all she or he wants from that breast. The baby should then
be offered the other breast and may or may not want it. The baby should
be kept on the breast until she or he has finished suckling.
● A low-birthweight baby may need frequent pauses during breastfeeding.
● The baby may be ill and should be checked by a trained health worker.
● The baby may be getting water or other fluids, which can reduce the
intake of breastmilk.The mother may need guidance on how to reduce
and eliminate other fluids and to increase and give only breastmilk.
Feeding a baby only with breastmilk and on demand during the first six
months can help to delay the return of the mother’s menstruation.This may
help to delay the next pregnancy. However, there is some possibility – less
than 2 per cent – that a mother can become pregnant before her periods
return.This becomes increasingly likely after six months.
KEY MESSAGE
2. Newborn babies should be given to the mother to hold immediately after
delivery.They should have skin-to-skin contact with the mother and begin
breastfeeding within one hour of birth.
Skin-to-skin contact and breastfeeding soon after birth stimulate production
of the mother’s breastmilk. Breastfeeding also helps the mother’s womb
contract, which reduces the risk of heavy bleeding or infection and helps to
expel the placenta (afterbirth).
Colostrum, the thick yellowish milk the mother produces in the first few
days after giving birth, is the perfect food for newborn babies. It is very
nutritious and full of antibodies that help protect the baby against infections.
Sometimes mothers are advised not to feed colostrum to their babies. This
advice is incorrect. Newborns benefit from colostrum.
CHILDDEVELOPMENT

52 Facts for Life
The newborn needs no other food or drink while the mother’s milk supply is
coming in and breastfeeding is being fully established. Giving any other food
or drink may slow the production of milk. It can also increase the chance of
diarrhoea and other infections.The milk produced by the mother is nutritious
and the right amount for the newborn.The baby should breastfeed as often as
she or he wants.
A baby who has problems suckling in the ﬁrst few days should be kept
close to the mother, offered the breast frequently, helped to take the breast
and given breastmilk expressed directly into the mouth or fed expressed
breastmilk from a clean cup (not from a bottle).The mother should receive
help to improve the baby’s attachment and suckling, and should also be
shown how to express breastmilk, if necessary.
A mother’s own milk is best for low-birthweight babies. However, not all
of these infants are able to feed from the breast in the ﬁrst days of life. For
them, other options are available. In order of preference, they are: expressed
breastmilk (from the mother); donor breastmilk (only if the donor is HIV-tested
and the milk is correctly heat-treated); and infant formula. All of these should
be given by cup, spoon or paladai (a cup feeding device), or medical tubes
used by a trained health worker in a health facility.
Heat-treated breastmilk involves heating expressed breastmilk (enough for
one or two feeds) in a small pan or in a metal container standing in a pan of
water until it comes to a boil.The milk is then left to cool in a clean, covered
container before it is fed to the baby by cup. A trained health worker can
provide further guidance on expressing and heat-treating breastmilk.
It is best for the mother and her baby to stay together in the same room
immediately after birth. If a mother gives birth in a hospital or clinic, she is
entitled to have her baby near her, 24 hours a day. She should insist that no
formula or water be given to her baby if she is breastfeeding.
KEY MESSAGE
3. Almost every mother can breastfeed successfully. Breastfeeding the baby
frequently causes production of more milk.The baby should breastfeed at
least eight times daily, day and night, and on demand.
A mother’s breasts make as much milk as the baby wants. If the baby
suckles more, more milk is produced. Almost every mother can successfully
breastfeed and produce enough milk when:
● she breastfeeds exclusively
● the baby is in a good position and is well attached to the breast, with the
breast well in the baby’s mouth

● the baby feeds as often and for as long as she or he wants, including
during the night, and is kept on the breast until she or he has finished
suckling.The baby should finish feeding from one breast before being fed
from the other breast.
Holding the baby in a good position makes it easier for the baby to take the
breast well into the mouth and suckle.
Signs that the baby is in a good position for breastfeeding are:
● the baby’s head and body are in line
● the baby is close to the mother’s body
● the baby’s whole body is turned towards the mother
● the baby is relaxed, happy and suckling.
Holding the baby in a poor position can cause difficulties such as:
● sore and cracked nipples
● the baby does not receive enough milk
● the baby refuses to feed.
Signs that the baby is well attached:
● more of the dark skin around the mother’s nipple (areola) can be seen
above the baby’s mouth than below it
● the baby’s mouth is wide open
● the baby’s lower lip is turned outward
● the baby’s chin is touching the mother’s breast.
Signs that the baby is suckling well:
● the baby takes long, deep sucks
● the cheeks are round when suckling
● the baby releases the breast when finished.
Generally, the mother does not feel any pain in her breast when
breastfeeding.
From birth, the baby should breastfeed whenever she or he wants. A baby
should be fed on demand at least eight times in a 24-hour period, during
both the day and the night. If a newborn sleeps more than three hours after
breastfeeding, she or he may be gently awakened and offered the breast.
Crying is not a sign that the baby needs other foods or drinks. It normally
means the baby wants to be held and cuddled more, the baby’s diaper or
nappy needs changing, or the baby is too hot or cold. Some babies need
CHILDDEVELOPMENT

54 Facts for Life
to suckle the breast for comfort. More suckling produces more breastmilk,
which helps satisfy the baby’s feeding needs. If the baby cries a lot and does
not settle after feeding and being cuddled, the mother may need additional
breastfeeding support or the baby might not be well. A trained health worker
should be consulted.
Using pacifiers, dummies or bottles can interfere with establishing
breastfeeding in the baby’s first months of life, as the sucking action for these
is different from suckling at the breast.The baby may become used to the
bottle teat or pacifier and refuse the breast.This may cause less suckling time
at the breast, which reduces milk production. Pacifiers and bottle teats may
become contaminated, increasing a baby’s risk of illness.
Mothers who fear they do not have enough breastmilk often give their babies
other food or drink in the first few months of life.This causes the baby to
suckle less often, so less breastmilk is produced.The mother will produce
more milk if she does not give the child other food or liquids and if she
breastfeeds often.
Mothers need to be reassured that they can feed their babies under 6 months
of age properly with breastmilk alone, and they need to be shown how to
do it. All mothers, especially those lacking the confidence to breastfeed,
need encouragement and support from the child’s father and their families,
neighbours, friends, health workers, employers and women’s organizations.
A mother who has undergone a Caesarean birth may require extra help to
begin breastfeeding her baby.
Skilled birth attendants can raise awareness and understanding about
the benefits of breastfeeding.They should support mothers to initiate and
continue breastfeeding and help fathers and other family members accept
breastfeeding as a natural and nutritious practice that protects the life of
the baby.
KEY MESSAGE
4. Breastfeeding helps protect babies and young children against dangerous
illnesses. It also creates a special bond between mother and child.
Breastmilk is a baby’s ‘first immunization’. It helps to protect against
diarrhoea, ear and chest infections, and other health problems.The protection
is greatest when breastmilk alone is given for the first six months and when
breastfeeding continues along with other foods well into the second year and
beyond. No other milks, foods or supplements can provide the protection
of breastmilk.

Breastfeeding helps a mother and baby form a close, loving relationship –
a process called bonding.The close contact and attention help infants feel
secure and loved, which is important for their growth and development.
The father and other family members can help by encouraging the mother
to rest quietly while she breastfeeds the baby.They can also make sure the
mother has enough nutritious food and help with household tasks and caring
for older children.
KEY MESSAGE
5. Bottle feeding and giving a baby breastmilk substitutes such as infant
formula or animal milk can threaten the baby’s health and survival. If
a woman cannot breastfeed her infant, the baby can be fed expressed
breastmilk or, if necessary, a quality breastmilk substitute from an ordinary
clean cup.
Babies who do not receive breastmilk do not receive protection from illnesses
provided by the mother’s antibodies and other components that come in her
milk.These babies are more likely to get diarrhoea and respiratory and ear
infections. Diarrhoea and respiratory infections, such as pneumonia, can be
deadly in babies and young children.
Feeding the baby breastmilk substitutes can cause poor growth or illness if
(1) too much or too little water is added, (2) the water is not from a safe
source and/or (3) the bottles and teats are not cleaned properly. Powdered
breastmilk substitutes may contain harmful bacteria that can cause illness.
Studies suggest that children fed breastmilk substitutes, as compared to
breastfed children, are at greater risk of childhood obesity and some chronic
illnesses, such as heart disease, later in life.
Feeding the baby breastmilk substitutes can be expensive and particularly
risky if parents cannot afford to buy enough of a quality breastmilk substitute.
For example, to feed one baby for the ﬁrst six months requires 20 kilograms
(about 40 tins) of infant formula.Trained health workers should inform all
parents considering the use of breastmilk substitutes about the costs.
If it is necessary to feed the baby with formula, it is important to boil clean
drinking water ﬁrst and then add the hot water to the powdered formula.The
water should not be added after it has cooled down.The directions for mixing
should be carefully followed.This ensures that the right amounts of formula
and safe water are mixed and that the process is hygienic. Before giving the
formula to the baby, the mother, father or other caregiver must make sure it
is not too hot.
CHILDDEVELOPMENT

56 Facts for Life
Animal milk and infant formula go bad if left at room temperature (around
20–25 degrees Celsius) for more than two hours. Breastmilk can be stored
for up to eight hours at room temperature without going bad. Of course, it is
better to safely store all types of milk in a clean, covered container, preferably
in a refrigerator.
Cup feeding is safer than bottle feeding because the cup can be easily cleaned
with soap and water. Cup feeding also provides some of the contact and
stimulation the baby needs, since the person has to hold the baby. Feeding
with a cup does not cause problems with suckling at the breast.
The best food for a baby who cannot be breastfed directly is milk expressed
from the mother’s breast, given from a clean, open cup. Even newborn
babies can be fed with an open cup. If it is necessary to feed a baby with
a nutritionally adequate breastmilk substitute, it should be fed to the baby
by cup.
KEY MESSAGE
6. If a woman is infected with HIV, there is a risk that she can pass the infection
to her infant through breastfeeding. In the ﬁrst six months, this risk is much
greater if the infant is fed both breastmilk and other liquids and foods than
if fed breastmilk alone.Therefore, it is recommended that the baby receives
breastmilk alone for the ﬁrst six months, unless it is acceptable, feasible,
affordable, sustainable and safe to give breastmilk substitutes (infant
formula) exclusively.
HIV testing, treatment and counselling
Pregnant women and new mothers who think they may be infected with
HIV should consult a trained health worker for HIV testing and counselling.
Women who are HIV-positive should be counselled on how to reduce the risk
of passing HIV to their children during pregnancy, childbirth or breastfeeding.
They should also be counselled and supported on how to get treatment and
care for themselves.
A trained health worker can provide women who are HIV-positive with
information on antiretroviral therapy (ART), a group of medicines for
people with HIV infection. ART can help reduce the risk of mother-to-child
transmission of HIV and contribute to keeping the mother healthy.
All health workers should know if HIV testing and ART are available at their
local clinic.They should provide information on these and other related
services to pregnant women and new mothers.

Assess the risks and determine what is manageable
The HIV-positive mother should be counselled and provided with information
to help her decide which feeding option is best for her baby and most
manageable for her.The HIV-positive mother should know that:
● if she breastfeeds exclusively during the first six months she reduces the
baby’s risk of illness, malnutrition and death
● if she uses breastmilk substitutes such as infant formula exclusively she
avoids the risk of HIV infection through breastmilk
● shortening the duration of breastfeeding can reduce the risk of
transmitting the infection to the infant.
The most appropriate infant feeding option for the child of an HIV-infected
mother ultimately depends on individual circumstances.The mother needs to
assess the risks through discussion with a trained health worker.The mother
infected with HIV has the right to (1) the information she needs to make an
informed decision and (2) all the services and support necessary to help her
implement that decision.
Infant Feeding Options
The first six months:
● Feeding the baby with infant formula (breastmilk substitutes) should be
considered only if it is acceptable, affordable, feasible, sustainable and
safe for the mother and child. If all these conditions can be met, the baby
can be fed a quality breastmilk substitute alone for the first six months,
with no breastmilk or other foods.This eliminates the risk of passing HIV
to the baby through breastfeeding.
● If the HIV-positive mother decides to breastfeed, she should feed her baby
breastmilk exclusively, giving no other liquids, milks or foods, for the first
six months. Feeding breastmilk alone in the first six months can reduce a
baby’s risk of HIV infection compared to giving both breastmilk and other
foods and liquids (‘mixed feeding’).
● Mixed feeding not only greatly increases the risk of transmitting HIV
to the baby in the first six months but also causes more illness, such
as diarrhoea and pneumonia, and malnutrition, and increases the risk
of death.
After six months:
● All infants should be started on other foods to meet their growing
nutritional needs.
● Women who have breastfed their infants during the first six months
should continue to give their babies breastmilk along with other foods
unless they meet the conditions to give safe replacement foods, including
CHILDDEVELOPMENT

58 Facts for Life
infant formula and other milks and foods. Once a nutritionally adequate
and safe diet can be provided, all breastfeeding should stop.
Other Important Information
During counselling, a pregnant woman or new mother with HIV can be helped
to determine whether she can provide her baby with a nutritionally adequate
and safe diet without breastmilk.This assessment should be undertaken not
only once, such as before the child is born, but also throughout the period of
breastfeeding, with the support of the trained health worker.
If the mother is confident that she can provide sufficient amounts of a quality
breastmilk substitute, properly and hygienically prepared with clean water,
then she can opt to stop all breastfeeding and begin using the breastmilk
substitute. A trained health worker should provide the mother and father with
guidance on safe and clean practices to prepare the breastmilk substitute.
A new mother who does not know her HIV status should exclusively
breastfeed her child for the first six months and continue breastfeeding for
up to two years and beyond in addition to feeding the child other nutritious
foods and drinks.
Infants confirmed as HIV-positive should be breastfed so they can receive the
benefits of breastmilk.
(Refer to the HIV chapter for more information on children and families living
with HIV.)
KEY MESSAGE
7. A woman employed away from her home can continue to breastfeed her
child. She should breastfeed as often as possible when she is with the infant
and express her breastmilk when they are apart so that another caregiver can
feed it to the baby in a clean and safe way.
If a mother cannot be with her baby during working hours, she should
breastfeed often when they are together. With frequent breastfeeding, she will
continue to produce breastmilk.
If a woman cannot breastfeed at her workplace, she can express her milk
two or three times during the workday and refrigerate it or store it at room
temperature for up to eight hours in a clean, covered container.The expressed
milk can be given to the child by another caregiver from a clean cup.
Families and communities can encourage employers to provide paid
maternity leave, crèches, and the time and a suitable place for women to

breastfeed or express and store their milk.The place should be clean, safe and
private. It should have clean water available for washing hands and utensils.
KEY MESSAGE
8. After 6 months of age, when babies begin to eat foods, breastfeeding should
continue for up to two years and beyond because it is an important source of
nutrition, energy and protection from illness.
Breastmilk remains an important source of energy, protein and other
nutrients such as vitamin A and iron, even when babies begin to consume
additional foods after 6 months of age. Breastmilk helps protect a child
against disease for as long as the child breastfeeds.
It is recommended that a mother continue to breastfeed her child up to
two years and beyond – as long as she and the child wish to continue.
Breastfeeding can comfort a child who is upset and is an important source of
nourishment during a child’s illness.
CHILDDEVELOPMENT

©UNICEF/NYHQ2008-1279/Estey
NUTRITION
AND GROWTH

Introduction 61
M
ore than one third of all child deaths
every year around the world are
attributed to malnutrition, specifically
undernutrition, which weakens the body’s
resistance to illness.
If a woman is malnourished during pregnancy
or if her child is malnourished during the first
two years of life, the child’s physical and mental
growth and development will be slowed.This
cannot be corrected when the child is older – it will
affect the child for the rest of his or her life.
Malnutrition develops when the body does not get
the proper amount of energy (calories), proteins, carbohydrates, fats, vitamins, minerals and
other nutrients required to keep the organs and tissues healthy and functioning well. A child
or adult can be malnourished by being undernourished or overnourished.
In most parts of the world malnutrition occurs when people are undernourished. Primary
reasons for undernourishment, especially of children and women, are poverty, lack of
food, repeated illnesses, inappropriate feeding practices, lack of care and poor hygiene.
Undernourishment raises the risk of malnutrition.The risk is greatest in the first two years
of life.The risk further increases when diarrhoea and other illnesses sap the body of the
proteins, minerals and nutrients required to stay healthy.
When a household does not have enough food and has conditions that make diarrhoea and
other illnesses common, children are the most vulnerable to becoming malnourished. When
children become sick, they lose energy and nutrients quickly, which puts their lives at risk
faster than adults.
Overnutrition is when a person is overweight or obese. It can cause diabetes in childhood
and cardiovascular disease and other diseases in adulthood. Sometimes children eat large
quantities of foods that are high in energy but not rich in other necessary nutrients, such as
sugary drinks or fried, starchy foods. In such cases improving the quality of the child’s diet is
crucial along with increasing his or her level of physical activity.
Children with chronic diseases, such as HIV, are even more susceptible to malnutrition.
Their bodies have a harder time absorbing vitamins, iron and other nutrients. Children with
disabilities may need extra attention to make sure they get the nutrition they need.
All girls and boys have the right to a caring and protective environment, with mothers,
fathers or other caregivers making sure they are well nourished with a healthy diet.
CHILDDEVELOPMENT

62 Facts for Life
KEY MESSAGES:
NUTRITION
AND GROWTH
1. A young child should grow and gain weight rapidly. From birth to age 2,
children should be weighed regularly to assess growth. If regular weighing
shows that the child is not gaining weight, or the parents or other
caregivers see the child is not growing, something is wrong.The child
needs to be seen by a trained health worker.
2. Breastmilk alone is the only food and drink an infant needs in the first six
months of life. After six months, a baby needs a variety of other foods in
addition to breastmilk to ensure healthy growth and development.
3. From the age of 6–8 months a child needs to eat two to three times per
day and three to four times per day starting at 9 months – in addition to
breastfeeding. Depending on the child’s appetite, one or two nutritious
snacks, such as fruit or bread with nut paste, may be needed between
meals.The baby should be fed small amounts of food that steadily
increase in variety and quantity as he or she grows.
4. Feeding times are periods of learning, love and interaction, which promote
physical, social and emotional growth and development.The parent or
other caregiver should talk to children during feeding, and treat and feed
girls and boys equally and patiently.
5. Children need vitamin A to help resist illness, protect their eyesight
and reduce the risk of death. Vitamin A can be found in many fruits and
vegetables, red palm oil, eggs, dairy products, liver, fish, meat, fortified
foods and breastmilk. In areas where vitamin A deficiency is common,
high-dose vitamin A supplements can also be given every four to six
months to children aged 6 months to 5 years.

Key Messages 63
6. Children need iron-rich foods to protect their physical and mental abilities
and to prevent anaemia.The best sources of iron are animal sources, such
as liver, lean meats and fish. Other good sources are iron-fortified foods
and iron supplements.
7. Iodine in a pregnant woman’s and young child’s diet is especially critical
for the development of the child’s brain. It is essential to help prevent
learning disabilities and delayed development. Using iodized salt instead
of ordinary salt provides pregnant women and their children with as much
iodine as they need.
8. As the child’s intake of foods and drinks increases, the risk of diarrhoea
substantially increases. Contamination of foods with germs is a major
cause of diarrhoea and other illnesses that cause children to lose nutrients
and energy needed for growth and development. Good hygiene, safe
water and proper handling, preparation and storing of foods are crucial to
prevent illnesses.
9. During an illness, children need additional fluids and encouragement to
eat regular meals, and breastfeeding infants need to breastfeed more
often. After an illness, children need to be offered more food than usual to
replenish the energy and nourishment lost due to the illness.
10. Very thin and/or swollen children need special medical care.They should
be taken to a trained health worker or health facility for assessment
and treatment.
CHILDDEVELOPMENT

64 Facts for Life
KEY MESSAGE
1. A young child should grow and gain weight rapidly. From birth to age 2,
children should be weighed regularly to assess growth. If regular weighing
shows that the child is not gaining weight, or the parents or other
caregivers see the child is not growing,something is wrong. The child
needs to be seen by a trained health worker.
Weight gain is the most important sign that a child is healthy and is growing
and developing well. From birth to 1 year of age, infants should be weighed
at least once every month. From 1–2 years of age they should be weighed at
least once every three months.
Whenever a child visits a health centre, he or she should be weighed.This can
help early detection of faltering growth so appropriate actions can be taken.
A health check-up can also detect if a child is gaining weight too fast for his
or her age.This requires examining a child’s weight in relation to his or her
height, which can determine if the child is overweight.
If the child is underweight or overweight, it is important to examine the child’s
diet and provide the parents or other caregiver with advice on good nutrition.
Increasingly there are undernourished and overnourished people side by side
in a family.
A child who is given only breastmilk for the ﬁrst six months usually grows
well during this time. Breastfeeding helps protect babies from common
illnesses and ensures good physical and mental growth and development.
Infants who are breastfed tend to learn more readily than infants who are
fed other kinds of milk.
NUTRITION
AND GROWTH

From the age of 6 months, a child needs to start eating a variety of other
nutritious foods, in addition to breastmilk, to ensure healthy growth
and development.
Every child should have a growth chart that tracks his or her growth. It
shows whether the child is growing appropriately for his or her age. At each
weighing the child’s weight should be marked with a dot on the growth chart
and the dots should be connected.This will produce a line that shows how
well the child is growing. If the line goes up, the child is doing well. A line that
stays flat or goes down is a cause for concern.
Children need to gain not only adequate weight but also adequate height.
A child’s height can also be tracked on a chart. Good nutrition, care and
hygiene, especially in the first two years of life, are necessary to prevent
children from becoming too short for their age (stunted). If a mother is
undernourished or does not have proper nutrition during pregnancy, her child
may be born too small.This puts the child at risk of becoming stunted later
on. A low-birthweight baby needs additional attention to feeding and care to
grow adequately.
A child who is not gaining enough weight over one or two months may
need larger servings, more nutritious food or more frequent meals.The child
may be sick or may need more attention and care or assistance with eating.
Parents and trained health workers need to act quickly to discover the cause of
the problem and take steps to correct it.
Here are some important questions to ask to help identify growth problems:
● Is the child eating often enough? In addition to breastfeeding, a child aged
6–8 months needs to eat two to three times per day and three to four
times per day starting at 9 months. Additional nutritious snacks, such as
a piece of fruit or bread with nut paste, may be needed one or two times
per day. A child with developmental delays or disabilities may require
extra help and time for feeding.
● Is the child receiving enough food? A child aged 6–8 months needs to
receive initially 2–3 spoonfuls of food, increasing gradually to 1
⁄2 cup
(250-millilitre), at each meal. A child 9–12 months old needs to receive 1
⁄2
cup at each meal. A child 12–23 months old requires 3
⁄4 to 1 whole cup of
‘family foods’ at each meal. Children 2 years and older need to receive
at least 1 whole cup at each meal. If the child finishes his or her food and
wants more, the child needs to be offered more.
● Do the child’s meals have too little ‘growth’ or ‘energy’ foods? Foods
that help children grow are beans, nuts, meat, fish, eggs, dairy products,
grains and pulses.The daily inclusion of animal-source foods in the diet is
particularly important. A small amount of oil can add energy. Red palm oil
or other vitamin-enriched edible oils are good sources of energy.
CHILDDEVELOPMENT

66 Facts for Life
High-quality ‘growth’ foods are especially important to ensure that
children gain both adequate weight and height. Foods such as highly
processed fatty foods or sugary snacks are not rich in vitamins and
minerals and other important nutrients and may cause children to gain
too much weight without a proportionate growth in height.
● Is the child refusing to eat? If the child does not seem to like the taste of
a particular food, other foods should be offered. New foods should be
introduced gradually.
● Is the child sick? A sick child needs encouragement to eat small, frequent
meals.The child needs to be breastfed more frequently. After an illness,
the child needs to eat more than usual to regain the weight lost and to
replenish energy and nourishment. If the child is frequently ill, he or she
should be checked by a trained health worker.
● Is the child getting enough foods with vitamin A? Breastmilk is rich in
vitamin A. Other foods with vitamin A are liver, eggs, dairy products,
red palm oil, yellow and orange fruits and vegetables, and green leafy
vegetables. If these foods are not available in adequate amounts, a health-
care provider can provide the child with a vitamin A supplement (tablet or
syrup) every four to six months.
● Is the child being given breastmilk substitutes by bottle? If a breastmilk
substitute is given, it should be fed from a clean, open cup, rather than
from a bottle.
● Is the food kept clean? If not, the child will often be ill. Raw food should
be washed or cooked with clean water from a safe source. Cooked food
should be eaten without delay. Leftover food should be carefully stored
and thoroughly reheated.
● Is the water kept clean? Clean water is vital for a child’s health. Water
should come from a safe source and be kept clean by storing it in covered
containers that are clean on the inside and outside. Clean drinking water
can be obtained from a regularly maintained, controlled and chlorinated
piped supply, public standpipe, borehole, protected dug well, protected
spring or rainwater collection. If water is drawn from ponds, streams,
unprotected springs, wells or tanks, it needs to be puriﬁed. Home water
treatments can be used such as boiling, ﬁltering, adding chlorine or
disinfecting with sunlight in accordance with information provided by a
trained health worker or extension agent.
● Are faeces being put in a latrine or toilet or buried? Are hands being
washed with soap and water or a substitute, such as ash and water, after
use of the latrine or toilet? If not, the child may frequently get worms and
other sicknesses. A child with worms needs deworming medicine from a
trained health worker.
● Is the young child left alone much of the time or in the care of an older
child? If so, the young child may need more attention and interaction from
adults, especially during mealtime.

KEY MESSAGE
2. Breastmilk alone is the only food and drink an infant needs in the first six
months of life. After six months, a baby needs a variety of other foods in
addition to breastmilk to ensure healthy growth and development.
In the first six months, when a baby is most at risk, exclusive breastfeeding
helps to protect against diarrhoea and other common infections and gets the
baby off to a good start in life.
At 6 months of age, the child needs other foods and drinks in addition to
breastmilk.These provide energy, protein, vitamins and other nutrients
needed to support growth and development.
A variety of foods – vegetables and fruits, meat, poultry, fish, eggs and dairy
products – help to meet the child’s nutrition needs. Breastfeeding for up to
two years and beyond provides an important source of nutrients that protect
against disease.
If soft, semi-solid or solid foods are introduced too late, the child may not be
getting the necessary nutrients.This can slow down growth and development.
When introducing solid foods, it is important to start with soft, mushy foods
and move gradually to more solid foods.The greater the variety of healthy
foods, the more balanced and nutritious the child’s diet.
The consistency and variety of foods should be adapted to a child’s
requirements and eating abilities. At 6 months of age infants can eat pureed
or mashed foods, thick soups and porridges. By 8 months most infants
can also eat ‘finger foods’ (snacks that children can eat by themselves). By
12 months, most children can eat the same types of foods as the rest of
the family.
Parents or other caregivers should avoid giving foods that may cause choking,
such as nuts, grapes and raw carrots and other foods that have a shape and/or
consistency that may cause them to become lodged in the child’s throat.
It may be difficult to meet all the child’s nutrient requirements without a lot of
foods from animal sources. So it may be necessary to give the child fortified
foods or spreads or multiple vitamin and mineral supplements, such as
powders, syrups or dissolvable tablets. A trained health worker can advise
the parent or other caregiver about foods that provide the most nutrients and
which supplements to use.
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68 Facts for Life
Following are some nutritious foods for young children (older than six
months) to eat:
● Staple foods, including cereals (rice, wheat, maize, millet, quinoa), roots
(cassava, yam, potatoes) and starchy fruits (plantain and breadfruit).
● High-protein foods, such as red meat, poultry, fish, liver and eggs (can be
given as often as possible).
● Dairy products, such as cheese, yogurt, curds and dried milk (which can be
mixed with other foods, such as cooked porridge).These are good choices
in the second six months of a breastfed child’s life.These are better
choices than raw milk, which is harder for the child to digest.
● Green leafy and orange-coloured vegetables, such as spinach, broccoli,
chard, carrots, pumpkins and sweet potatoes (which provide vitamins).
● Pulses, such as chickpeas, lentils, cowpeas, black-eyed peas, kidney beans
and lima beans (to add variety and provide protein, energy and some
iron).
● Oils, especially rapeseed oil, soy oil, red palm oil, butter or margarine.
● Seeds, including groundnut paste, other nut pastes and soaked or
germinated seeds, such as pumpkin, sunflower, melon or sesame seeds
(for energy and some vitamins).
It is difficult to provide all the nutrients needed by young children in a
vegetarian diet.This is because foods from animal sources provide key
nutrients, such as iron. A child eating a vegetarian diet needs additional
nutrients in the form of multiple vitamin tablets or powders, fortified spreads
or nutrient-rich food supplements.
Iron from plant foods is generally not absorbed very well by the body.
However, plant foods such as pulses (white beans, chickpeas, lentils) have
more iron.The iron will be better absorbed if eaten together with foods that
are high in vitamin C, such as oranges and other citrus fruits and juices.
KEY MESSAGE
3. From the age of 6–8 months a child needs to eat two to three times per
day and three to four times per day starting at 9 months, in addition to
breastfeeding. Depending on the child’s appetite, one or two nutritious
snacks, such as fruit or bread with nut paste, may be needed between meals.
The baby should be fed small amounts of food that steadily increase in
variety and quantity as he or she grows.
Good nutrition in the first two years of life is crucial. Inadequate nutrition
during this period can slow a child’s physical and mental development for the
rest of his or her life.

In order to grow and stay healthy, young children need a variety of nutritious
foods such as meat, fish, pulses, grains, eggs, fruits and vegetables, as well
as breastmilk.
A child’s stomach is smaller than an adult’s, so a child cannot eat as much at
one meal. However, children’s energy and body-building needs are great. It is
important that children eat frequently to provide for all their needs.
Foods such as mashed vegetables and chopped meat, eggs or fish should be
added to the child’s diet as often as possible. A small amount of oil may be
added, preferably vitamin-enriched oil.
If meals are served in a common dish, younger children may not get enough
food. Giving a young child his or her own plate or bowl makes it easier for
the parent or other caregiver to know what foods and how much the child
has eaten.
Young children may need to be encouraged to eat, and they may need help
in handling food or utensils. A child with a developmental delay or disability
may need extra help eating and drinking.
The following gives information on how often and how much a young child
should be fed:
6–8 months:
Children should breastfeed frequently and receive other foods two to three
times a day. Parents should start with soft or mushy foods (such as porridge)
and gradually increase the consistency (thickness) of food. Animal foods such
as meat, eggs and fish can be given as early as possible, but they should be
mashed, minced or cut into very small pieces. Start with 2–3 spoonfuls per
feeding, increasing gradually to 1
⁄2 of a 250-millilitre cup.
9–24 months:
Children should receive other foods three to four times a day in addition to
breastfeeding. Give infants aged 9–11 months 1
⁄2 of a 250-millilitre cup per
feeding. Provide children aged 12–23 months 3
⁄4 to 1 whole 250-millilitre cup
per feeding. Give children 2 years and older at least 1 whole 250-millilitre
cup per feeding. Foods from animals, such as meat, fish and eggs, should be
included as much as possible.
By 12 months:
Most children are able to consume ‘family foods’ of a solid consistency.They
can still be offered semi-solid foods, which are easier for young children to eat.
Additional nutritious snacks (such as fruit, bread or bread with nut paste)
can be offered once or twice per day, as desired, starting at six months.
If the quality or amount of food per meal is low, or the child is no longer
breastfeeding, give 1–2 cups of milk plus one or two extra meals each day.
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70 Facts for Life
KEY MESSAGE
4. Feeding times are periods of learning, love and interaction, which promote
physical, social and emotional growth and development.The parent or other
caregiver should talk to children during feeding, and treat and feed girls and
boys equally and patiently.
Mealtimes provide the opportunity for mothers and fathers or other
caregivers to interact and talk with children and support their learning.This
helps to stimulate social and emotional development.
It is important to encourage children to eat, but not to force-feed them. Each
child’s needs vary due to differences in breastmilk intake and variability in
growth rate. Infants need to be fed directly.Young children should be assisted
when they are learning to feed themselves.
If a child refuses to eat a variety of foods, the caregiver can experiment with
different food combinations, tastes, textures and methods of encouragement.
The caregiver should minimize distractions during meals if the child loses
interest easily.
Girls and boys require the same amount of attention and time for feeding.
They should receive the same quantity and quality of food and drink.They
both need to be breastfed for the first six months and receive an adequate
variety and quantity of foods after six months. It is important for both
mothers and fathers to be informed about child nutrition. Both parents should
take part in feeding their daughters and sons.
KEY MESSAGE
5. Children need vitamin A to help resist illness, protect their eyesight
and reduce the risk of death.Vitamin A can be found in many fruits and
vegetables, red palm oil, eggs, dairy products, liver, fish, meat, fortified foods
and breastmilk. In areas where vitamin A deficiency is common, high-dose
vitamin A supplements can also be given every four to six months to children
aged 6 months to 5 years.
Until infants are 6 months old, breastmilk is the main source of vitamin A,
provided the mother has enough vitamin A from her diet or supplements.
Children aged 6 months to 5 years can get vitamin A from a variety of
other foods, such as liver, eggs, dairy products, fatty fish, red palm oil, ripe
mangoes and papayas, oranges, yellow sweet potatoes, dark green leafy
vegetables and carrots.
When children do not have enough vitamin A they are less able to fight
potentially fatal diseases and are at risk of night blindness. A child who has

difficulty seeing in the early evening and at night is probably deficient in
vitamin A.The child should be taken to a trained health worker for treatment
with high-dose vitamin A supplements.
In a few countries, vitamin A has been added to cooking oils, sugar, wheat
and flours, milk and dairy products, and other foods. In many countries where
vitamin A deficiency is widespread and children often die from illnesses such
as diarrhoea and measles, vitamin A is distributed twice a year to children
6 months to 5 years of age in a high-dose capsule or syrup.
Diarrhoea and measles deplete vitamin A from the child’s body. A child
with diarrhoea lasting several days or with measles, or who is severely
malnourished, should be treated with high-dose vitamin A supplements
obtained from a trained health worker.
In areas where it is known or suspected that children suffer from vitamin A
deficiency, those children with diarrhoea should be given a vitamin A
supplement if they have not received one within the past month, or if they are
not already receiving vitamin A at regular four to six month intervals.
Children with measles should receive vitamin A on the day of diagnosis, a
dose on the following day and another dose at least two weeks later.
Zinc (tablet or syrup) can also be given for 10–14 days to reduce the severity
and the duration of the diarrhoea as well as protect the child for up to
two months from future diarrhoea episodes.The dosage for children over
6 months of age is 20 milligrams per day, for children under 6 months of age
it is 10 milligrams per day.
KEY MESSAGE
6. Children need iron-rich foods to protect their physical and mental abilities
and to prevent anaemia.The best sources of iron are animal sources, such
as liver, lean meats and fish. Other good sources are iron-fortified foods and
iron supplements.
A lack of iron in the diet is a common cause of anaemia. Children can also
become anaemic from malaria and hookworm. Iron deficiency can impair
physical and mental development in infants and young children. Even mild
iron deficiency can impair intellectual development. Anaemia is the most
common nutritional disorder in the world.
Iron is found in animal foods such as liver, lean meats and fish. It is also in
some vegetarian foods such as pulses. Foods such as wheat and maize flours,
salt, fish sauce or soy sauce are sometimes fortified with iron. Iron-rich foods
help prevent anaemia. Consuming them with vitamin C helps the digestive
system to better absorb the iron.
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72 Facts for Life
Symptoms of anaemia include paleness of the palms of the hands and
of the tongue and inside the eyelids and lips as well as tiredness and
breathlessness.
● In children under 2 years of age:
Anaemia may cause problems with coordination and balance, and the
child may appear withdrawn and hesitant.This can limit the child’s ability
to interact and may hinder intellectual development.
The child can benefit from iron-containing vitamin and mineral
preparations, such as supplements and multiple vitamin and mineral
powders.These powders can be easily mixed by the caregiver in home-
prepared foods for children older than 6 months.
● In pregnant women and adolescent girls:
Anaemia increases the severity of haemorrhage and the risk of infection
during childbirth. It is an important cause of maternal mortality. Infants
born to anaemic mothers often suffer from low birthweight and anaemia.
Iron supplements for pregnant women protect both the mothers and their
babies. Adolescent girls who are anaemic will also benefit from a weekly
iron-folic acid supplement to build their iron stores and prepare their
bodies for healthy pregnancies.
Malaria and hookworm can be main causes of anaemia.Taking iron
supplements to treat anaemia while having malaria can worsen the anaemia.
With regard to malaria:
● Children living in malarial areas should not take iron and folic acid
preparations, including iron-containing powders, unless the malaria has
been diagnosed and treated and they have been screened for anaemia.
● In general, children living in malarial areas should not be given
preventive doses of iron-containing vitamin and mineral preparations or
supplements unless they are delivered through a fortified food.
● Pregnant women, mothers, fathers and other caregivers living in malarial
areas need to ask a trained health worker about using iron supplements
for their children.
● To help prevent malaria, children, pregnant women, and mothers and
other family members should sleep under insecticide-treated mosquito
nets.
With regard to worms:
● Children living in areas where worms are highly endemic should be
treated two to three times a year with a recommended deworming
(anthelmintic) medication. Deworming the child regularly helps treat the
anaemia caused by worms and also helps children regain their appetite.
Good hygiene practices prevent worms. Children should not play near the

latrine, should wash their hands often with soap and water or a substitute,
such as ash and water, and should wear shoes or sandals to prevent
worm infestations.
● Pregnant women living in areas where worms are common should be
treated with a recommended deworming medication.
KEY MESSAGE
7. Iodine in a pregnant woman’s and young child’s diet is especially critical for
the development of the child’s brain. It is essential to help prevent learning
disabilities and delayed development. Using iodized salt instead of ordinary
salt provides pregnant women and their children with as much iodine as
they need.
Small amounts of iodine are essential for children’s growth and development.
If a woman does not have enough iodine during pregnancy, her child is likely
to be born with a mental disability or possibly a hearing or speech disability.
If the child does not get enough iodine during infancy and childhood, he or
she may have delayed physical, mental or cognitive development. Even mild
deﬁciency can reduce learning ability and lower intelligence.
Goitre, an abnormal enlargement of the thyroid gland causing a swelling
of the neck, is a sign of iodine missing in the diet. Iodine deﬁciency in early
pregnancy increases the risk of miscarriage or stillbirth.
Using iodized salt instead of ordinary salt provides pregnant women and children
with as much iodine as they need. Iodized salt is safe for the whole family and is
the only salt needed for all cooking. Families should be sure to buy only iodized
salt of good quality – properly marked and packaged. Mothers need to make sure
they consume only iodized salt before, during and after pregnancy. Mothers and
fathers need to ensure that the salt consumed by their children is iodized.
KEY MESSAGE
8. As the child’s intake of foods and drinks increases, the risk of diarrhoea
substantially increases. Contamination of foods with germs is a major
cause of diarrhoea and other illnesses that cause children to lose nutrients
and energy needed for growth and development. Good hygiene, safe
water and proper handling, preparation and storing of foods are crucial to
prevent illnesses.
As children grow and become mobile they put everything in their mouths.
They can pick up germs more easily as they explore and discover the world
around them.This makes it very important for parents and other caregivers
to practice good hygiene, such as hand washing with soap.They also need
to handle and prepare food properly, use safe water and keep the living
CHILDDEVELOPMENT

74 Facts for Life
environment clean.These practices are important to prevent diarrhoea and
other illnesses and to protect a child’s health.
Foods should be served immediately after preparation and leftovers safely
stored. Clean utensils and surfaces should be used to prepare and serve food.
Children should be fed with clean cups and bowls. Bottles and nipples/teats
should be avoided because they are difficult to keep clean.
Five key ways to keep food safe are: keep it clean; separate raw and cooked
foods; cook food thoroughly; keep it at a safe temperature; and wash raw
food materials in safe water.
(Refer to the Hygiene chapter for more information.)
KEY MESSAGE
9. During an illness, children need additional fluids and encouragement to eat
regular meals, and breastfeeding infants need to breastfeed more often. After
an illness, children need to be offered more food than usual to replenish the
energy and nourishment lost due to the illness.
When children are sick, such as when they have diarrhoea, measles or
pneumonia, their appetite decreases and their body uses food less effectively.
If the child is sick several times a year, his or her growth will slow or stop.
It is very important to encourage a sick child to eat.This can be difficult, as
children who are ill may not be hungry.The parent or other caregiver should
keep offering foods the child likes, a little at a time and as often as possible.
Extra breastfeeding is especially important since it can provide nutrients
required for recovery from infections.
It is essential to encourage a sick child to drink as often as possible.
Dehydration (lack of fluids in the body) is a serious problem for children with
diarrhoea. Drinking plenty of liquids will help prevent dehydration. When a
child has diarrhoea, giving him or her oral rehydration salts (ORS) dissolved
in clean water, along with foods and liquids, can help prevent dehydration.
Giving the child a zinc supplement every day for 10–14 days can reduce the
severity of the diarrhoea.The child is not fully recovered from an illness until
he or she weighs about as much as when the illness began.
A child can die from persistent diarrhoea if it is not treated quickly. If
diarrhoea and poor appetite persist for more than a few days, the mother,
father or other caregiver needs to consult a trained health worker.
(Refer to the Diarrhoea chapter for more information.)

KEY MESSAGE
10. Very thin and/or swollen children need special medical care.They should
be taken to a trained health worker or health facility for assessment
and treatment.
A short period of inadequate nutrition together with illness or infection can
quickly make a child dangerously malnourished.The child needs urgent
treatment with special foods and medicine. He or she should be taken directly
to the nearest health-care provider.
Children with severe acute malnutrition are very thin.They may also have
swollen parts of the body, usually the feet and the legs. A trained health
worker can identify severe acute malnutrition by measuring the child’s weight
and height, using a special band to measure the upper arms or checking for
equal swelling in both legs.
Treating a child with severe acute malnutrition effectively needs to be done
by a health-care provider. The treatment depends on how sick the child is.
Most children over 6 months old can be treated with a special ready-to-
use therapeutic food (RUTF).This is a soft pre-packaged food that contains
all the nutrients needed for the child’s recovery. RUTF is easy for children
to consume directly from the packet and requires no mixing with water or
other foods, making it safe to use anywhere. Parents or other caregivers are
provided with a week’s supply of RUTF, along with information on how to
treat the child. Medications are also provided as part of the treatment.The
child should be taken back to the health-care provider every week to monitor
his or her progress.
More intensive treatment is needed for children who are not able to eat RUTF,
have other medical problems or are under 6 months old.These cases should
be referred to a hospital or other facility that can provide 24-hour medical
care, therapeutic milks and breastfeeding support.
Children with severe acute malnutrition get cold more quickly than other
children, so they must always be kept warm. Skin-to-skin contact with the
mother or other caregiver can help keep a child warm. Both the mother and
child should be covered.The child’s head should also be kept covered.
Although children with severe acute malnutrition need special nutritional
treatment, breastmilk is still a vital source of nutrients and protection from
disease. In addition to the special treatment (either at home or in a facility),
children who are breastfeeding should continue to breastfeed.
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76 Facts for Life
©UNICEF/NYHQ2006-0081/Noorani
IMMUNIZATION

Introduction 77
E
ach year, over 1.4 million children die from
diseases that are preventable with readily
available vaccines.2
These diseases include measles, meningitis
caused by Haemophilus influenzae type B
(Hib), diphtheria, tetanus, pertussis (whooping
cough), yellow fever, polio and hepatitis B.
New vaccines against other illnesses, such as
pneumonia and diarrhoea caused by rotavirus,
have been developed and are now more
widely used.
Children who are immunized are protected from
these dangerous diseases, which can often lead to disability or death. All children have
the right to this protection.
Every girl and boy needs to be fully immunized. Early protection is critical.The
immunizations in the child’s first year and into the second year are especially important.
It is also essential that pregnant women are immunized against tetanus to protect
themselves as well as their newborns.
Although there has been progress in the past years in immunizing children, in 2008
nearly 24 million children — almost 20% of children born each year — did not get the
routine immunizations scheduled for the first year of life.
Parents or other caregivers need to know why immunization is important, the
recommended immunization schedule, and where their children can be immunized.
Parents or other caregivers need to know that it is safe to immunize a child who has a
minor illness or a disability or is suffering from malnutrition.
2 As of 2002 (latest data available).
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78 Facts for Life
KEY MESSAGES:
IMMUNIZATION
1. Immunization is urgent. Every child should complete the recommended
series of immunizations. Early protection is critical; the immunizations in the
ﬁrst year and into the second year are especially important. All parents or
other caregivers should follow the advice of a trained health worker on when
to complete the required immunizations.
2. Immunization protects against several dangerous diseases. A child who
is not immunized is more likely to become sick, permanently disabled or
undernourished, and could possibly die.
3. It is safe to immunize a child who has a minor illness or a disability or is
malnourished.
4. All pregnant women and their newborns need to be protected against
tetanus. Even if a woman was immunized earlier, she needs to check with a
trained health worker for advice on tetanus toxoid immunization.

Key Messages 79
5. A new syringe must be used for every person being immunized. People
should demand a new syringe for every vaccination.
6. Disease can spread quickly when people are crowded together. All children
living in congested conditions, particularly in refugee or disaster situations,
should be immunized immediately, especially against measles.
7. The vaccination card of a child (or an adult) should be presented to the
health worker before every immunization.
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80 Facts for Life
KEY MESSAGE
1. Immunization is urgent. Every child should complete the recommended
series of immunizations. Early protection is critical; the immunizations in the
first year and into the second year are especially important. All parents or
other caregivers should follow the advice of a trained health worker on when
to complete the required immunizations.
Children must be immunized early in life. It is essential that infants, both girls
and boys, get all recommended vaccines at the right time. Some vaccines
require multiple doses for full protection. It is important for every child to
complete the full number of these immunizations.
To protect the child during and beyond the first year of life, the immunizations
in the following chart are necessary.These are most effective when given at
the ages specified, or as close to those ages as possible.
IMMUNIZATION

Immunization schedule for infants3
Age at
immunization
Location Immunization
At birth All countries BCG4
Some countries Hepatitis B, polio
6–8 weeks All countries DTP5
(also known as DPT),
polio
Most countries Hepatitis B and Hib
Some countries Pneumococcal (conjugate),
rotavirus
10–12 weeks All countries DTP, polio
rotavirus
14–24 weeks All countries DTP, polio
rotavirus6
9 months Some countries Yellow fever
9–15 months All countries Measles
12–18 months Some countries Mumps and rubella
15 months–
6 years
All countries Measles7
3 Parents, caregivers and health workers should follow the national immunization schedule.
4 BCG (Bacille Calmette-Guérin) vaccine offers partial protection against some forms of tuberculosis and
leprosy.
5 DTP (DPT) protects against diphtheria, tetanus and pertussis (whooping cough); many countries use
DTPHepBHib, a five-in-one combination, vaccine also known as a pentavalent vaccine.
6 This is only for those receiving Rotateq™ vaccine, which has a three-dose schedule. A two-dose schedule is
recommended for the Rotarix™ vaccine.
7 A minimum gap of one month should be given between the first and second doses of measles vaccine.
As new vaccines become available, more vaccines are recommended for
all countries. But some vaccines are only needed in countries where certain
diseases are present.
Parents and health workers should follow the locally recommended
immunization schedule.
If a child does not complete the full series of immunizations in the first and
into the second year of life, it is extremely important to have the child fully
immunized as soon as possible.This can be done during special campaigns.
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82 Facts for Life
In some countries, additional vaccine doses, called ‘booster shots’, are offered
after the first year of life.These help to sustain the effectiveness of the vaccine
so the child is protected longer.
KEY MESSAGE
2. Immunization protects against several dangerous diseases. A child who
is not immunized is more likely to become sick, permanently disabled or
undernourished, and could possibly die.
Immunization protects children against some of the most dangerous diseases
of childhood. All children, including those who are disabled, need to be
vaccinated. A child is immunized by vaccines, which are injected or given
by mouth.The vaccines work by building up the child’s defences against
diseases. Immunization only works if given before the disease strikes.
A child who is not immunized is very likely to get measles, whooping cough
and many other diseases that can kill. Children who survive these diseases
are weakened and may not grow well.They may be permanently disabled.
They may die later from malnutrition and other illnesses.
All children need to be immunized with BCG (Bacille Calmette-Guérin)
vaccine, which offers partial protection against some forms of tuberculosis
and leprosy.
All children need to be immunized against diphtheria, tetanus and pertussis
with DTP vaccine (also known as DPT vaccine). Diphtheria causes infection
of the upper respiratory tract, which in severe cases may lead to breathing
difficulties and death.Tetanus causes rigid muscles and painful muscle
spasms and can be deadly. Pertussis, or whooping cough, affects the
respiratory tract and can cause a cough that lasts four to eight weeks.The
disease is very dangerous in infants.
All pregnant women and infants need to be immunized against tetanus.
● Immunizing a woman or adolescent with at least two doses of tetanus
toxoid before or during pregnancy protects the newborn for the first few
weeks of life and protects the mother.
● At 6 weeks old, a baby needs the first dose of tetanus toxoid (the tetanus
component of the DTP (DPT) vaccine) to extend the protection received
from the mother against tetanus.
All children need to be immunized against measles, which can be a major
cause of malnutrition, poor mental development, and hearing and visual
impairments.The signs that a child has measles are a fever and rash, together
with a cough, a runny nose or red eyes. A child can die from measles.

All children need to be immunized against polio.The signs of polio are a
floppy limb or the inability to move. For every 200 children infected, one will
be disabled for life.
In countries where hepatitis B is a problem, up to 10 out of every 100 children
will harbour the infection for life if they are not immunized with hepatitis B
vaccine. Up to one quarter of children infected with hepatitis B may develop
serious liver conditions such as cancer when they are older.
In many countries, pneumonia caused by pneumococcus bacteria or
Haemophilus influenzae type B (Hib) bacteria is common and kills many
young children. Either of these bacteria can also cause childhood meningitis
and other serious infections.These bacteria are among the most dangerous
for children, particularly those under 5 years old. Vaccination with
Haemophilus influenzae type B vaccine (Hib vaccine) and pneumococcal
(conjugate) vaccine (PCV) can prevent these deaths.
A pentavalent vaccine (five vaccines in one), combining the DTP (DPT),
hepatitis B and Hib vaccines, is increasingly being used by national
immunization programmes.
Diarrhoea caused by rotavirus is common and can be severe. It affects
nearly every child under age 5. Severe rotavirus diarrhoea is more common
in developing countries where health care can be more difficult to access,
resulting in many deaths in children under 5 years old, especially children
under 2. Vaccination against rotavirus prevents diarrhoea caused by this virus.
However, diarrhoea due to other bacteria or viruses can still occur in children
who receive the rotavirus vaccine.
In some countries, yellow fever puts the lives of many young children and
adults at risk. Vaccination can prevent the disease.
Japanese encephalitis virus is spread by mosquitoes, mainly in rural areas
of Asian countries. It causes a severe illness, killing up to one third of those
affected. Many survivors have brain damage. A trained health worker should
be consulted for advice and information on national guidelines regarding use
of this vaccine.
Breastmilk and colostrum, the thick yellow milk produced during the first
few days after a woman gives birth, provide protection against diarrhoea,
pneumonia and other diseases. Colostrum is sometimes referred to as a
newborn’s ‘first vaccine’, helping to build the child’s immunity to disease.
In many countries where vitamin A deficiency is common, high-dose
vitamin A capsules (or syrup) are administered to each child aged 6 months
to 5 years, every four to six months. Vitamin A is distributed during routine
immunization (such as with measles vaccine at 9 months) as well as during
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84 Facts for Life
special immunization campaigns. Vitamin A is also an important part of
measles treatment.
KEY MESSAGE
3. It is safe to immunize a child who has a minor illness or a disability or is
malnourished.
Many parents do not take a child to be immunized because the child has a
fever, cough, cold, diarrhoea or some other illness. However, it is safe to
immunize a child who has a minor illness.
It is also safe to immunize a child who has a disability or is malnourished. If a
child is HIV-positive or suspected to be HIV-positive, a trained health worker
should be consulted about which vaccines to give the child.
After an injection, the child may cry or develop a fever, a minor rash or a
small sore.This is normal and shows that the vaccine is working. Children
under 6 months of age should breastfeed frequently; older children should
be given plenty of liquids and foods. If the child develops a high fever (over
38 degrees Celsius) the child should be taken to a trained health worker or
health centre.
Measles can be extremely dangerous for malnourished children, so they
should be immunized against measles, especially if the malnutrition is severe.
KEY MESSAGE
4. All pregnant women and their newborns need to be protected against
tetanus. Even if a woman was immunized earlier, she needs to check with a
trained health worker for advice on tetanus toxoid immunization.
In many parts of the world, mothers give birth in unhygienic conditions.This
puts both the mother and the child at risk of getting tetanus, a major killer of
newborn infants.

If a pregnant woman is not immunized against tetanus, and tetanus bacteria
or spores enter her body, her life will also be at risk.
Tetanus bacteria or spores grow in dirty cuts.These bacteria can grow if the
umbilical cord is cut with an unclean knife or if anything unclean touches the
end of the cord. Any tool used to cut the cord should be cleaned, boiled or
heated over a flame, and allowed to cool. For the first week after birth, the
baby’s umbilical stump must be kept clean. No substances should be put on
the stump.
All pregnant women should make sure they have been immunized against
tetanus.This protects both mothers and newborns.
It is safe for a pregnant woman to be immunized against tetanus. She should
be immunized according to this schedule:
First dose: As soon as she knows she is pregnant.
Second dose: One month after the first dose, and no later than two weeks
before her due date.
Third dose: Six months to one year after the second dose, or during the
next pregnancy.
Fourth dose: One year after the third dose, or during a subsequent
pregnancy.
Fifth dose: One year after the fourth dose, or during a subsequent
pregnancy.
After five properly spaced doses, the mother is protected for life and her
children are protected for the first few weeks of life.
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86 Facts for Life
KEY MESSAGE
5. A new syringe must be used for every person being immunized. People
should demand a new syringe for every vaccination.
Sharing syringes and needles, even among family members, can spread life-
threatening diseases. A new syringe should be used for every person.
All immunizations in any setting, including emergencies, should be given
with auto-disable syringes – syringes that can be used only once.
Parents and other caregivers should demand a new syringe for every
vaccination. Health workers must discard the syringes and any other waste
by-products safely.
KEY MESSAGE
6. Disease can spread quickly when people are crowded together. All children
living in congested conditions, particularly in refugee or disaster situations,
should be immunized immediately, especially against measles.
Emergencies that make people ﬂee their homes often lead to the spread of
communicable diseases.Therefore, all displaced children under 15 years of
age should be immediately immunized, especially for measles, at the ﬁrst
point of contact or settlement.
Measles is even more serious when children are malnourished or living in
conditions of poor sanitation.
● Diseases like measles spread very quickly. A child with measles needs to
be kept away from other children, be examined by a trained health worker
and be given a high dose of vitamin A.
● When there is an outbreak of measles in an area, children should
be immunized. Neighbouring areas should be alerted and children
immunized.
If routine child immunization has been disrupted, a trained health worker
should be consulted to complete the immunizations according to national
guidelines. If the child’s vaccination record is lost and the parents do not
remember which vaccines the child has received, it is safe to repeat doses.

KEY MESSAGE
7. The vaccination card of a child (or an adult) should be presented to the health
worker before every immunization.
It is important to follow the vaccination schedule in accordance with national
guidelines. Children should be immunized at the recommended ages and
should receive subsequent doses at recommended intervals.
When a child is immunized, the health worker should record the vaccine,
which dose it is (ﬁrst, second, etc.) and the date on an immunization or health
card given to the parents or other caregiver.The immunizations should also
be recorded and kept at the health clinic. It is important for the parents or
other caregiver to keep the immunization card and bring it with them the
next time the child is vaccinated. With it, the health worker can record which
vaccines the child has received and the date they were given.The health
worker can also provide information to the parents or other caregiver on
vaccines that are missing or remaining.
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88 Facts for Life
©UNICEF/NYHQ1993-0112/LeMoyne
DIARRHOEA

Introduction 89
D
iarrhoea is the second most common cause
of death in young children, after pneumonia.
About 4 billion cases of diarrhoea are
estimated to occur every year among children
under 5. It kills more than 1.5 million children under
5 years of age every year, representing 17 per cent
of all deaths in children under 5. Children are more
likely than adults to die from diarrhoea because
they become dehydrated and malnourished
more quickly.
Diarrhoea is caused by germs that are swallowed,
especially germs from faeces.This happens most
often where there is unsafe disposal of faeces, poor hygiene practices, lack of clean drinking
water, or when infants are not breastfed.
Infants who are exclusively breastfed in their ﬁrst six months and who receive all their
immunizations on time are less likely to get diarrhoea. Children with diarrhoea should be
given lots of ﬂuids and foods along with a special solution called oral rehydration salts
(ORS) and zinc to help reduce the severity of the illness.
Families and communities, with support from governments and non-governmental
organizations (NGOs), can do much to raise awareness of (1) what causes diarrhoea, (2) why
it is important to treat diarrhoea as soon as it starts, and (3) how to prevent the conditions
that cause it.
When everyone works together to reduce diarrhoea, children’s right to life, survival, health
and development can be better assured.
CHILDDEVELOPMENT
ANDEARLYLEARNINGDIARRHOEA
TIMINGBIRTHS

90 Facts for Life
KEY MESSAGES:
DIARRHOEA
1. Diarrhoea kills children by draining liquid from the body, which dehydrates
the child. As soon as diarrhoea starts, it is essential to give the child extra
fluids along with regular foods and fluids.
2. A child’s life is in danger if she or he has several watery stools within an hour
or if there is blood in the stool. Immediate help from a trained health worker
is needed.
3. Exclusive breastfeeding for the first six months of life and continued
breastfeeding after six months can reduce the risks associated with
diarrhoea. Immunization against rotavirus (where recommended and
available) reduces deaths from diarrhoea caused by this virus. Vitamin A and
zinc supplementation can reduce the risk of diarrhoea.
4. A child with diarrhoea needs to continue eating regularly. While recovering,
she or he needs to be offered more food than usual to replenish the energy
and nourishment lost due to the illness.

Key Messages 91
5. A child with diarrhoea should receive oral rehydration salts (ORS) solution
and a daily zinc supplement for 10–14 days. Diarrhoea medicines are
generally ineffective and can be harmful.
6. To prevent diarrhoea, all faeces, including those of infants and young
children, should be disposed of in a latrine or toilet or buried.
7. Good hygiene practices and use of safe drinking water protect against
diarrhoea. Hands should be thoroughly washed with soap and water or a
substitute, such as ash and water, after defecating and after contact with
faeces, and before touching or preparing food or feeding children.
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92 Facts for Life
KEY MESSAGE
1. Diarrhoea kills children by draining liquid from the body, which dehydrates
the child. As soon as diarrhoea starts, it is essential to give the child extra
fluids along with regular foods and fluids.
A child has diarrhoea when she or he passes three or more watery
stools a day.The more numerous the watery stools, the more dangerous
the diarrhoea.
Some people think that drinking liquids makes diarrhoea worse. This is not
true. A child with diarrhoea should be given drinks, including breastmilk,
as often as possible. Drinking lots of liquids helps to replace the fluids lost
during diarrhoea.
Recommended drinks for a child with diarrhoea include:
● breastmilk (mothers should breastfeed more often than usual)
● oral rehydration salts (ORS) mixed with the proper amount of clean water
(refer to the box on ORS after Message 5)
● soups
● rice water
● fresh fruit juices
● coconut water
DIARRHOEA

● clean water from a safe source. If there is a possibility the water is not
clean and safe to drink, it should be purified by boiling, filtering, adding
chlorine or disinfecting with sunlight in accordance with information
provided by a trained health worker or extension agent.
To avoid dehydration, breastfed children should breastfeed as often as
possible. Children who are not breastfeeding should drink the following
amounts of liquids every time a watery stool is passed:
● for a child under the age of 2 years: between 1
⁄4 and 1
⁄2 of a large
(250-millilitre) cup
● for a child 2 years or older: between 1
⁄2 and 1 whole large (250-millilitre)
cup.
Drinks should be given from a clean cup. A feeding bottle should not be used.
It is difficult to clean bottles completely, and unclean bottles can contain
germs that cause diarrhoea.
If the child vomits, the caregiver should wait 10 minutes and then begin again
to give the drink to the child slowly, small sips at a time.
The child should be given extra liquids in addition to regular foods and drinks
until the diarrhoea has stopped.
Diarrhoea usually stops after three or four days. If it lasts longer, parents or
other caregivers should seek help from a trained health worker.
KEY MESSAGE
2. A child’s life is in danger if she or he has several watery stools within an hour
or if there is blood in the stool. Immediate help from a trained health worker
is needed.
Parents should immediately seek help from a trained health worker if the
child:
● passes several watery stools in an hour
● passes blood in the stool
● vomits frequently
● has a fever
● is extremely thirsty
● does not want to drink
● refuses to eat
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94 Facts for Life
● has sunken eyes
● looks weak or is lethargic
● has had diarrhoea for several days.
If the child has any of these signs, help from a trained health worker is
needed urgently. In the meantime, the child should be given ORS solution
and/or other liquids, plus zinc.
If the child passes several watery stools in one hour and vomits, there is
cause for alarm – these are possible signs of cholera. Cholera can kill children
in a matter of hours. Medical help should be sought immediately and the
child should continue to receive ORS solution and zinc.
● Cholera can spread throughout the community quickly through
contaminated water or food. Cholera usually occurs in situations where
there is poor sanitation and overcrowding.
● There are four steps to take to limit the spread of cholera or diarrhoea:
1. Always wash hands with soap and water or a substitute, such as ash
and water, after defecation, after contact with faeces, before touching
or preparing food, before eating and before feeding children.
2. Dispose of all faeces, including those of infants and young children,
in a latrine or toilet, or bury them. Disinfect the places touched by the
faeces.
3. Use safe drinking water.
4. Wash, peel or cook all foods.
Trained health workers and health centres should provide families and
communities with clear information on the risks of diarrhoea and cholera and
what steps to take when either one occurs.
KEY MESSAGE
3. Exclusive breastfeeding for the first six months of life and continued
breastfeeding after six months can reduce the risks associated with
diarrhoea. Immunization against rotavirus (where recommended and
available) reduces deaths from diarrhoea caused by this virus.Vitamin A
and zinc supplementation can reduce the risk of diarrhoea.
Breastmilk is the best source of liquid and food for a young child with
diarrhoea. It is nutritious and clean and helps fight illness and infections.
An infant who is fed only breastmilk in her or his first six months of life is less
likely to get diarrhoea during this time.

Breastmilk prevents dehydration and malnutrition and helps replace lost
fluids. Mothers are sometimes advised to give less breastmilk if a child has
diarrhoea. This advice is wrong. Mothers should breastfeed more often than
usual when the child has diarrhoea. Fathers should support mothers who are
breastfeeding by caring for the sick child and other children in the family, and
by helping with household tasks.
Rotavirus causes diarrhoea. Children should be immunized against rotavirus
in countries that offer this vaccination.
Vitamin A supplementation, particularly in areas deficient in vitamin A, is
an important measure to reduce the risk of diarrhoea. Foods that contain
vitamin A include breastmilk, liver, fish, dairy products, orange or yellow
fruits and vegetables, and green leafy vegetables.
Including zinc as part of the treatment for diarrhoea for 10–14 days helps
to reduce its severity and duration, and also protects the child from future
diarrhoea episodes for up to two months. Children over 6 months of age
can take 20 milligrams per day of zinc (tablet or syrup). For children under
6 months, 10 milligrams per day (tablet or syrup) is an appropriate amount.
The trained health worker should show the mother, father or other caregiver
how to give the child a zinc tablet by dissolving it in a small amount of
expressed breastmilk, ORS or clean water in a small cup or spoon. If the child
is too young for a tablet, zinc syrup can be used.
KEY MESSAGE
4. A child with diarrhoea needs to continue eating regularly.While recovering,
she or he needs to be offered more food than usual to replenish the energy
and nourishment lost due to the illness.
A child with diarrhoea loses weight and can quickly become malnourished. A
child with diarrhoea needs all the foods and fluids, including breastmilk, she
or he can take. Nutritious foods will help the child recover more quickly.
A child with diarrhoea may not want to eat or may vomit, so feeding can be
difficult. Breastfeeding should be more frequent. If the child is 6 months of
age or older, parents and other caregivers should encourage the child to eat
as often as possible, offering small amounts of soft, mashed foods or foods
the child likes.These foods should contain a small amount of salt. Soft foods
are easier to eat and contain more fluid than hard foods.
Recommended foods for a child with diarrhoea are well-mashed mixes of
cereals and beans, fish, well-cooked meat, yogurt and fruits. A little oil can
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96 Facts for Life
be added to cereal and vegetables, about 1 or 2 teaspoons. Foods should be
freshly prepared and given to the child ﬁve or six times a day.
After the diarrhoea stops, extra feeding is vital for a full recovery. At this time,
the child needs to be given more food than usual, including breastmilk, to
help replenish the energy and nourishment lost due to the diarrhoea.
A child is not fully recovered from diarrhoea until she or he is at least the
same weight as when the illness began.
KEY MESSAGE
5. A child with diarrhoea should receive oral rehydration salts (ORS) solution
and a daily zinc supplement for 10–14 days. Diarrhoea medicines are
generally ineffective and can be harmful.
Diarrhoea usually cures itself in three to four days with rehydration (drinking
a lot of liquids).The real danger is the loss of liquid and nutrients from the
child’s body, which can cause dehydration and malnutrition.
A child with diarrhoea should never be given any tablets, antibiotics or other
medicines unless prescribed by a trained health worker.
The best treatment for diarrhoea is to (1) drink lots of liquids and oral
rehydration salts (ORS), properly mixed with clean water from a safe source,
and (2) take zinc tablets or syrup for 10–14 days.

ORS Solution
A special drink for diarrhoea
What is ORS? ORS (oral rehydration salts) is a special combination
of dry salts that is mixed with safe water. It can help
replace the ﬂuids lost due to diarrhoea.
When should ORS
be used?
When a child has three or more loose stools in a
day, begin to give ORS. In addition, for 10–14 days,
give children over 6 months of age 20 milligrams of
zinc per day (tablet or syrup); give children under
6 months of age 10 milligrams per day (tablet
or syrup).
Where can ORS be
obtained?
In most countries, ORS packets are available from
health centres, pharmacies, markets and shops.
How is the ORS drink
prepared?
1. Put the contents of the ORS packet in a clean
container. Check the packet for directions and
add the correct amount of clean water. Too little
water could make the diarrhoea worse.
2. Add water only. Do not add ORS to milk, soup,
fruit juice or soft drinks. Do not add sugar.
3. Stir well, and feed it to the child from a clean cup.
Do not use a bottle.
How much ORS
drink to give?
Encourage the child to drink as much as possible.
A child under the age of 2 years needs at least 1
⁄4 to
1
⁄2 of a large (250-millilitre) cup of the ORS drink after
each watery stool.
A child aged 2 years or older needs at least 1
⁄2 to
1 whole large (250-millilitre) cup of the ORS drink
after each watery stool.
What if ORS is not
available?
Give the child a drink made with 6 level teaspoons
of sugar and 1
⁄2 level teaspoon of salt dissolved in
1 litre of clean water.
Be very careful to mix the correct amounts.Too much
sugar can make the diarrhoea worse.Too much salt
can be extremely harmful to the child.
Making the mixture a little too diluted (with more
than 1 litre of clean water) is not harmful.
Diarrhoea usually stops in three or four days.
If it does not stop, consult a trained health worker.
CHILDDEVELOPMENT
TIMINGBIRTHS

98 Facts for Life
KEY MESSAGE
6. To prevent diarrhoea, all faeces, including those of infants and young children,
should be disposed of in a latrine or toilet or buried.
Children and adults can swallow germs that cause diarrhoea if faeces
come in contact with drinking water, food, hands, utensils or food
preparation surfaces.
Flies that settle on faeces and then on food also transmit the germs that cause
diarrhoea.To keep away ﬂies and prevent the spread of germs, (1) dispose
of faeces safely in a latrine or toilet, (2) keep the latrine or toilet clean, and
(3) cover food and drinking water.
All faeces, even those of infants and young children, carry germs and are
dangerous. If children defecate without using the latrine or toilet, their faeces
should be cleaned up immediately and disposed of in the latrine or toilet or
buried. Afterwards, hands should always be washed with soap and water.
If soap is not available, ash and water can be used as a substitute. Men and
boys can help women and girls in disposing of the faeces.
If there is no toilet or latrine, adults and children should defecate away from
houses, paths, water supplies and places where children play. Faeces should
then be buried under a layer of soil. Human and animal faeces should be kept
away from water sources.
In communities without toilets or latrines, the community should consider
joining together to build such facilities. Households can be encouraged to
build their own.

KEY MESSAGE
7. Good hygiene practices and use of safe drinking water protect against
diarrhoea. Hands should be thoroughly washed with soap and water or a
substitute, such as ash and water, after defecating and after contact with
faeces, and before touching or preparing food or feeding children.
Hands should always be washed with soap and water or a substitute, such as
ash and water, after defecating, after helping children use the toilet or latrine,
after cleaning the baby’s bottom, after disposing of refuse, and immediately
before feeding children, handling food or eating.
Young children frequently put their hands in their mouths. So it is important
to keep the household area clean and to teach children to wash their hands
properly and frequently, especially after defecating and before eating.
Using safe drinking water and keeping it clean and free of germs helps to
reduce diarrhoea.
Other hygiene measures that can help to prevent diarrhoea include:
● peel fruit and vegetables or wash them thoroughly with clean water,
especially if young children eat them raw
● prepare and thoroughly cook food just before eating (Food left standing
can collect germs that can cause diarrhoea. After two hours, cooked foods
are not safe unless they are kept very hot or very cold.)
● bury, burn or safely dispose of all food refuse to stop ﬂies from spreading
disease.
CHILDDEVELOPMENT
TIMINGBIRTHS

©UNICEF/NYHQ2009-0690/Ramoneda
COUGHS, COLDS AND
MORE SERIOUS ILLNESSES

Introduction 101
C
oughs, colds, sore throats and runny noses
are common in the lives of children. Usually
they are no cause for alarm.
In some cases, however, coughs are danger signs
of more serious illnesses, such as pneumonia or
tuberculosis. Pneumonia is the world’s leading
cause of death in girls and boys under age 5, closely
followed by diarrhoea. Around 2 million children die
from pneumonia every year. Pneumonia kills more
children than AIDS, malaria and measles combined.
One out of every ﬁve deaths of children under age 5
is caused by this respiratory infection.
All girls and boys have the right to quality health care to make sure that respiratory
infections and other illnesses are accurately diagnosed and treated before it is too late.
COUGHS,COLDSANDMORE
SERIOUSILLNESSESSAFEMOTHERHOOD

102 Facts for Life
KEY MESSAGES:
COUGHS, COLDS AND
MORE SERIOUS ILLNESSES
1. A child with a cough or cold should be kept warm and encouraged to eat and
drink as much as possible.
2. Sometimes, coughs are signs of a serious problem. A child who is breathing
rapidly or with difﬁculty might have pneumonia, an infection of the lungs.
This is a life-threatening disease.The child needs immediate treatment from
a trained health worker, who can also provide a referral to a health facility.
3. Families can help prevent pneumonia by making sure babies are exclusively
breastfed for the ﬁrst six months and that all children are well nourished and
fully immunized.

Key Messages 103
4. A child who has a prolonged cough that persists for more than three weeks
needs immediate medical attention.The child may have tuberculosis, an
infection in the lungs.
5. Children and pregnant women exposed to smoke from tobacco or cooking
ﬁres are particularly at risk of pneumonia or other breathing illnesses.
COUGHS,COLDSANDMORE

104 Facts for Life
KEY MESSAGE
1. A child with a cough or cold should be kept warm and encouraged to eat and
drink as much as possible.
Babies and very young children lose their body heat easily. When they have a
cough or cold they should be kept covered and warm.
Children with coughs, colds, runny noses or sore throats who are breathing
normally can be treated at home and will recover without medicines.They
need to be kept warm, but not overheated, and to be given plenty to eat and
drink. Medicines should be used only if prescribed by a trained health worker.
A child with a fever needs careful attention. She or he should be sponged or
bathed with cool but not cold water. The child should be kept well hydrated
with additional fluids. In areas where malaria is common, the fever could
be caused by malaria, which is dangerous to the health and survival of the
child. A child with a fever in these areas should be checked by a trained health
worker immediately.
The nose of a child with a cough or cold should be cleared often, especially
before the child eats or goes to sleep. A moist atmosphere can make breathing
easier. It can help if the child breathes water vapour from a bowl of water that
is hot but not boiling.The parent or other caregiver should make certain the
water is not too hot and that the child is carefully supervised when breathing the
water vapour.
A breastfed child who has a cough or cold may have difficulty breastfeeding.
Since breastfeeding helps to fight the illness and is important for the child’s
growth, the mother should continue to breastfeed often. If a child cannot
COUGHS, COLDS
AND MORE SERIOUS
ILLNESSES

suckle, the breastmilk can be expressed into a clean cup and the child can then
be fed from the cup by the mother, father or other caregiver. Before putting
the baby to the breast or feeding the baby breastmilk (or breastmilk substitute)
from a cup, it helps to clear the baby’s nose if it is blocked with secretions.
Children who are 6 months of age or older should be encouraged to breastfeed,
eat and drink frequently.When the illness is over, the child should be given extra
nutritious foods every day until she or he is at least the same weight as before
the illness.
Coughs and colds spread easily. People with coughs and colds should avoid
coughing, sneezing or spitting near children.They should cough or sneeze
into their elbow or a tissue and dispose safely of the tissue.This should be
followed by hand washing with soap.This helps stop the spread of germs.
KEY MESSAGE
2. Sometimes, coughs are signs of a serious problem. A child who is
breathing rapidly or with difﬁculty might have pneumonia, an
infection of the lungs.This is a life-threatening disease.The child
needs immediate treatment from a trained health worker,
who can also provide a referral to a health facility.
Most coughs, colds, fevers, sore throats and runny noses end without
requiring medication. But sometimes a cough and a fever are signs of
pneumonia, which needs to be treated by a trained health worker.
If a trained health worker provides antibiotics to treat the pneumonia, it is
important to follow the instructions and give the child all the medicine for as
long as the instructions say, even if the child seems better.
Many children die of pneumonia at home because their parents or other
caregivers do not realize the seriousness of the illness and the need for
immediate medical care. Millions of child deaths from pneumonia can be
prevented if:
● parents and other caregivers know that rapid and difﬁcult breathing is a
danger sign, requiring urgent medical help
● parents and other caregivers know where to get medical help
● medical help and appropriate and low-cost antibiotics are readily
available.
The child should be taken immediately to a trained health worker or clinic if
any of the following symptoms are present:
● the child is breathing much more quickly than usual: from birth to 59 days
– 60 breaths a minute; 2 months to 12 months – 50 breaths a minute or
more; over 12 months to 5 years – 40 breaths a minute or more
COUGHS,COLDSANDMORE

106 Facts for Life
● the child is breathing with difficulty or gasping for air
● the lower part of the chest sucks in when the child breathes in, or it looks
as though the stomach is moving up and down
● the child has had a cough for more than three weeks
● the child is unable to breastfeed or drink
● the child vomits frequently.
Health-care providers have a responsibility to provide parents and other
caregivers with this information on the health risks for a child with
pneumonia and the preventive steps and treatments to take.
KEY MESSAGE
3. Families can help prevent pneumonia by making sure babies are exclusively
breastfed for the first six months and that all children are well nourished
and fully immunized.
Breastfeeding helps to protect babies from pneumonia and other illnesses. It
is important to give breastmilk alone for the first six months of a baby’s life.
After 6 months of age, a child should eat a variety of healthy foods, and
continue to be breastfed, to ensure that she or he gets the nutrients necessary
to stay healthy and be less susceptible to respiratory infections and other
illnesses. Some examples of healthy foods include fruits and vegetables
(including green leafy vegetables), liver, red palm oil, dairy products, fish
and eggs.
Safe water and good hygiene practices help to reduce the number of
respiratory infections and other illnesses, such as diarrhoea.These practices
include washing vegetables and fruits, keeping food preparation surfaces
clean, and washing hands with soap and water or with a substitute, such as
ash and water.
Every child should complete a recommended series of immunizations.
Early protection is critical; the immunizations in the first year and into the
second year are especially important.The child will then be protected against
measles, pertussis (whooping cough), tuberculosis and other respiratory
illnesses, which can lead to pneumonia.
Parents and other caregivers should ensure that both girls and boys are
equally provided with a varied and healthy diet and all immunizations. Health
workers can provide parents and other caregivers with information on diets,
hygiene and immunizations and how they protect against pneumonia and
other illnesses.

KEY MESSAGE
4. A child who has a prolonged cough that persists for more than three weeks
needs immediate medical attention.The child may have tuberculosis, an
infection in the lungs.
Tuberculosis is a serious disease that can kill a child or permanently damage
the lungs. Families and caregivers can help prevent tuberculosis if they
ensure that children:
● are fully immunized – BCG immunization offers some protection against
some forms of tuberculosis
● are kept away from anyone who has tuberculosis or has a cough with
blood in the sputum.
If a trained health worker provides special medicine for tuberculosis, it is
important to give the child all the medicine according to the instructions. It must
be given for as long as specified, even if the child seems better. If not, the child
could build up resistance to the medicine, reducing its effectiveness the next time
it is needed.
KEY MESSAGE
5. Children and pregnant women exposed to smoke from tobacco or cooking
fires are particularly at risk of pneumonia or other breathing illnesses.
Children are more likely to get pneumonia and other breathing illnesses if
they live in an environment with smoke.
Exposure to smoke can harm a child, even before birth. Pregnant women
should not smoke or be exposed to smoke. Babies especially should be kept
out of smoky kitchens and away from cooking fires.
Tobacco use generally begins during adolescence. Adolescents are more
likely to start smoking if (1) the adults around them smoke, (2) tobacco
advertising and promotion are common, and (3) tobacco products are cheap
and easily accessible. Adolescents should be encouraged to avoid smoking
and caution their friends about its dangers.
Second-hand smoke is particularly harmful to young children. It stays in the
air for hours after cigarettes, pipes or cigars have been put out. Non-smokers
who inhale this smoke are more vulnerable to respiratory infections, asthma
and cancer.
Parents and other caregivers need to be aware of the detrimental effects of
second-hand smoke and take responsibility to refrain from smoking around
children. Governments and communities can work together to inform the
public of the harmful effects of smoky environments and second-hand smoke
on children.
COUGHS,COLDSANDMORE

©UNICEF/NYHQ2008-1512/Holtz
HYGIENE

Introduction 109
Y
oung children are more vulnerable than
any other age group to the ill effects of
unsafe water, poor sanitation and lack of
hygiene.These contribute to 88 per cent of deaths
from diarrhoeal diseases. Children under 5 years
old account for nearly 90 per cent of deaths
from diarrhoea.
The simple habit of handwashing with soap is
estimated to reduce the incidence of diarrhoea
by nearly half. It also greatly reduces the risk
of respiratory infections such as pneumonia
and other diseases, including eye infections,
especially trachoma.
Parents and caregivers should wash their hands with soap and water at these critical
moments: (1) after cleaning the infant or young child who has defecated, (2) after helping
the child use the toilet or latrine, (3) after going to the latrine or toilet themselves, (4) before
touching food and feeding young children, and (5) after dealing with refuse.
Parents and caregivers need to help children develop the habit of washing their hands with
soap before eating and after using the latrine or toilet. Where soap is not available hands
can be washed with ash and water. Animal and human faeces should be kept away from
houses, paths, water sources and children’s play areas.
The use of latrines and toilets together with good hygiene practices – speciﬁcally hand
washing with soap – are essential public health tools.They protect children and families at
little cost and help realize children’s right to good health and nutrition.
Everyone in the community needs to work together to build and use toilets or latrines,
practise good hygiene, protect water sources, and safely dispose of waste water and refuse.
It is important for governments to support communities by providing information on how to
design and build latrines and toilets that all families can afford. In urban areas particularly,
government support is also needed for low-cost sanitation and drainage systems, safe
drinking water and refuse collection.
HYGIENENUTRITIONANDGROWTH
CHILDDEVELOPMENT

110 Facts for Life
KEY MESSAGES:
HYGIENE
1. All faeces, including those of babies and young children, should be disposed
of safely. Making sure that all family members use a toilet, latrine or potty
(for young children) is the best way to dispose of faeces. Where there is no
toilet, faeces should be buried.
2. All family members, including children, need to wash their hands thoroughly
with soap and water after any contact with faeces, before touching or
preparing food, and before feeding children. Where soap is not available,
a substitute, such as ash and water, can be used.
3 Washing the face and hands with soap and water every day helps to
prevent eye infections. In some parts of the world, eye infections can lead to
trachoma, which can cause blindness.
4. All water that people drink and use should come from a safe source or be
puriﬁed. Containers for carrying and storing water need to be kept clean
inside and outside and covered to keep the water clean. Where necessary,
home-based water treatment, such as boiling, ﬁltering, adding chlorine or
disinfecting with sunlight, should be used to purify the water.

Key Messages 111
5. Raw or leftover cooked food can be dangerous. Raw food should be washed
or cooked. Cooked food should be eaten without delay or thoroughly
reheated before eating.
6. Food, utensils and preparation surfaces should be kept clean and away from
animals. Food should be stored in covered containers.
7. Safe disposal of all household refuse helps to keep the living environment
clean and healthy.This helps prevent illness.
8. Hygiene is very important during menstruation. Clean and dry feminine
hygiene products should be available to girls and women. A clean, private
space should be provided to allow them to clean themselves and wash and
dry their cloths. Sanitary napkins need to be disposed of carefully with other
refuse or burned.
CHILDDEVELOPMENT

112 Facts for Life
KEY MESSAGE
1. All faeces, including those of babies and young children, should be disposed
of safely. Making sure that all family members use a toilet, latrine or potty
(for young children) is the best way to dispose of faeces.Where there is no
toilet, faeces should be buried.
Many illnesses, especially diarrhoea, come from germs found in human
faeces. If the germs get into water or onto food, hands, utensils or surfaces
used for preparing and serving food, they can be swallowed and cause
illness. Safe disposal of all faeces – both human and animal – is the single
most important action to prevent the spread of germs by people or flies.
Human faeces need to be put down a toilet or latrine, or buried.
All faeces, including those of babies and young children, carry germs and are
dangerous. If children defecate without using a toilet or latrine, their faeces
should be cleaned up immediately and flushed down the toilet or put down
the latrine or buried. Parents’ or other caregivers’ and children’s hands should
then be washed with soap and water or a substitute, such as ash and water.
If it is not possible to use a toilet or latrine, everyone should always defecate
well away from houses, paths, water sources and places where children play.
The faeces should then be buried immediately. Animal faeces also need to be
kept away from the houses, paths and areas where children play.
Latrines and toilets need to be cleaned frequently. Latrines should be
kept covered and toilets should be flushed. A clean latrine attracts fewer
HYGIENE

ﬂies. People are more likely to use a clean latrine. Local governments
and non-governmental organizations can often advise households and
communities on the design, materials and construction for building low-cost
sanitary latrines.
In urban areas, the government and communities should work together to
determine how to install low-cost latrines or toilets, sanitation and drainage
systems, safe drinking water and refuse collection.
KEY MESSAGE
2. All family members, including children, need to wash their hands thoroughly
with soap and water after any contact with faeces, before touching or
preparing food, and before feeding children.Where soap is not available,
a substitute, such as ash and water, can be used.
Washing the hands with soap and water removes germs. Rinsing the ﬁngers
with water is not enough – both hands need to be rubbed together with soap
and water, and then rinsed with water.This helps to stop germs and dirt
from getting onto food or into the mouth. Washing hands can also prevent
infection with worms. Soap and water should be placed conveniently near the
latrine or toilet. Where soap is not available, ash and water can be used.
● It is especially important to wash the hands with soap after defecating and
after cleaning the bottom of a baby or child who has just defecated. It is
also important to wash hands after handling animals and raw foods.
● Hands should always be washed before preparing, serving or eating food,
and before feeding children. Children should be taught to wash both
hands rubbed together with soap after defecating and before eating to
help protect them from illness.
Children often put their hands into their mouths, so it is important to
wash their hands often, especially after they have been playing in dirt or
with animals. Washing a child’s body regularly is also important to avoid
skin infections.
Children are easily infected with worms, which deplete the body’s nutrients.
Worms and their eggs can be found in human and animal faeces and urine, in
surface water and soil, and in poorly cooked meat.
● Children should not play near the latrine, toilet or defecation areas. Shoes
or sandals should be worn near latrines to prevent worms from entering
the body through the skin of the feet.
CHILDDEVELOPMENT

114 Facts for Life
● Children living in areas where worms are common should be treated two
to three times per year with a recommended deworming medication.
Washing hands with soap and water after handling poultry or poultry
products, after touching eggs and raw meat, and after cleaning the place
where poultry is kept can also help prevent the spread of germs and avian
influenza (bird flu).
KEY MESSAGE
3. Washing the face and hands with soap and water every day helps to
prevent eye infections. In some parts of the world, eye infections can lead to
trachoma, which can cause blindness.
Flies carry germs. A dirty face attracts flies, spreading the germs from person
to person. If the eyes become sore or infected, vision may be impaired or lost.
Eyes must be kept clean and healthy.
If the eyes are healthy, the white part is clear, the eyes are moist and shiny,
and vision is sharp. If the eyes are extremely dry or very red and sore, if there
is a discharge or if there is difficulty seeing, the child should be examined by
a trained health worker as soon as possible.
KEY MESSAGE
4. All water that people drink and use should come from a safe source or be
purified. Containers for carrying and storing water need to be kept clean
inside and outside and covered to keep the water clean.Where necessary,
home-based water treatment, such as boiling, filtering, adding chlorine or
disinfecting with sunlight, should be used to purify the water.
Families have fewer illnesses when they have an adequate supply of safe
water and know how to keep it clean and free from germs. If the water is not
clean it can be purified using low-cost solutions at home. It can be (1) boiled,
(2) cleaned through a filter, (3) purified with chlorine or (4) disinfected with
sunlight or other simple measures.10
The trained health worker or extension
agent should have information on home treatments that are available locally.
Safe water sources include properly constructed and maintained piped
systems, public standpipes, boreholes, pond sand filters, protected dug wells,
protected springs and rainwater collection. Water from unsafe sources –
10 Other home-based water treatment measures include keeping water in clear plastic bottles in strong sunlight for six hours or using
combination flocculation-disinfection sachets that clean and disinfect the water.

rivers, dams, lakes, ponds, streams, canals, irrigation channels, unprotected
wells and springs – is best avoided. If necessary it can be made safer by the
home-based water treatment methods referred to above. Water should be
safely stored in a covered container that is clean on the inside and outside.
Families and communities can protect their water supply by:
● lining and covering open wells, installing a handpump and protecting the
immediate area from animals and vandalism
● protecting a spring with a spring box
● disposing of faeces and waste water (especially from latrines and
household cleaning) well away from any water source used for cooking,
drinking or washing
● building latrines at least 15 metres away and downhill from a water
source
● always keeping jerry-cans, buckets, pitchers, ropes and jars used to collect
and store water as clean as possible by storing them in a clean place, off
the ground and away from animals
● keeping all animals away from drinking water sources and family living
areas
● avoiding the use of pesticides or chemicals anywhere near a water source.
Families can keep water clean in the home by:
● storing drinking water in a clean, covered container
● washing hands regularly – including before handling stored clean water
● taking water out of the container with a clean ladle or cup
● having a tap on the water container
● not allowing anyone to put their ﬁngers or hands into the container or to
drink directly from it
● keeping all animals away from stored water.
If there is uncertainty about the safety of the drinking water, local authorities
should be consulted. HYGIENENUTRITIONANDGROWTH
CHILDDEVELOPMENT

116 Facts for Life
KEY MESSAGE
5. Raw or leftover cooked food can be dangerous. Raw food should be washed
or cooked. Cooked food should be eaten without delay or thoroughly
reheated before eating.
Cooking food thoroughly kills germs. Food, especially meat and poultry,
should be cooked all the way through.
Germs grow quickly in warm food. Food should be eaten as soon as possible
after cooking so it does not have time to collect germs.
● If food has to be kept for more than two hours, it should be kept either
very hot or very cool.
● If cooked food is saved for another meal, it should be covered to keep off
flies and insects and then thoroughly reheated before being eaten.
● Yogurt and sour porridge are good to use in the preparation of meals
because their acid prevents the growth of germs.
Raw food, especially poultry and seafood, usually contains germs. Cooked
food can collect germs if it touches raw food, and these germs can breed in
the cooked food in a few hours. Raw and cooked foods should always be kept
separate. Knives, chopping boards and surfaces should always be cleaned
with soap and water after preparing raw food.
● Special care should be taken in preparing food for infants and small
children.Their food should be freshly made and eaten immediately, not
left standing.
● Breastmilk is the safest (and most nutritious) milk for infants and young
children. Expressed breastmilk can be stored at room temperature for up
to eight hours in a clean, covered container. If older children are given
animal milk it should be freshly boiled or pasteurized (a special way of
heating milk to destroy harmful bacteria).
● All poultry and poultry products should be cooked the whole way through
to prevent the spread of avian influenza (bird flu).
● Fruit and vegetables should be peeled or washed thoroughly with clean
water, especially if they are to be eaten raw by young children. Fruits
and vegetables are often treated with chemicals such as pesticides and
herbicides, which can be harmful.
● Hands should be washed with soap and water after handling raw foods.

KEY MESSAGE
6. Food, utensils and preparation surfaces should be kept clean and away from
animals. Food should be stored in covered containers.
Germs on food can be swallowed and cause illness.To protect food from
germs:
● keep food preparation surfaces clean
● keep knives, cooking utensils, pots and plates clean and covered
● wash cloths used to clean dishes or pans thoroughly every day and dry
them in the sun. Wash plates, utensils and pans immediately after eating
and put them on a rack to dry
● keep food in clean, covered containers to protect it from insects and
animals
● do not use feeding bottles or teats, because they may contain germs that
cause diarrhoea. Breastfeed, or feed children from a clean, open cup. If
bottles/teats are used, clean them after each use with boiling water.
CHILDDEVELOPMENT

118 Facts for Life
KEY MESSAGE
7. Safe disposal of all household refuse helps to keep the living environment
clean and healthy.This helps prevent illness.
Germs can be spread by ﬂies, cockroaches, rats and mice, which thrive in
garbage such as food scraps and peelings from fruit and vegetables.
If there is no community-wide refuse collection, each family needs a garbage
pit where household refuse is buried or burned every day.
Keeping the household and nearby areas clean and free of faeces, refuse
and waste water can help prevent disease. Household waste water can be
disposed of safely by making a soak pit or a channel to the kitchen garden or
to the ﬁeld.
Chemicals such as pesticides and herbicides can be very dangerous if even
small quantities get into the water supply or onto food, hands or feet. Clothes
and containers used when handling chemicals should not be washed near a
household water source.
Pesticides and other chemicals should not be used around the household
or near a water source. Chemicals should not be stored in or near drinking
water containers or near food. Never store food or water in pesticide or
fertilizer containers.

KEY MESSAGE
8. Hygiene is very important during menstruation. Clean and dry feminine
hygiene products should be available to girls and women. A clean, private
space should be provided to allow them to clean themselves and wash and
dry their cloths. Sanitary napkins need to be disposed of carefully with other
refuse or burned.
Adolescent and pre-adolescent girls need to be informed about the
signiﬁcance of menstruation in relation to reproduction and the importance
of menstrual hygiene.They need information on how to care for and clean
themselves when they are menstruating. Boys should also learn about
menstruation and be aware of girls’ particular hygiene needs.
Hygienic menstruation practices among adolescent girls and women should
be promoted and supported.
● Clean and dry feminine hygiene products such as cloths or napkins
should be available. Where cloths are used it is important that they are
regularly washed with soap and water and dried fully in the sun before
the next use. Damp cloths can carry germs that can lead to infections.
Used sanitary napkins should be disposed of in a refuse pit or collected
and burned.
● Water and soap should be provided in a private place (bathing area,
latrine) for girls and women to wash during menstruation and for washing
their hands after changing their cloth/napkin. Poor menstruation hygiene
can lead to fungal infections. Repeated infections can lead to serious
reproductive tract infections.These could cause infertility.
● Schools should have separate latrines for girls and boys.The girls’
latrine in particular needs access to water and soap so girls can clean
themselves. Latrines that are private, clean and safe contribute to keeping
girls in school longer, which can delay early marriage and pregnancy.
When girls and women are menstruating, their privacy needs to be respected.
CHILDDEVELOPMENT

MALARIA

Introduction 121
M
alaria is a serious disease spread
through mosquito bites.The World Health
Organization estimates that around
250 million malaria episodes occurred in 2006,
resulting in nearly 1 million deaths. About 90 per
cent of all malaria deaths occur in sub-Saharan
Africa, most among children under age 5.
Malaria is found in many regions of the world. In
sub-Saharan Africa, it is a leading cause of death,
illness, and poor growth and development among
young children. It is estimated that a child dies of
malaria every 30 seconds in this area.
Malaria is particularly dangerous for pregnant women. Some 50 million pregnant women
are exposed to malaria each year. Malaria during pregnancy contributes to nearly
20 per cent of low-birthweight babies in endemic areas, plus anaemia, stillbirth and even
maternal deaths.
Malaria is spread by the bite of an Anopheles mosquito.The mosquito transfers the
malaria parasite, Plasmodium, from person to person. People get very sick with high
fevers, diarrhoea, vomiting, headache, chills and ﬂu-like illness. Especially in children, the
disease can worsen rapidly, causing coma and death. Children under 5 years old are most
susceptible to malaria because they have very little acquired immunity to resist it.
Many lives can be saved by preventing malaria and treating it early. Children and their
family members have the right to quality health care for prompt and effective treatment and
malaria prevention.
Governments, in collaboration with communities and non-governmental and community-
based organizations, can minimize the number of malaria cases. They need to support
preventive actions, such as distributing long-lasting insecticide-treated mosquito nets for
families to sleep under.
BREASTFEEDINGMALARIA
CHILDDEVELOPMENT

122 Facts for Life
KEY MESSAGES:
MALARIA
1. Malaria is transmitted through the bites of some mosquitoes. Sleeping
under an insecticide-treated mosquito net is the best way to prevent
mosquito bites.
2. Wherever malaria is present, children are in danger. A child with a fever
should be examined immediately by a trained health worker and receive an
appropriate antimalarial treatment as soon as possible if diagnosed with
malaria. Artemisinin-based combination therapies (ACTs) are recommended
by WHO for treatment of Plasmodium falciparum malaria. It is the most
serious type of malaria and causes nearly all malaria deaths.

Key Messages 123
3. Malaria is very dangerous for pregnant women. Wherever malaria is
common, they should prevent malaria by taking antimalarial tablets
recommended by a trained health worker and by sleeping under an
insecticide-treated mosquito net.
4. A child suffering or recovering from malaria needs plenty of liquids
and foods.
CHILDDEVELOPMENT

124 Facts for Life
KEY MESSAGE
1. Malaria is transmitted through the bites of some mosquitoes. Sleeping
under an insecticide-treated mosquito net is the best way to prevent
mosquito bites.
All members of the community should be protected against mosquito bites,
particularly young children and pregnant women. Protection is needed after
sunset and before sunrise, when malaria mosquitoes bite.
Long-lasting insecticide-treated mosquito nets last for at least three years
and do not require re-treatment with insecticide.These nets are distributed
by malaria control programmes and can be obtained through health facilities
or during child health days or integrated campaigns. Most mosquito nets are
distributed free of charge, especially to pregnant women and young children.
They can also be purchased in the marketplace or through social marketing
programmes, mainly in urban areas. In the few cases where untreated nets
might still be in use, trained health workers can advise on safe insecticides
and re-treatment.
Insecticide-treated mosquito nets should be used throughout the year, even
when there are fewer mosquitoes, such as during the dry season.
Some countries operate programmes to spray the walls of houses with long-
lasting insecticides to kill resting mosquitoes. Communities should cooperate
with spray teams to ensure that all houses are sprayed.
MALARIA

In addition to using insecticide-treated mosquito nets, or if mosquito nets
are not available or used, other actions can help, but they are not nearly as
effective as using mosquito nets:
● putting screens on doors and windows; these are mostly used in urban
settings and are not very effective in traditional rural housing
● using mosquito coils; these are used to repel but not kill mosquitoes –
they have no lasting effect
● wearing clothing that covers the arms and legs (long sleeves and long
trousers or skirts); these can help reduce mosquito bites if worn when
malaria mosquitoes are most active – from dusk until dawn.
KEY MESSAGE
2. Wherever malaria is present, children are in danger. A child with a fever
should be examined immediately by a trained health worker and receive an
appropriate antimalarial treatment as soon as possible if diagnosed with
malaria. Artemisinin-based combination therapies (ACTs) are recommended
by WHO for treatment of Plasmodium falciparum malaria. It is the most
serious type of malaria and causes nearly all malaria deaths.
Malaria should be suspected if anyone in the family has a fever, or if young
children refuse to eat or have vomiting, diarrhoea, drowsiness or ﬁts.
A child with a fever believed to be caused by malaria needs immediate
antimalarial treatment as recommended by a trained health worker. If
possible, the child should be tested with a Rapid DiagnosticTest (RDT) or
microscopy (laboratory diagnosis involving the examination of the person’s
blood under a microscope) to conﬁrm the malaria infection. RDTs are
inexpensive and increasingly available.
If a child with a malarial fever is not treated within a day, she or he might die.
ACTs are recommended by WHO for treatment of Plasmodium falciparum
malaria. A trained health worker can advise on what type of ACT treatment is
best and how long it should be taken in accordance with national guidelines.
Malaria usually causes a high fever and chills. A child with a high fever should
be kept cool for as long as the fever persists by:
● sponging or bathing the child with tepid water (cool, not cold)
● providing treatment with antipyretics (medication that prevents or
reduces fever), such as paracetemol or ibuprofen, but not aspirin.
Keeping the fever from going too high is important to prevent convulsions,
which could lead to disabilities.
CHILDDEVELOPMENT

126 Facts for Life
A child with malaria needs to take the full course of treatment, even if the
fever disappears rapidly. If the treatment is not completed, the malaria could
become more severe and difficult to cure. Incomplete treatment regimens
can also lead to the development of drug resistance among people in the
local area.
If the malaria symptoms continue after treatment, the child should be taken to
a health centre or hospital.The problem may be:
● the child is not receiving enough medicine
● the child has an illness other than malaria
● the malaria is resistant to the medicine, and another medicine is needed.
Health-care providers have the responsibility to ensure that parents and
caregivers are well informed about ways to prevent malaria and the best
practices for caring for a child with malaria.
KEY MESSAGE
3. Malaria is very dangerous for pregnant women.Wherever malaria is common,
they should prevent malaria by taking antimalarial tablets recommended
by a trained health worker and by sleeping under an insecticide-treated
mosquito net.
Pregnant women are more likely to suffer from malaria than other women.
The disease is more dangerous during pregnancy, especially during the first
pregnancy.This is due to changes in a woman’s body that lower her previous
level of resistance to malaria. Malaria can cause severe anaemia (‘thin
blood’), miscarriage, premature birth or stillbirth.
Babies born to mothers who have had malaria during pregnancy are often
underweight.This makes them more vulnerable to infection or death during
their first year.
Women in their first pregnancy in areas where malaria is prevalent often do
not show the typical signs of malaria.
As preventive treatment, pregnant women in malarial areas, especially those
in their first pregnancy who can be asymptomatic (without symptoms),
should take antimalarial tablets in the second and third trimesters as
recommended by a trained health worker.The health worker will know which
antimalarial tablets are best to take.

It is also very important that pregnant women sleep under insecticide-treated
mosquito nets.
Pregnant women with signs and symptoms of Plasmodium falciparum
malaria must be treated immediately by a trained health worker with quinine
in the ﬁrst trimester and ACTs in the second and third trimesters.
KEY MESSAGE
4. A child suffering or recovering from malaria needs plenty of liquids and food.
A girl or boy suffering from malaria should be offered liquids and foods
frequently to help prevent dehydration and malnutrition.
Frequent breastfeeding prevents dehydration and helps the child ﬁght
infections, including malaria. Children who are breastfeeding and suffering
from malaria should be breastfed as often as possible.
Frequent malarial infection can cause anaemia. A child who has had malaria
several times should be checked for anaemia.
CHILDDEVELOPMENT

©UNICEF/NYHQ2009-0716/Nesbitt
HIV

Introduction 129
HIVANDAIDS
H
IV (human immunodeficiency virus) is
the virus that causes AIDS (acquired
immunodeficiency syndrome). HIV touches
the lives of children and families in every country
in the world. Over 2 million children under age
15 are living with HIV (infected with HIV). Millions
more are affected by HIV (not infected but living
in families with infected members). An estimated
17.5 million children have lost one or both parents
to AIDS; more than 14 million of these children live
in sub-Saharan Africa. (Latest data available, 2007)
HIV is transmitted through (1) unprotected sex
with an HIV-infected person; (2) an HIV-infected
woman to her baby during pregnancy, childbirth or breastfeeding; and (3) blood from
HIV-contaminated syringes, needles or other sharp instruments and from transfusion with
HIV-contaminated blood. HIV is not transmitted through casual contact or by other means.
Children are among the most vulnerable to HIV. But they typically receive the fewest
services.The disease can progress rapidly in young children. Antiretroviral drugs are used to
treat HIV because they restore the immune system and delay progression to AIDS. However,
most children infected with HIV do not begin taking these drugs until they are 5–9 years old.
This is too late. Without antiretroviral treatment, half of all babies born with HIV will die by
their second birthday.
Although HIV is still incurable, it is a manageable condition. If infected infants and children
are diagnosed early, receive effective treatment and take antiretroviral drugs as prescribed,
they have a better chance to grow, learn, develop and have dreams for the future.
Families and communities, especially women and girls, are the first lines of protection and
care for children living with or affected by HIV. Families should receive the support they
need to provide their children with a nurturing and protective environment. Keeping HIV-
positive mothers and fathers alive and healthy is vital for children’s growth, development
and stability. Without the security of the family, children run a greater risk of being exploited
and discriminated against.
Adolescents and young people 15–24 years old accounted for about 45 per cent of all
new HIV infections among people aged 15 and older in 2007. HIV is more common among
adolescent girls and young women than adolescent boys and young men. Life skills
education is critical for children, adolescents and young people so that they acquire the
knowledge and skills to make healthy life choices.
Governments, with support from families, communities and non-governmental and faith-
based organizations, have a responsibility to ensure people’s right to information on HIV
prevention, treatment and care.They also have the responsibility to ensure the rights of
children living with or affected by HIV to protection, care and support. It is important that
children, families and communities help stop the spread of HIV.
CHILDDEVELOPMENT
HIV

130 Facts for Life
KEY MESSAGES:
HIV
1. HIV (human immunodeﬁciency virus) is the virus that causes AIDS (acquired
immunodeﬁciency syndrome). It is preventable and treatable, but incurable.
People can become infected with HIV through (1) unprotected sexual contact with
an HIV-infected person (sex without the use of a male or female condom); (2)
transmission from an HIV-infected mother to her child during pregnancy, childbirth
or breastfeeding; and (3) blood from HIV-contaminated syringes, needles or
other sharp instruments and transfusion with HIV-contaminated blood. It is not
transmitted by casual contact or other means.
2. Anyone who wants to know how to prevent HIV or thinks he or she has HIV
should contact a health-care provider or an AIDS centre to obtain information on
HIV prevention and/or advice on where to receive HIV testing, counselling, care
and support.
3. All pregnant women should talk to their health-care providers about HIV. All
pregnant women who think they, their partners or family members are infected
with HIV, have been exposed to HIV or live in a setting with a generalized HIV
epidemic should get an HIV test and counselling to learn how to protect or care for
themselves and their children, partners and family members.
4. All children born to HIV-positive mothers or to parents with symptoms, signs or
conditions associated with HIV infection should be tested for HIV. If found to be
HIV-positive, they should be referred for follow-up care and treatment and given
loving care and support.
5. Parents or other caregivers should talk with their daughters and sons about
relationships, sex and their vulnerability to HIV infection. Girls and young women are
especially vulnerable to HIV infection. Girls and boys need to learn how to avoid, reject
or defend themselves against sexual harassment, violence and peer pressure. They
need to understand the importance of equality and respect in relationships.

Key Messages 131
6. Parents, teachers, peer leaders and other role models should provide adolescents
with a safe environment and a range of life skills that can help them make healthy
choices and practise healthy behaviour.
7. Children and adolescents should actively participate in making and implementing
decisions on HIV prevention, care and support that affect them, their families and
their communities.
8. Families affected by HIV may need income support and social welfare services
to help them take care of sick family members and children. Families should be
guided and assisted in accessing these services.
9. No child or adult living with or affected by HIV should ever be stigmatized or
discriminated against. Parents, teachers and leaders have a key role to play in HIV
education and prevention and in reducing fear, stigma and discrimination.
10. All people living with HIV should know their rights.
CHILDDEVELOPMENT
HIV

132 Facts for Life
KEY MESSAGE
1. HIV (human immunodeficiency virus) is the virus that causes AIDS (acquired
immunodeficiency syndrome). It is preventable and treatable, but incurable.
People can become infected with HIV through (1) unprotected sexual contact
with an HIV-infected person (sex without the use of a male or female
condom); (2) transmission from an HIV-infected mother to her child during
pregnancy, childbirth or breastfeeding; and (3) blood from HIV-contaminated
syringes, needles or other sharp instruments and transfusion with
HIV-contaminated blood. It is not transmitted by casual contact or
other means.
People infected with HIV usually live for years without any signs of the
disease.They may look and feel healthy, but they can still pass on the virus to
others.Timely initiation of antiretroviral therapy (ART), a group of medicines
used to treat HIV, allows a person to handle HIV as a chronic disease and lead
a relatively healthy life.
AIDS is the late stage of HIV infection. People who have AIDS grow weaker
because their bodies lose the ability to fight off illnesses. In adults not
receiving antiretroviral treatment, AIDS develops 7–10 years after HIV
infection, on average. In young children it usually develops much faster.There
is no cure for AIDS, but new medicines can help people with AIDS live longer.
In most cases, HIV is passed from one person to another through unprotected
sexual intercourse, during which the semen, vaginal fluid or blood of an
infected person passes into the body of another person.
HIV

HIV can also pass from one person to another through the use of non-sterile,
HIV-contaminated needles and syringes (most often among drug users
sharing needles and syringes), razor blades, knives or other instruments for
injecting, cutting or piercing the body.
People may also become infected by HIV through transfusions of infected
blood. All blood for transfusions should be screened for HIV.
HIV is passed to infants and young children primarily from the mother during
pregnancy or childbirth or through breastfeeding.
It is not possible to get HIV from working, socializing or living side by side
with HIV-positive people.Touching those who are infected with HIV, hugging,
shaking hands, coughing and sneezing will not spread the disease. HIV
cannot be transmitted through toilet seats, telephones, plates, cups, eating
utensils, towels, bed linen, swimming pools or public baths. HIV is not spread
by mosquitoes or other insects.
KEY MESSAGE
2. Anyone who wants to know how to prevent HIV or thinks he or she has HIV
should contact a health-care provider or an AIDS centre to obtain information
on HIV prevention and/or advice on where to receive HIV testing,
counselling, care and support.
Information on HIV and on services and education to learn how to prevent or
reduce the risk of infection is increasingly available in almost every country.
Information can be found at health centres, ﬁxed and mobile HIV care
units, testing and counselling centres, youth centres and in many schools.
Information is also available through the internet and other media.
HIV testing and counselling can help in early detection of infection. It can
enable those who are infected to:
● get the support services they need
● manage other infections they might have
● learn about living with HIV
● learn how to avoid infecting others.
Anyone who thinks that he or she might be infected with HIV should contact
a health-care provider or an AIDS centre to receive conﬁdential testing and
counselling. Anyone who lives in an area where HIV is prevalent and has had
unprotected sex should be encouraged to be tested and counselled.
CHILDDEVELOPMENT
HIV

134 Facts for Life
Voluntary HIV testing and counselling can help people make informed choices
about their health and their sexual behaviour. It can help couples decide
whether or not to have children. If one partner has HIV there is a risk the other
partner can become infected while trying to conceive. If a couple is expecting
a baby, testing and counselling can help them make decisions regarding the
health of their baby.
Counselling and testing can also help those not infected to remain uninfected
through education about ways to avoid risk, including safer sex choices.
There are many types of HIV tests. It is important to talk to a professional to
learn about the type of test being used and its accuracy.
If the result of an HIV test is negative, this means the person tested is not
infected or it is too early to detect the virus. In adults, the HIV blood test may
not detect infection for up to six weeks after exposure. Depending on the
test, detection in babies may take up to 18 months after birth. However, early
infant diagnosis (EID) can be conducted as early as six weeks.
Families and communities should insist on and support conﬁdential HIV
testing, counselling and information. Conﬁdentiality helps protect children,
adolescents and adults from experiencing stigma, discrimination, exclusion
and isolation.
Counselling can help to empower women and adolescent girls, promote
safer sex and condom use, and help detect and facilitate treatment of
sexually transmitted infections – all of which can reduce the chances of
HIV infection. If a woman or adolescent girl is diagnosed with HIV and has
children or is pregnant, assistance may be required to help her protect, care
for and support her children. Community support groups and NGOs often
provide assistance.
Increasing access to testing followed by treatment, care and support can help
to reduce stigma by demonstrating that HIV is not a ‘death sentence’ and
that many people infected with HIV can lead relatively healthy, happy and
productive lives.

KEY MESSAGE
3. All pregnant women should talk to their health-care providers about HIV.
All pregnant women who think they, their partners or family members
are infected with HIV, have been exposed to HIV or live in a setting with a
generalized HIV epidemic should get an HIV test and counselling to learn
how to protect or care for themselves and their children, partners and
family members.
The most effective way to reduce transmission of HIV from the mother to
the child is to prevent women from becoming infected with HIV. Access to
family planning services and condoms for women and men are critical to
prevent HIV transmission.
In many countries, pregnancy is the only time when women seek health
services.This provides them an important opportunity to receive an HIV test
and counselling whether in high- or low-level epidemic areas. If a woman is
found to be HIV-positive, she should have access to counselling, referrals, HIV
care and treatment, and other health-care services. Health-care and support
services for the mother will help reduce the risk of HIV transmission to
the baby.
The HIV-positive woman should be encouraged to have her partner and
other children tested and counselled. If any test results are positive, HIV care,
treatment, and other prevention and health-care services should be offered.
A pregnant woman infected with HIV can take antiretroviral drugs.This
can help improve her own health and also reduce the chances of her child
becoming infected.
The risk of transmitting HIV to infants may be reduced to less than 2 per
cent if pregnant women receive comprehensive counselling, health care and
antiretroviral treatment during pregnancy and through the ﬁrst six months
after childbirth.This is often part of a comprehensive programme called
Prevention of Mother-to-ChildTransmission (PMTCT).
An HIV-positive mother of a newborn should be provided with information
and skills to select the best feeding option for her baby. She should receive
nutrition and health-care counselling for the newborn and herself and be
supported in having her child tested and treated for exposure to HIV. She
should be informed that babies born to HIV-positive women who have not
taken antiretroviral medicines during pregnancy have about a 1 in 3 chance of
being born with HIV. Without intervention, half of the babies infected with HIV
die before they are 2 years of age.
CHILDDEVELOPMENT
HIV

136 Facts for Life
A pregnant woman infected with HIV needs to know that:
● taking specific medicines (antiretroviral drugs) during pregnancy can
help improve her health and reduce the risk of passing the infection to
the infant
● prenatal and post-natal care – visiting a skilled birth attendant for check-
ups before and after the birth of the baby and receiving care during
pregnancy and childbirth – can help reduce the risk of passing the
infection to the infant
● starting HIV-exposed newborns on cotrimoxazole or Bactrim between
4 and 6 weeks of age and continuing it until HIV infection can be
definitively ruled out can help prevent ‘opportunistic’ infections (infections
that take advantage of a weakened immune system)
● there are various infant feeding practices, each with advantages and risks.
The mother needs to decide which infant feeding practice is the safest and
the most manageable for her circumstances:
● exclusive breastfeeding for the first six months of the child’s life protects
the infant from death due to diarrhoea, pneumonia and malnutrition.
There is, however, a risk of HIV infection through the breastmilk.The
risk of transmitting HIV to the infant is much lower with exclusive
breastfeeding than with mixed feeding (breastmilk and other foods
and drinks).The risk can also be reduced by shortening the duration
of breastfeeding once a nutritionally adequate and safe diet without
breastmilk can be provided to the child.
● feeding the baby a breastmilk substitute (infant formula) alone eliminates
the risk of transmitting HIV through breastmilk but can greatly increase
the risk of dying from infections such as diarrhoea or pneumonia,
especially in the first 6 months of life.This is a good option only if the
mother has access to clean water and the means to obtain the formula for
at least 12 months, and the use of infant formula is acceptable to her and
her community.
● breastfeeding beyond 6 months should continue until safe and adequate
replacement foods, including infant formula and other milks and foods,
are available. Once a nutritionally adequate and safe diet can be provided,
all breastfeeding should stop.
● all infants, whether they are receiving breastmilk or breastmilk
substitutes, should receive other nutritious foods and drinks from
6 months of age onward to provide the energy and nutrients needed to
support their growth and development.
(Refer to Message 6 in the Breastfeeding chapter for more information.)

KEY MESSAGE
4. All children born to HIV-positive mothers or to parents with symptoms, signs
or conditions associated with HIV infection should be tested for HIV. If found
to be HIV-positive, they should be referred for follow-up care and treatment
and given loving care and support.
The earlier a child is tested, diagnosed with HIV and started on HIV
treatment, the better the chance of his or her survival and living a longer and
healthier life.
The health-care provider should recommend HIV testing and counselling
as part of standard care to all children, adolescents and adults who exhibit
signs, symptoms or medical conditions that could indicate HIV infection
or who have been exposed to HIV. HIV testing and counselling should be
recommended for all children seen in health services in settings where there
is a generalized HIV epidemic.
A child whose mother is known to be HIV-positive should be tested for HIV
within six weeks of birth or as soon as possible. Infants have their mother’s
antibodies for several weeks after birth, and therefore standard antibody tests
are not accurate for them. A special polymerase chain reaction (PCR) test is
required to tell if an infant has the virus around 6 weeks of age. If positive, the
child needs to begin treatment immediately.The health-care provider can help
the family set up a feasible and appropriate antiretroviral therapy regimen for
the child.The parents should receive counselling and social services.
An important part of HIV care and antiretroviral treatment (ART) for children is
the antibiotic cotrimoxazole. It helps prevent ‘opportunistic’ infections related
to HIV, especially PCP (pneumocystis pneumonia).This treatment is called
cotrimoxazole preventive therapy, or CPT.
Children with HIV should be given ART in ﬁxed-dose combinations.These
can be prescribed by a trained health worker, who can also provide follow-up
support. If the child is going to school, the school can also provide support to
make sure that the child takes the medicines while at school.
It is critical to encourage children taking ART to keep taking the medicines
on the recommended schedule.This will help ensure the treatment
remains effective.
Children need a healthy, balanced diet under any circumstances, but when
they receive HIV treatment, ensuring proper nutrition is especially important.
CHILDDEVELOPMENT
HIV

138 Facts for Life
HIV or opportunistic infections may cause reduced food intake due to
decreased appetite, difﬁculty swallowing or poor absorption.Therefore, extra
attention should be given to the nutrition of children who are HIV-positive to
make sure they receive high-quality, easily digestible foods. Without proper
nutrition, their growth and development can be hindered.This could lead
to more opportunistic infections that further deplete children’s energy and
increase their nutritional needs.
Once children who are HIV-positive are old enough to understand, they need
to be involved in decisions about their medical care and support. They also
should be made aware of the importance of prompt care and treatment of
infections.This is a critical part of developing their ability to make healthy
decisions in the future.
KEY MESSAGE
5. Parents or other caregivers should talk with their daughters and sons about
relationships, sex and their vulnerability to HIV infection. Girls and young
women are especially vulnerable to HIV infection. Girls and boys need to
learn how to avoid, reject or defend themselves against sexual harassment,
violence and peer pressure.They need to understand the importance of
equality and respect in relationships.
While children need to know the biological facts about sex, they also need
to understand that sexual relationships involve caring and responsibility.
Discussing and stressing the emotional aspect of a sexual relationship with
children can help them make healthy decisions and resist peer pressure as
they grow and develop. It is important to talk about sex in a way that ﬁts the
child’s age and stage of development, and conveys values.
Everyone needs to be aware of the fact that adolescent girls and young
women are especially vulnerable to HIV infection. Adolescent girls and young
women need support to protect themselves from unwanted and unsafe sex.
In many countries, HIV rates are higher among adolescent girls than
adolescent boys.
Adolescent girls are more susceptible to HIV infection because:
● they may not have a choice about when to have sex or whether a condom
is used

● their vaginal membranes are thinner than those of mature women
and thus susceptible to lesions from sexual activity that can allow HIV
infection and other sexually transmitted infections (STIs) to enter
● they sometimes are targeted by and engage in relationships with older
men who may be infected
● they are vulnerable to being sexually exploited and trafﬁcked, which puts
them in high-risk situations.
Girls and women have the right to refuse unwanted and unprotected sex.
They also have the right to learn skills on how to avoid, reject or defend
themselves against unwanted sexual advances.
Girls and women need to know what to do and where to go if they
have been victims of sexual assault.They should seek the support of a
trained health worker or go to a health facility for medical attention and
counselling. Health-care providers and social workers should be trained to
be understanding of girls and women in these situations.This information
also applies to cases involving boys.
To effectively address violence, boys and men need to be actively engaged in
ﬁnding solutions.Their full engagement with girls and women is needed to
work on preventing violence and sexual harassment, resisting peer pressure
and achieving gender equality.This should include an understanding of
gender stereotypes and inequalities.
Discussions at home, in school and in the community between children
and adolescents and their parents, teachers, community leaders and other
role models can help develop healthy attitudes and behaviours.They can
contribute to:
● respect for girls and women and their rights
● equality in decision-making and relationships
● skills development on how to confront peer pressure, sexual harassment,
violence and stereotypes.
KEY MESSAGE
6. Parents, teachers, peer leaders and other role models should provide
adolescents with a safe environment and a range of life skills that can help
them make healthy choices and practise healthy behaviour.
It is important for children to learn about HIV at an early age. When children
become adolescents, they need accurate and full information on making and
negotiating healthy life choices.This will help them avoid becoming infected
with HIV and other sexually transmitted infections (STIs).
CHILDDEVELOPMENT
HIV

140 Facts for Life
Adolescents need to be supported in learning the life skills that can help
them protect themselves in situations where they could be vulnerable
to HIV infection.These skills include problem solving, decision-making,
goal setting, critical thinking, communication, assertiveness and
self-awareness. Adolescents also need skills for coping with stressful or
confrontational situations.
Adolescents and young people look to parents, teachers, peer leaders and
other role models for guidance.These role models should develop their base
of knowledge on HIV so they will know how to communicate about HIV and
how to share important life skills.
Adolescents need to know the risks of HIV.They need to understand how it is
passed through unprotected sex with an infected person or through the use
of contaminated needles or syringes for injecting drugs.They should know
about safer practices and the consequences of lifestyle choices.They should
also know how HIV is not transmitted so they can reject myths and prevent
discrimination against people living with HIV that is based on unfounded
fears of contagion.
It is important to know and reduce the risks of getting HIV from
unprotected sex:
The risk of getting HIV can be reduced if people do not have sex. If they have
sex, correct and consistent use of male or female condoms is important.To
reduce risk, people can:
● decrease their number of sex partners
● stay in a mutually faithful relationship with a partner(s) who is not
infected
● have safer sex – sex without penetration (where the penis does not
enter the vagina, rectum or mouth) or penetrative sex using a condom
correctly (as the directions indicate) and consistently (during every act of
penetrative sex).
In combination with safer practices, male circumcision reduces the possibility
of transmission of HIV infection from female to male.
The more sex partners people have, the greater the risk that one of them
will have HIV and pass it on (if they do not use male or female condoms
consistently and correctly).
However, anyone can have HIV – it is not restricted to those with many sex
partners. People who do not show signs of infection may carry the virus.
Testing is the only sure way to tell.
A well-lubricated condom is essential for protection during vaginal or
anal intercourse.

● The male condoms that come with lubrication (slippery liquid or gel) are
less likely to tear during handling or use. If the condom is not lubricated
enough, a water-based lubricant, such as silicone or glycerin, should be
added. If such lubricants are not available, saliva can be used (although
this can transmit other infections, such as herpes). Lubricants made from
oil or petroleum should never be used with a male condom because they
can damage the condom. Oil or petroleum lubricants include cooking oil,
shortening, mineral oil, baby oil, petroleum jellies and most lotions.
● The female condom is a safe alternative to the male condom.The most
commonly used female condom is a soft, loose-fitting sheath that lines
the vagina. It has a soft ring at each end.The ring at the closed end is
used to put the device inside the vagina; it holds the condom in place
during sex.The other ring stays outside the vagina and partly covers the
labia. Before sex begins, the woman inserts the female condom with her
fingers. Only water-based lubricants should be used with female condoms
made of latex, whereas water-based or oil-based lubricants can be used
with female condoms made of polyurethane or artificial latex (nitrile).
HIV can be transmitted through oral sex, although available information
suggests the risk is minimal as compared to vaginal and anal sex. However,
oral sex can transmit STIs which can increase the risk of HIV transmission. In
the case of oral-penile sex, a male condom is recommended.
Because most sexually transmitted infections can be spread through genital
contact, a condom should be used before genital contact begins.
Drinking alcohol or taking drugs interferes with judgement. Even those who
understand the risks of HIV and the importance of safer sex may become
careless after drinking or using drugs.
People who have sexually transmitted infections (STIs) are at greater risk of
getting HIV and spreading HIV to others:
STIs, including HIV, are infections that are spread through sexual contact.
They can be spread through the exchange of body fluids (semen, vaginal fluid
or blood) or by contact with the skin of the genital area. STIs are spread more
easily if there are lesions such as blisters, abrasions or cuts. STIs often cause
lesions, which contribute to spreading the infection.
STIs often cause serious physical suffering and damage.
Any STI, such as gonorrhoea or syphilis, can increase the risk of HIV infection
or HIV transmission. Anyone suffering from an STI has a much higher risk of
becoming infected with HIV if they have unprotected sexual intercourse with
an HIV-infected person.
● People who suspect they have an STI should see a trained health
worker promptly to be diagnosed and treated.They should avoid sexual
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intercourse or practise safer sex (non-penetrative sex or sex using a male
or female condom).
● Correct and consistent use of male and female condoms when engaging
in sexual intercourse – vaginal, anal or oral – can greatly reduce the
spread of most STIs, including HIV.
● People who have an STI should tell their partner(s). Unless both partners
are treated for an STI, they will continue infecting each other. Most STIs
are curable.
Some STI symptoms:
● A man may have pain while urinating; a discharge from his penis; or
sores, blisters, bumps or rashes on the genitals or inside the mouth.
● A woman may have vaginal discharge that has a strange colour or bad
smell, pain or itching around the genital area, and pain or bleeding from
the vagina during or after intercourse. More severe infections can cause
fever, pain in the abdomen and infertility.
● Many STIs in women and some in men produce no noticeable symptoms.
Not every problem in the genital area is an STI. Some infections, such as
candidiasis (yeast infection) and urinary tract infections, are not spread by
sexual intercourse. But they can cause great discomfort in the genital area.
HIV can be spread by unsterilized, contaminated needles or syringes, most
often those used for injecting drugs, and by other instruments:
An unsterilized needle or syringe can pass HIV and other infections, such as
hepatitis, from one person to another if contaminated with infected blood.
Nothing should be used to pierce a person’s skin unless it has been sterilized.
People who inject themselves with drugs or have unprotected sex with
injecting drug users are at high risk of becoming infected with HIV. People
who inject drugs should always use a clean needle and syringe.They should
never use another person’s needle or syringe.
Injections should be given only by a trained health worker using an auto-
disable syringe (a syringe that can be used only once).
Any kind of cut using an unsterilized object such as a razor or knife can
transmit HIV.The cutting instrument must be fully sterilized for each person,
including family members, or rinsed with bleach and/or boiling water.
Equipment for dental treatment, tattooing, facial marking, ear or body
piercing, and acupuncture is not safe unless the equipment is sterilized for
each person.The person performing the procedure should take care to avoid
any contact with blood during the procedure.

KEY MESSAGE
7. Children and adolescents should actively participate in making and
implementing decisions on HIV prevention, care and support that affect
them, their families and their communities.
Children, adolescents, youth and families can be powerful agents of change
in HIV prevention and education and reducing stigma and discrimination.
They need to be a central part of defining and implementing responses to HIV.
Children and young people can raise awareness of HIV and compassion
for those living with HIV.They often gain confidence and self-esteem in the
process of working with their peers and in their communities.
● Child forums and other events provide opportunities for children and
young people to mobilize communities to create supportive and caring
environments for children and families living with and affected by HIV.
● Schools and non-formal educational activities can help children form
peer-to-peer support groups and children’s clubs.These can bring together
children who, with support from teachers or community workers, take on
responsibility to conduct HIV prevention and life skills education.
Children, young people, parents, other caregivers and families affected by
HIV can find support by joining or organizing self-help groups, peer groups
and community support groups.These groups can:
● provide a social network that gives members psychological support
● share practical information and help families access social welfare
services
● offer opportunities for members to become active in efforts to find
innovative ways to address HIV prevention, protection, care and support.
In collaboration with local authorities and governments, non-governmental
and faith-based organizations often help support these groups.
When groups join to form a network, they can help to create a movement
to raise awareness and understanding of HIV and promote protection, care
and support of orphans and vulnerable children and families affected by HIV.
Such efforts can help to address the exclusion, stigma and discrimination
experienced by those living with or affected by HIV.
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KEY MESSAGE
8. Families affected by HIV may need income support and social welfare
services to help them take care of sick family members and children. Families
should be guided and assisted in accessing these services.
Families provide the ‘ﬁrst line’ response for protecting, caring for and
supporting children infected with or affected by HIV. Families and relatives
absorb almost all the costs involved in caring for these children.
Families are generally recognized as the best source of the loving care,
protection and support that children need. Mothers, fathers or other primary
caregivers infected with HIV need support to live longer. Prolonging their
lives and keeping them healthy helps to keep a family together.
The majority of children who have lost one or both parents are living in
families that are often stretched economically and in need of support.
Caregivers tend to be female, including some who are children themselves
and many who are elderly, such as grandmothers.
Partnerships involving the government and community or non-governmental
or faith-based organizations can provide support to improve the economic
situation of families affected by HIV. Support might include access to
microcredit, low-interest bank loans and social grants.
How to access income support, such as social grants, and social welfare
services, should be clearly detailed in national guidelines.These should
be well communicated, understood and administered at the local level.
Information provided by families when applying for social grants and services
should be kept conﬁdential.
As part of the social welfare services, health-care providers should make
sure that HIV-positive children and adults from the same family can obtain
treatment and support in the same health facility.This helps conserve the
family’s time, energy and resources.
Social welfare services, with support from community and non-governmental
and faith-based organizations, should help parents and other caregivers
develop the skills needed to care for children infected with or affected by HIV.

If the child is HIV-positive, the caregivers need help to:
● learn about the HIV infection
● know how to care for and support the child, including ensuring adherence
to an ART regimen
● reduce their fear of contracting HIV from the child
● know how to protect themselves when caring for the child
● understand and respond to the emotional needs of the child.
A child who has lost a parent, other caregiver or sibling because of AIDS
needs psychosocial support from his or her family and possibly counselling
to work through the trauma and grief. A parent or other caregiver may need
support to understand the stages of a child’s grief relative to his or her age, as
well as appropriate psychosocial responses.
Parents living with HIV should make sure that each of their children has a
birth certiﬁcate. Parents should make a will to establish 1) who will be the
guardians of their children and 2) if they have money land or livestock how
these assets will be distributed. If the children are old enough to understand,
they should be involved in these deliberations with their parents.
KEY MESSAGE
9. No child or adult living with or affected by HIV should ever be stigmatized
or discriminated against. Parents, teachers and leaders have a key role
to play in HIV education and prevention and in reducing fear, stigma and
discrimination.
Educating children, families and communities about HIV is an essential way
to help reduce fear, stigma and discrimination against the child and his or
her family living with or affected by HIV, as well as the child’s own fears and
self-stigma.
Children, parents, other family members, teachers, community and faith-
based organizations, local leaders and authorities, and the government have
a signiﬁcant role to play in HIV education and prevention and in reducing fear,
isolation, stigma and discrimination.
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HIV prevention and education should include:
● Raising awareness and support for the rights of children and family
members living with or affected by HIV
– Children, adolescents and adults living with or affected by HIV
have the same rights as any other person to education, health care,
housing and appropriate representation in the media.They should
also have access to fair and equal treatment in the justice system.
● Ensuring that all children and young people understand the risks of
HIV and know that they cannot get it from ordinary social contact with
someone who is infected with HIV
– Children and young people need to be informed that HIV has no
vaccination or cure, but that people can lead relatively healthy and
productive lives with treatment. It is important that they understand
how to prevent HIV infection and how to protect themselves and
their loved ones.
● Empowering adolescents and youth to make decisions on when to have
or not to have sex and how to negotiate condom use
–Talking with and listening to young people is very important to
understand their situation and how best to provide them with
protection, care and support. It can sometimes be awkward for adults
to discuss sexual issues with children and adolescents. One way to
begin the discussion with school-aged children is to ask them what
they have heard about HIV and AIDS. If any of their information
is wrong, it provides an opportunity to give them the correct
information.
● Stimulating ideas and providing guidance on ways children, adolescents
and youth can show their compassion and friendship with children and
families they know who are living with or affected by HIV.
KEY MESSAGE
10. All people living with HIV should know their rights.
Governments have a responsibility to ensure protection of the rights of
children and their family members infected with or affected by HIV and to
collaborate with families, communities and non-governmental and faith-
based organizations.
Where AIDS intersects with extreme poverty, conﬂict and large families,
comprehensive support to all orphans and vulnerable children is wise and
cost-effective. Children infected with or affected by HIV should be fully
included in such strategies and their rights should be protected – including
rights to privacy, conﬁdentiality and non-discrimination.

Many children live in difﬁcult circumstances without full protection of their
rights.They may be infected with HIV or at risk of exposure.They may live on
the streets, in orphanages or in extreme poverty or exploitative situations.
These children have the right to live in a family.Their families may need help
reuniting and/or staying together. All these children should receive support to
go to school and/or get vocational training.They should also receive support
to access health and nutritional care as well as legal and social welfare
services.They have a right to these services.
Local authorities and non-governmental, faith-based and community-
based organizations can help mothers, fathers, other caregivers, children
and adolescents living with or affected by HIV know their rights and
understand how to advocate for them in relation to the country’s judicial and
administrative systems, as well as with government authorities responsible
for policies, programmes and services.
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Introduction 149
A
ll children have the right to protection.
They have the right to survive, to be safe,
to belong, to be heard, to receive adequate
care and to grow up in a protective environment.
A family is the first line of protection for children.
Parents or other caregivers are responsible for
building a protective and loving home environment.
Schools and communities are responsible for
building a safe and child-friendly environment
outside the child’s home. In the family, school and
community, children should be fully protected so
they can survive, grow, learn and develop to their
fullest potential.
Millions of children are not fully protected. Many of them deal with violence, abuse, neglect,
exploitation, exclusion and/or discrimination every day. Such violations limit their chances
of surviving, growing, developing and pursuing their dreams.
Any child can be vulnerable to violations in many places, including the home.The actual
number of children experiencing violations is not easy to determine.This type of data is hard
to collect and is not updated frequently. However, it is estimated that:
● about 150 million girls and 73 million boys under 18 experienced forced sexual
intercourse and other forms of sexual violence and exploitation during 2002
● 150 million children aged 5–14 are engaged in child labour
● millions of children, mostly girls, work as domestic labourers (maids) in private homes
● approximately 1.2 million children are trafficked annually (most recent annual estimate
from 2000)
● the births of around 51 million children born in 2007 were not registered
● between 22 per cent and 84 per cent of children 2–14 years old experienced physical
punishment in the home in 37 countries surveyed between 2005 and 2007.
Governments, communities, local authorities and non-governmental organizations,
including faith-based and community-based organizations, can help ensure that children
grow up in a family environment.They can make sure that schools and communities protect
all children and prevent child maltreatment.They can protect girls and boys from violations
such as abuse, sexual exploitation, trafficking and work in hazardous conditions, as well as
harmful practices, including child marriage.
Girls and boys should be encouraged and supported to speak up for children’s rights
and to take an active role in their own protection against abuse, violence, exploitation
and discrimination.
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KEY MESSAGES:
CHILD PROTECTION
1. Every child should have the opportunity to grow up in a family. If a family
is unable to care for the child, steps should be taken by the authorities to
address the reasons and make every effort to keep the family together.
2. Every child has a right to a name and nationality. Registering a child’s birth
helps to ensure a child’s right to education, health care and legal and social
services. Birth registration is a vital step towards protection from abuse
and exploitation.
3. Girls and boys must be protected from all forms of violence and abuse.This
includes physical, sexual and emotional abuse, neglect and harmful practices
such as child marriage and genital mutilation/cutting of girls. Families,
communities and authorities are responsible for ensuring this protection.
4. Children must be protected from all work that is hazardous. Work should
not prevent them from attending school. Children should never be involved
in the worst forms of child labour, such as slavery, forced labour, drug
production or trafﬁcking.
5. Girls and boys can be at risk of sexual abuse and exploitation in their home,
school, workplace or community. Measures should be taken to prevent
sexual abuse and exploitation. Sexually abused and exploited children need
immediate help to stop such abuse.

Key Messages 151
6. Children are vulnerable to trafficking where protection for children is weak
or missing.The government, civil society and families are responsible
for preventing trafficking, as well as helping children who are victims to
reintegrate into their families and communities, if it is in their best interest.
7. Justice for children should be based on child rights. Depriving children of
their liberty (incarcerating them) must always be a last resort. Procedures
that are sensitive to children should be put in place for children who are
victims or witnesses of crime.
8. Income support and social welfare services can help keep families together
and children in school and ensure access to health care.
9. All children have a right to age-appropriate information, to be heard and to
participate in making decisions that concern them. Fulfilment of this right
enables children to take an active role in their own protection against abuse,
violence and exploitation, and to become active citizens. BREASTFEEDINGNUTRITIONANDGROWTH
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152 Facts for Life
KEY MESSAGE
1. Every child should have the opportunity to grow up in a family. If a family
is unable to care for the child, steps should be taken by the authorities to
address the reasons and make every effort to keep the family together.
Children grow best in a loving family environment in which their best
interests are always taken into account.
If a child is living without a parent or other caregiver, the authorities should
take immediate action to reunite the child with her or his own family or
extended family. But if it is determined that reuniﬁcation is not the best
option for the child, another permanent family situation should be sought.
Every effort should be made to keep siblings together.
Governments, with the support of civil society, have a responsibility to
provide appropriate and well-monitored alternative care for children without
families. Options include placement with:
● extended family
● a pre-screened foster family
● a residential facility that is integrated within the community, providing
family-like care and supporting regular contact between the child and her
or his family with the aim of reuniﬁcation, if it is in the best interest of
the child.
Children should be involved in decisions on their placement in alternative
living situations.
CHILD PROTECTION

Very often children placed in institutions could be raised in a family with
the proper social support. While some orphanages are well managed,
institutional life can be detrimental to children’s development. It typically
separates them from family and community life and offers less protection
from abuse and exploitation.
Any form of institutional care should be considered a last resort and a
temporary solution.
KEY MESSAGE
2. Every child has a right to a name and nationality. Registering a child’s birth
helps to ensure a child’s right to education, health care and legal and social
services. Birth registration is a vital step towards protection from abuse
and exploitation.
Birth registration provides an official record of a child’s existence and
nationality. It is considered a fundamental human right. A child without a birth
certificate can be denied health care, legal services, access to school and the
right to vote upon reaching adulthood.
Registering a child’s birth is a vital step towards her or his protection. Children
under age 5 with a birth certificate are more likely to be immunized and
receive health care for childhood illnesses, assuring them a healthy start
in life.
Any enforcement of minimum-age legislation depends upon an official
record of a child’s age. For example, a birth certificate can be used to protect
a child from illegal recruitment by armed forces or armed groups, from child
marriage or from hazardous forms of work.
Birth registration should be free and accessible for every child. Where it is
not, civil society organizations can sometimes assist families in registering
their children.
The birth registration process may be supported by social services, such as
health care and education. Health centres and hospitals sometimes have civil
registrars on site that can provide a child’s birth certificate at birth or during
a health-care visit. Registration sometimes takes place in early childhood
education programmes.
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154 Facts for Life
KEY MESSAGE
3. Girls and boys must be protected from all forms of violence and abuse.This
includes physical, sexual and emotional abuse, neglect and harmful practices
such as child marriage and genital mutilation/cutting of girls. Families,
communities and authorities are responsible for ensuring this protection.
Girls and boys can encounter different forms of violence, abuse and/or
harmful practices in many settings:
In the family and home:
● physical violence
● psychological violence
● sexual violence and abuse
● corporal (physical) punishment
● neglect and abandonment
● child marriage
● harmful traditional practices, such as female genital mutilation/cutting
(FGM/C).
In schools and other educational activities:
● corporal punishment
● psychological punishment
● sexual and gender-based violence
● verbal and physical bullying
● ﬁghting.
In care and justice institutions (e.g., orphanages, children’s homes and
detention facilities):
● physical and psychological violence under the guise of discipline
● neglect
● child-on-child violence
● sexual abuse and violence.
In workplaces:
● physical and psychological punishment
● humiliation
● sexual harassment and abuse.
In the community (among peers, between gangs, by the police and
by trafﬁckers):
● physical violence
● armed violence
● sexual violence.

Children who experience or witness violence often remain silent out of
fear, shame or stigma. Some accept it as part of life. While some violence is
perpetrated by strangers, most is carried out by people children know and
should be able to trust and look to for protection.These may include parents,
step-parents or a parent’s partner, relatives, caregivers, boyfriends and
girlfriends, schoolmates, teachers, religious leaders and employers.
All girls and boys can be subjects of abuse. Generally, boys tend to be at
greater risk of physical and armed violence and girls face greater risk of
neglect and sexual violence and exploitation.
Certain groups of children are particularly vulnerable to violence.These
include children with disabilities, children of minority groups, children living
or working on the street, children in conflict with the law, and children who
are refugees, displaced or migrating.
Babies and young children are sometimes the object of a parent’s or other
caregiver’s anger or frustration, often when children do not stop crying.
The caregiver may shake the baby or young child so hard and violently
that it causes injury to the child’s brain that can lead to permanent injury or
death. It is never okay to shake a child. Symptoms of violent shaking include
irritability, difficulty staying awake, difficulty breathing, shakiness, vomiting,
seizures or coma.These symptoms require immediate medical care.
Typically, the focus is on intervention after child maltreatment occurs. Due
to the magnitude of the problem, it is critical that communities shift the
emphasis to preventing child violence, abuse, neglect and harmful practices.
Every community should create and implement a plan of action to eliminate
violence against children.
Some key actions may include:
● develop and broadly communicate codes of conduct against all forms of
violence in settings where children live, go to school, play and work
● educate parents and caregivers to respect the child’s perspective, learn
how to use positive and non-violent discipline and not to discipline a child
when angry
● support schools to nurture attitudes that reject violence and promote
non-violent conflict resolution.This can involve changing classroom
management (traditionally based on fear, threats, humiliation and physical
punishment) to a child-friendly approach that is non-discriminatory and
supports cooperative learning
● sponsor public campaigns to stop corporal punishment, abuse and
harmful practices such as child marriage and genital mutilation/cutting
● provide children affected by violence with health and social services to
help them reintegrate into their families and communities
● establish safe ways for children to report violence against them, such as
telephone hotlines or accessible social protection centres.
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KEY MESSAGE
4. Children must be protected from all work that is hazardous.Work should not
prevent them from attending school. Children should never be involved in the
worst forms of child labour, such as slavery, forced labour, drug production
or trafficking.
Children who work often do so to support their families’ livelihood so they
can eat and have basic necessities. Many children begin working at an early
age, as young as 4 years old. In many cases, it is considered normal for
children to work long hours before or after school, or to work all day and
evening and not attend school at all.
Children can be found working in agriculture, commerce, factories, fishing,
markets, housekeeping, childcare, handicrafts, restaurants, garbage dumps
and in the streets.
Close to 70 per cent of working children work in agriculture, which can be
extremely hazardous. It can involve heavy manual labour, long hours, and the
use of pesticides and dangerous tools. Children can be at risk of sexual abuse
and exploitation, especially during harvesting season (when they often work
extra-long hours) and while working on plantations.
Some children are engaged in the worst forms of child labour, such as child
slavery, debt bondage, forced labour, drug production and trafficking. These
are illegal. Children must be removed immediately from such situations and,
if it is in their best interest, reintegrated into their families and communities.
The work children do should not be hazardous to their health or well-being. It
should not prevent children from going to school.
The government and local authorities, with support from families and civil
society, should develop measures to address harmful child labour situations,
such as:
● identifying and communicating to the general public the different forms
of harmful child labour found in the community and the forms children
might encounter if they migrate
● identifying and removing children from harmful child labour
● helping children removed from harmful child labour who live away from
their families to reintegrate into their family and community, if it is in their
best interest
● ensuring that all children in the community attend a child-friendly school
full-time and receive an education that is of good quality, equal for all
children and free from violence

● providing income support and/or social welfare services to families who
need them, so they are less reliant on their children’s income and can
send them to school.
Families need to know the risks involved in sending their children away for
work, such as domestic and agricultural work.
Children and adolescents should be well informed about the dangers of
leaving home and taking work that might land them in high-risk situations
such as prostitution and drug trafﬁcking.
KEY MESSAGE
5. Girls and boys can be at risk of sexual abuse and exploitation in their home,
school, workplace or community. Measures should be taken to prevent
sexual abuse and exploitation. Sexually abused and exploited children need
immediate help to stop such abuse.
Children need to be protected from all forms of sexual exploitation and
sexual abuse.
Most children who are sexually abused know their abusers. Most abusers
are relatives or acquaintances of the child. A much smaller percentage of
offenders are strangers. Most child sexual abuse is committed by men.
Whatever the case, sexual abuse or exploitation is never the child’s fault.
The responsibility always lies with the abuser.
Every person has a unique reaction to sexual abuse or sexual exploitation,
regardless of the type, extent or duration. Victims may show a range of
emotional responses such as calm, anger, indifference or shock.
Some children may be exposed to life-threatening situations, such as sexually
transmitted infections, including HIV. Girls may face the added risk of early
and unwanted pregnancies that endanger their lives and can subject them to
stigma and discrimination.
Children can begin to learn early on about ‘good’ touch versus ‘bad’ touch.
Children can also be taught to tell an adult they trust if they have experienced
a ‘bad’ touch. If a child comes to an adult with such information, the adult
must take the child’s claims seriously and immediately ensure that the abuse
stops.The abuse should be reported to the authorities, and the child should
receive protection services.
Many children and young people who have been victims of sexual abuse or
exploitation heal and go on to lead normal lives. Sexual abuse in childhood
does not automatically lead to sexually aggressive behaviour. Most sexual
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offenders have not been sexually abused as children, and most children who
are sexually abused do not abuse others.
Governments are responsible for ensuring that systems and specific
measures are in place to:
● prevent child abuse, violence and exploitation
● enable children to report abuse and exploitation
● make sure perpetrators of sexual abuse and exploitation are dealt with to
the full extent of the law
● make social services, such as health care, psychosocial support,
temporary care, education and legal assistance, timely and available for
children who have been abused and exploited.
KEY MESSAGE
6. Children are vulnerable to trafficking where protection for children is weak
or missing.The government, civil society and families are responsible
for preventing trafficking, as well as helping children who are victims to
reintegrate into their families and communities, if it is in their best interest.
Trafficking of children is one of the fastest growing transnational crimes,
occurring in and between countries. Profit from human trafficking has been
estimated at approximately US$9.5 billion annually.
Children who are trafficked are:
● treated as commodities
● subject to violence, abuse, neglect, exploitation and HIV infection.
It is calculated that the majority of the children trafficked every year are girls
who are sexually exploited.
Children and families burdened by poverty and with limited access to
information may leave their communities because they believe better
opportunities await them elsewhere. Sometimes children are promised a
good education, a well-paying job or a better life. Instead they may find
themselves smuggled or moved across borders or taken within their own
country by traffickers and forced into dangerous situations.These may
include domestic servitude, prostitution, forced marriage or begging.
It is important for children and families choosing to leave their communities
to understand where they are going.They should know:
● what they can expect
● potential risks involved during travel as well as at the destination
● what to do if they get into a trafficking situation.

Governments can support local authorities and civil society to:
● distribute information to parents and children on the risks of migration
and sending children away to work
● distribute information to communities on how negative attitudes towards
migrant children can lead to social acceptance of child trafficking or
indifference to it
● gain parental support to keep children in school and not allow them to
drop out for work
● provide social services as needed to help reduce parents’ dependence on
their children’s income or work
● address and reduce domestic violence, which can influence a child’s
decision to leave home
● treat children as victims of crime and not as criminals, and provide them
with support and the time they need to recover before returning them to
their families and communities or alternative care
● make and enforce laws that prosecute traffickers.
KEY MESSAGE
7. Justice for children should be based on child rights. Depriving children of
their liberty (incarcerating them) must always be a last resort. Procedures
that are sensitive to children should be put in place for children who are
victims or witnesses of crime.
Placing children who have committed crimes or have been accused of
committing crimes in a detention centre, prison or reform school or any other
closed setting should always be a last resort. Detention can be detrimental to
children’s development and make reintegration into society more difficult.
Alternatives such as mediation, community service and counselling
produce better results for children and their families and communities.
Such alternatives are generally more respectful of children’s rights and help
children learn how to take on a more constructive role in society.This should
be the objective of all justice interventions concerning children.
The majority of children in detention have not committed a serious offence.
They are often detained for dropping out of school, running away from home,
using alcohol, begging or vagrancy. Some children are in detention because
they have been exploited by adults through prostitution or drug dealing.
Children can remain in detention for months or years awaiting review of their
case.These children are at higher risk of violence and exposure to drugs, HIV
infection and other health problems. Detention can interrupt their schooling
and distance them from family. Children in detention generally need a social
protection response, not a judicial one.
CHILDDEVELOPMENT
ANDEARLYLEARNING
CHILDPROTECTION

160 Facts for Life
Children who are in detention should:
● be separated from adult offenders
● have their cases addressed within a short time frame
● be separated by gender
● have appropriate means to report violence committed against them while
in detention.
Pregnant women and mothers with children in detention need special
protection, care and support. All children in these circumstances are entitled
to protection of their rights, such as access to health care and education.
Child-sensitive procedures for boys and girls should be put in place for child
victims and witnesses of crime. Such procedures should:
● prevent contact between the child and the alleged perpetrator (the person
who is accused of committing the crime)
● allow for the child’s full participation in the justice process
● ensure that the child is treated with dignity and compassion.
KEY MESSAGE
8. Income support and social welfare services can help keep families together
and children in school and ensure access to health care.
Households that need income support and social welfare services may
be headed by the elderly, widows, children or individuals who are sick or
disabled.This can include families affected by HIV.
Income support and social welfare services can provide children and families
the means to:
● purchase food
● pay for or access health care and education
● keep families together
● keep children out of institutional care or from working or living on the
street
● help families break out of the cycle of poverty.
The government and local authorities, with support from civil society, can
help identify families in need.They can assist families with income support
and social welfare services such as counselling and legal aid. It is important to
ensure that families do not face discrimination related to accessing or using
the services.

Information on income support and social welfare services can be provided
through various communication channels, including health centres, schools
and community centres; during community meetings and events; and
through radio and loudspeaker announcements.
KEY MESSAGE
9. All children have a right to age-appropriate information, to be heard and to
participate in making decisions that concern them. Fulﬁlment of this right
enables children to take an active role in their own protection against abuse,
violence and exploitation, and to become active citizens.
From a very early age, including during infancy, girls and boys form and
express views and interests. As they grow so does their ability to participate
in decisions that concern them and their families and communities.
Children and adults should actively and consistently talk to each other, sharing
information and ideas in the home, school and community. The exchange should
be based on mutual respect. Children’s views should be listened to and taken
seriously in accordance with the child’s age and maturity.
Girls and boys who express their opinions freely are more likely to assume
responsibilities, develop critical thinking and communication skills, and make
informed decisions as they grow. They are often able to:
● learn and perform better in school
● contribute to making responsible decisions regarding their education
and health
● protect themselves against sexually transmitted infections, including HIV,
unwanted pregnancy, bullying, bias, discrimination, harassment, violence,
abuse and exploitation
● learn and practise active citizenship and grow into adults who will be
ready to exercise their rights and responsibilities.
Children are avid users, producers and subjects of media, a powerful source
for inﬂuencing opinion and perceptions among children. Different forms of
media can be used responsibly to broaden children’s knowledge, inform them
on how to protect themselves and develop their citizenship skills.
Children-led associations or clubs can give girls and boys a place to voice
their ideas, perspectives and concerns. Such clubs provide an opportunity for
them to socialize and develop their interests and leadership skills.
CHILDDEVELOPMENT
ANDEARLYLEARNING
CHILDPROTECTION

INJURY PREVENTION

Introduction 163
TIMINGBIRTHS
E
very year, nearly 1 million children die from
injuries.Tens of millions more require hospital
care for non-fatal injuries. Many are left with
permanent disabilities or brain damage.
Injuries affect children of all ages. Girls and boys
under 5 years of age are at particular risk. More
boys than girls die from injuries.
The most common injuries are trafﬁc injuries,
non-fatal drowning (sometimes referred to as near
drowning), burns, falls and poisoning.
Trafﬁc injuries and drowning are the leading causes of injury-related death.
The most common place for young children to be injured is in or around their homes.
Almost all injuries can be prevented.
Families, communities and governments have an obligation to ensure children’s right to live
in a safe environment and be protected from injury.
BREASTFEEDINGNUTRITIONANDGROWTHINJURYPREVENTION
SAFEMOTHERHOOD

164 Facts for Life
KEY MESSAGES:
INJURY PREVENTION
1. Many serious injuries can be prevented if parents and other caregivers
supervise children carefully and keep their environment safe.
2. Young children are at risk on or near roads.They should not play on or near
the road and should always have someone older with them when they are
near or crossing a road. They should wear a helmet when on a bicycle or
motorcycle and should be securely strapped into an age-appropriate child
restraint when being transported in a vehicle.
3. Children can drown in less than two minutes and in a very small amount of
water, even in a bathtub.They should never be left alone in or near water.
4. Burns can be prevented by keeping children away from ﬁres, cooking stoves,
hot liquids and foods, and exposed electric wires.

Key Messages 165
5. Falls are a major cause of injury for young children. Stairs, balconies, roofs,
windows, and play and sleeping areas should be made secure, using barriers
with vertical bars to protect children from falling.
6. Medicines, poisons, insecticides, bleach, acids and liquid fertilizers and
fuels, such as parafﬁn (kerosene), should be stored carefully out of children’s
sight and reach. Dangerous substances should be stored in clearly marked
containers and never in drinking bottles. Child-resistant closures, where
available, should be used on the containers of poisonous products.
7. Knives, scissors, sharp or pointed objects and broken glass can cause
serious injuries.These objects should be kept out of children’s reach. Plastic
bags, which can cause suffocation, should be kept away from young children.
8. Young children like to put things in their mouths.To prevent choking, small
objects, such as coins, nuts and buttons, should be kept out of their reach.
Children’s foods should be cut into small pieces that can be easily chewed
and swallowed.
SAFEMOTHERHOOD

166 Facts for Life
KEY MESSAGE
1. Many serious injuries can be prevented if parents and other caregivers
supervise children carefully and keep their environment safe.
Young children, especially as they begin to move around on their own – and
particularly between 12 months and 4 years old – are at high risk of injuries
in and near the home. Almost all these injuries can be prevented. Prevention
requires supervising children carefully and keeping them away from dangers,
such as cooking ﬁres, water sources, places where they can fall, roads, and
items that can poison, choke or hurt them.
INJURY PREVENTION

KEY MESSAGE
2. Young children are at risk on or near the roads.They should not play on or
near the road and should always have someone older with them when they
are near or crossing a road. They should wear a helmet when on a bicycle or
motorcycle and should be securely strapped into an age-appropriate child
restraint when being transported in a vehicle.
Children may be hurt when they are crossing or walking along roads, or
if they play near roads.Young children do not think before they run onto
the road.
Families need to:
● watch children carefully
● fence the house and close the gate to prevent young children from
running onto the road
● teach young children never to cross or walk along a road unless
accompanied by an adult or older child
● prevent children from playing near the road
● teach children not to run after balls, moving toys or kites that go on or
near the road
● instruct children to walk on the side of the road, facing trafﬁc
● if there is a sidewalk, teach children to use it rather than walk on the road.
When crossing the road, young children should be taught to:
● stop at the side of the road
● look both ways
● listen for cars or other vehicles before crossing
● hold the hand of another person
● walk, not run
● in urban areas, use pedestrian crossings
● avoid crossing the road at a curve or between parked cars
● avoid crossing roads with high-speed trafﬁc.
Children are also at high risk of serious injury if they travel in the front seat
of a car, unsupervised on the bed of a truck or agricultural machinery, or on
a motorcycle.
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168 Facts for Life
In a car, children should use an age-appropriate child restraint or a booster
seat until they are 150 centimetres tall or 10 years old, when they are big
enough to use an adult seat belt.
While travelling with parents or other caregivers on a motorbike, all
passengers, including children, should wear a helmet that is securely
strapped under the chin so it cannot come off in case of an accident.
Bicycle accidents are a frequent cause of injury and death among children. All
children should learn road safety and wear a bicycle helmet when riding a bike.
For first aid advice on injuries, refer to the end of this chapter.
KEY MESSAGE
3. Children can drown in less than two minutes and in a very small amount of
water, even in a bathtub.They should never be left alone in or near water.
Drowning may cause brain injury or death.To prevent children from
drowning, parents and other caregivers should always closely supervise
children who are near or in the water.
Where there is water, it is important to:
● cover wells and water tanks so children cannot open them
● turn tubs and buckets upside down when not in use, and always supervise
children taking a bath
● teach children to stay away from ditches and drains
● for families who live near bodies of water, install a fence around the house
and close the gates to prevent young children from going in the water
● fence ponds and pools with vertical rails spaced close together to prevent
children from getting through them to the water
● for families who live directly on the water, put vertical bars on terraces,
windows and doors to prevent young children from falling in the water
● teach children how to swim when they are young
● have young children and children who cannot swim wear an approved
flotation device (life jacket) when playing in the water or on a boat
● always supervise children who are swimming
● teach children never to swim in fast-flowing streams and never to
swim alone
● in flood-prone areas, carefully watch children when the water begins to
rise; make sure that all family members, including children old enough to
understand, are well informed of safe places to go to if they need to leave
the home quickly.
For first aid advice on drowning, refer to the end of this chapter.

KEY MESSAGE
4. Burns can be prevented by keeping children away from fires, cooking stoves,
hot liquids and foods, and exposed electric wires.
Burning and scalding are among the most common causes of serious injury
among young children. Burns often cause permanent scarring, and some are
fatal.The great majority of these are preventable.
One of the most common types of burns is from direct contact with fires or
flames or touching hot surfaces.To prevent this kind of burn:
● keep young children away from cooking fires, matches, paraffin lamps,
candles and flammable liquids such as paraffin and kerosene
● put stoves on a flat, raised surface out of the reach of children
● if an open cooking fire is used, make it on a raised mound of clay, not
directly on the ground. A barrier of mud, bamboo or other material or
a playpen can also be used to keep young children out of reach of the
cooking place.
● do not leave small children alone near fires or to tend fires or cook
● keep children away from heaters, hot irons and other hot appliances
● never leave a child alone in a room with a candle or fire burning.
Another major cause of burns is scalding from hot liquids or foods.To
prevent scalds:
● turn the handles of all cooking pots away from the reach of children
● keep hot foods and liquids in a safe place and out of children’s reach
● do not let children turn on the hot water tap in a bath or shower by
themselves
● keep the temperature of water heaters below a medium setting to prevent
scalding if children turn on the hot water
● teach children not to play rough around people with hot drinks or in the
kitchen when meals are being prepared
● never hold a child when having hot liquids or foods.
Children can get a serious shock or burn if they come in contact with
electricity.To prevent shocks and burns:
● teach children never to put their fingers or other objects into electric
sockets
● cover power sockets to prevent access
SAFEMOTHERHOOD

170 Facts for Life
● keep electric wires out of children’s reach
● cover bare electric wires, which are particularly dangerous, using
insulating tape.
For ﬁrst aid advice on burns, refer to the end of this chapter.
KEY MESSAGE
5. Falls are a major cause of injury for young children. Stairs, balconies, roofs,
windows, and play and sleeping areas should be made secure, using barriers
with vertical bars to protect children from falling.
Children often fall as they learn to walk, run and jump. Many of these falls
cause small scrapes and bruises. Sometimes falls can cause broken bones,
head injuries or other serious injuries, even death.
Infants left unattended may fall from beds, cots or hammocks.Young children
may fall down stairs or from windows or balconies.
Children like to climb.They can be seriously injured if they fall from a high
place or try to climb up on top of heavy furniture that might fall on them.
In addition to supervision, some steps to prevent children from serious
falls include:
● discourage and prevent children from climbing onto unsafe places
● do not allow children to play on stairs and balconies, and, if they do,
watch them closely
● use railings of appropriate width and height with vertical bars on stairs,
windows or balconies
● keep the home clean, well lit and free of sharp objects and rough edges
● properly secure babies in high chairs
● do not leave infants unattended on beds, cots, hammocks or in walkers or
other baby equipment
● keep furniture such as beds, chairs and cribs away from windows
● do not put toys or other items on high shelves that may attract small
children, and fasten heavy furniture such as cabinets or shelves to
the wall.
For ﬁrst aid advice on broken bones, bruises or sprains, refer to the end of
this chapter.

KEY MESSAGE
6. Medicines, poisons, insecticides, bleach, acids and liquid fertilizers and
fuels, such as paraffin (kerosene), should be stored carefully out of children’s
sight and reach. Dangerous substances should be stored in clearly marked
containers and never in drinking bottles. Child-resistant closures, where
available, should be used on the containers of poisonous products.
Poisoning is a serious danger to small children. Bleach, insect and rat poison,
paraffin (kerosene) and household detergents can kill or permanently injure
a child.
Many poisons can kill, cause brain damage, blind or permanently injure
if they:
● are swallowed
● are inhaled
● get onto the skin
● get into the eyes.
The key to preventing poisoning is to keep harmful substances out of
children’s reach.
● Poisons should never be put in soft drink or beer bottles, jars or cups, as
children may drink them by mistake. All medicines, chemicals and poisons
should be stored in their original containers, tightly sealed and out of
children’s reach.
● Detergents, bleaches, chemicals and medicines should never be left where
children can reach them.They should be tightly sealed and labelled.They
should also be locked in a cupboard or trunk or put on a high shelf where
children cannot see or reach them.
● Medicines meant for adults can kill or injure small children. Medicine
should only be given to a child if it is prescribed for that child. It should
never be given to a child if it is prescribed for an adult or some other
child. A child should never take medication on his or her own.The parent
or other caregiver should give the medication to the child each time it is
needed. Medication should be stored out of reach and sight of children.
● Child-resistant closures, where available, should be used on containers
storing poisonous substances.
For first aid advice on poisoning, refer to the end of this chapter.
SAFEMOTHERHOOD

172 Facts for Life
KEY MESSAGE
7. Knives, scissors, sharp or pointed objects and broken glass can cause serious
injuries.These objects should be kept out of children’s reach. Plastic bags,
which can cause suffocation, should be kept away from young children.
Broken glass can cause serious cuts, loss of blood and infected wounds.
Sharp metal objects, machinery and rusty cans can cause wounds that can
become badly infected.
Families can reduce the risk of children’s injuries from glass and sharp objects
if they:
● keep glass bottles out of reach of young children and keep the house and
play area free of broken glass and refuse
● place knives, razors and scissors in drawers or locked cabinets well out of
reach of young children
● safely dispose of household refuse, including broken bottles and old cans.
Other injuries around the home can be prevented by teaching children about
the dangers of throwing stones or other sharp objects and of playing with
knives or scissors.
Plastic bags should be kept away from young children to prevent suffocation.
For ﬁrst aid advice on cuts and wounds, refer to the end of this chapter.

KEY MESSAGE
8. Young children like to put things in their mouths.To prevent choking, small
objects, such as coins, nuts and buttons, should be kept out of their reach.
Children’s foods should be cut into small pieces that can be easily chewed
and swallowed.
One way young children explore their environment is by putting things in
their mouths which might cause them to choke. Also, young children have
difficulty chewing and swallowing some foods such as hard sweets that can
cause them to choke.
Parents or other caregivers should:
● keep play and sleeping areas free of small objects such as buttons, beads,
balloons, pen caps, coins, seeds and nuts
● check new toys carefully before children play with them to make sure they
have no loose or sharp pieces that could break and be swallowed by or
hurt the child
● never give young children foods they can choke on such as groundnuts
(peanuts), hard sweets or food with small bones or seeds
● always supervise young children during meals, and cut or tear children’s
food into small pieces that can be easily chewed or swallowed.
Coughing, gagging and high-pitched, noisy breathing or the inability to
make any sound at all indicate breathing difficulty and possible choking.
Parents and other caregivers should suspect a child is choking when he or
she suddenly has trouble breathing, even if no one has seen the child put
something into the mouth.
For first aid advice on choking, refer to the end of this chapter.
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174 Facts for Life
FIRST AID ADVICE
Until medical help is available, the following first aid measures should help prevent a
situation from becoming worse. Parents, other caregivers and older children should be
supported in learning about these first aid measures.
First aid for burns: ● If the child's clothing catches fire, quickly wrap the child
in a blanket or clothing or roll him or her on the ground
to put out the fire.
For minor burns, the
following steps can
be taken:
● Cool the burned area immediately. Use plenty of cold,
clean water, which helps to reduce pain and swelling. Do
not put ice on the burn; this can further damage the skin.
● Keep the burn clean and dry with a loose sterile gauze
bandage or clean cloth.This will protect blistered skin.
● Do not break blisters, as they protect the injured area.
If a blister is broken, the area is more susceptible to
infection. Do not apply butter or ointments to the burn;
they can prevent proper healing.
● A minor burn will usually heal without further treatment.
For major burns that
burn all layers of skin,
emergency care is needed
immediately. Until it is
available, the following
steps can be taken:
● Do not remove the burned clothing from the body.
Make sure the child is no longer near any burning or
smouldering materials or exposed to smoke or heat.
● Do not immerse large, serious burns in cold water, as
this could cause shock.
● Raise the burned body part or parts above heart level, if
possible.
● Loosely cover the burn area with cool, moist towels or
cloths or a sterile bandage.
● If the child is unconscious, keep him or her warm. Roll
the child onto his or her side so that the tongue does not
block breathing.
● Check for signs of breathing, movement and coughing.
If there are no signs, follow the steps under ‘First aid for
breathing problems or drowning’.

First aid for broken bones,
bruises or sprains:
● A child who is unable to move or is in extreme pain may
have broken bones. Do not move the injured area and
get medical help immediately.
● For bad bruises and sprains, immerse the injured area
in cold water or put ice on the injury for 15 minutes. Do
not put the ice directly on the skin; use a layer of cloth
between the ice and the skin. Remove the ice or water,
wait 15 minutes and repeat, if necessary.The cold should
help reduce pain, swelling and bruising.
First aid for cuts
and wounds:
For minor cuts and wounds:
● Wash the wound with clean (or boiled and cooled) water
and soap.
● Dry the skin around the wound.
● Cover the wound with a clean cloth and place a sterile
bandage over it.
For serious cuts and wounds:
● If a piece of glass or other object is sticking in the
wound, do not remove it. It may be preventing further
bleeding, and removing it could make the injury worse.
● If the child is bleeding heavily, raise the injured area
above the level of the chest and press ﬁrmly against the
wound (or near it if something is stuck in it) with a pad
made of folded clean cloth. Maintain pressure until the
bleeding stops.
● Do not put any plant or animal matter on the wound, as
this could cause infection.
● Put a clean sterile bandage on the wound. Allow for
swelling by not tying the bandage too tightly.
● Seek medical help immediately. Ask a trained health
worker if the child should have a tetanus injection.
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176 Facts for Life
First aid for choking: ● If an infant or child is coughing, let him or her try to
cough up the object. If the object does not release
quickly, try to remove the object from the child’s mouth.
● If the object is still lodged in the child’s throat:
For infants or young children:
● Support the head and neck.
● Turn the baby or young child face down with the head
lower than the feet. Deliver five careful blows to the back
between the shoulder blades.Turn the baby face up and
press firmly on the breastbone between the nipples five
times. Repeat (face down and face up) until the object
is dislodged.
● If you cannot dislodge the object, take the child to the
nearest health worker immediately.
For larger children:
● Stand behind the child with your arms around the
child’s waist.
● Form a clenched fist with your thumb against the child’s
body, above the navel and below the rib cage.
● Put the other hand over the fist and give a sharp inward
and upward thrust into the child’s abdomen. Repeat until
the object is dislodged.
● If you cannot dislodge the object, take the child to the
nearest health worker immediately.

First aid for breathing
problems or drowning:
● If there is any possibility of injury to the head or neck,
do not move the child’s head. Follow the breathing
directions below without moving the head.
● If the child is having difficulty breathing or is not
breathing, lay the child flat on the back and tilt her or his
head back slightly. Pinch the child’s nostrils closed and
blow (breathe) into the mouth, keeping all the mouth
covered. Blow gently but hard enough to make the
child’s chest rise.Then, count to three and blow again.
Continue until the child begins breathing.
● If the child is breathing but unconscious, roll the
child onto his or her side so the tongue does not
block breathing.
● If a person who cannot swim sees a child drowning
in deep water, the person should immediately throw
a rope, floating device or tree branch to the child and
shout loudly so that others can come to help rescue
the child.
First aid for poisoning: ● If a child has swallowed poison, do not try to make the
child vomit.This may make the child more ill.
● If poison is on the child’s skin or clothes, remove the
clothing and pour large amounts of water over the skin.
Wash the skin thoroughly several times with soap.
● If a child gets poison in his or her eyes, splash clean
water in the eyes for at least 10 minutes.
● Take the child immediately to a health centre or hospital
if any of these situations occur. If possible, bring a
sample of the poison or medicine or its container with
you. Keep the child as still and quiet as possible.
● If a child is bitten by a venomous or rabid animal, it is
important to see a health-care provider immediately
for treatment.
SAFEMOTHERHOOD

Introduction 179
E
mergencies, such as conflicts, disasters
or epidemics, expose families to risks
that make them especially vulnerable to
disease, malnutrition and violence. With the right
information and support, families and communities
can establish measures that map out what to do in
an emergency.
Girls, boys and women typically are the most
affected by emergencies. An estimated 26 million
people were displaced by armed conflicts and
violence in 2007. Each year, up to 50 million people
are displaced due to disasters. Climate change
could increase these numbers.
Displacement undermines families’ livelihoods and social support mechanisms.This can
lead to family separations and increase children’s vulnerability to discrimination, abuse,
violence, poverty and exploitation.
Conflict and disasters put children at risk of disease and malnutrition. Access to health
services is reduced, and food shortages are common. Water can become scarce, especially
when access is limited by overcrowding and poor sanitary conditions. Children’s access
to education is often undermined, since schools are frequently targeted for attacks and
abductions, and teachers and materials are in short supply.The risk of HIV transmission
increases in such contexts.
In situations of conflict, girls and boys are particularly vulnerable to forced recruitment by
armed forces and groups. Along with women, they are also at risk of abduction, trafficking
and sexual violence, including rape.
Epidemics (or outbreaks) of diseases can be caused by emergencies or can by themselves
cause an emergency.The emergency can arise because of the severe nature of the disease
or the community’s response to it.
A pandemic is a widespread, usually global, epidemic. An influenza pandemic results from
a new influenza virus against which the population has little or no immunity. It can spread
rapidly across the world and is recurrent and unpredictable.The youngest children, under
2 years of age, are particularly vulnerable to influenza and other infectious diseases.
Children and their family members have the right to protection and the information and
support they may need to prepare for and cope with such complex situations.
EMERGENCIES:PREPAREDNESS
ANDRESPONSE
NUTRITIONANDGROWTH
CHILDDEVELOPMENT

180 Facts for Life
KEY MESSAGES:
EMERGENCIES:
PREPAREDNESS
AND RESPONSE
1. In emergencies, children have the same rights as in non-emergency
situations.This is true whether the emergency is a conﬂict, disaster
or epidemic.
2. Girls and boys and their families and communities should plan ahead and
take simple steps to prepare for emergencies – at home, at school and in
the community.
3. Measles, diarrhoea, pneumonia, malaria, malnutrition and neonatal
complications are major causes of child deaths, particularly during
emergencies.
4. An epidemic (or outbreak) of disease can cause an emergency because
of the severity of the disease or responses to it. In the case of pandemic
inﬂuenza and other diseases spread by close personal contact, those who
are ill should be kept separated from others.
5. Mothers, even malnourished mothers, can still breastfeed even under the
stressful conditions of emergencies.

Key Messges 181
6. Children have the right to be protected from violence in emergencies.
Governments, civil society, international organizations, communities and
families have the responsibility to protect them.
7. It is generally preferable for children to be cared for by their parents or
other usual caregivers because it makes children feel more secure. If
separation occurs, every effort should be made to reunite the child with his
or her family, if it is in the child’s best interest.
8. The disruption and stress caused by disasters and armed conﬂict can
frighten and anger children. When such events occur, children need special
attention and extra affection.They should be kept as safe as possible
and supported in resuming normal activities. Children can be given age-
appropriate opportunities to participate in the responses to and decisions
regarding the emergency situation.
9. Children have the right to education, even during emergencies. Having
children attend a safe, child-friendly school helps to reinforce their sense of
normalcy and start the process of healing.
10. Landmines and unexploded devices are extremely dangerous.They
can explode and kill or disable many people if touched, stepped on or
disturbed in any way. Children and their families should stay only in areas
that have been declared safe and avoid unknown objects.
ANDRESPONSE
NUTRITIONANDGROWTH
CHILDDEVELOPMENT

182 Facts for Life
KEY MESSAGE
1. In emergencies, children have the same rights as in non-emergency
situations.This is true whether the emergency is a conflict, disaster
or epidemic.
All children and their families and communities have the right to receive
humanitarian assistance in emergencies.
Children and their families who are forced from their homes by conflicts
or disasters have the same rights as those living in their homes and
communities in non-emergency situations.
Communities can designate protected areas to shelter civilians and the sick.
These areas must never be used for any military purposes.
Humanitarian relief workers and supplies must always be respected
and protected. Combatants should always allow all civilians access to
humanitarian assistance.
The particular needs of women and adolescent girls in emergency situations
must be respected.Their specific needs of privacy, hygiene and protection
must be taken into account. Unaccompanied children, pregnant women,
mothers with young children, female heads-of-households, persons with
disabilities and the elderly may require specific attention to address their
particular needs.
EMERGENCIES:
PREPAREDNESS
AND RESPONSE

When children and families are displaced within a country, the national
authorities have the primary responsibility to protect children’s rights
and assist children and families.The United Nations, non-governmental
organizations and the International Committee of the Red Cross (ICRC),
among others, also have a critical role to play in providing assistance and
protection to children and families.
Displaced persons have the right to safely return to their homes as soon as
the reasons for their displacement are no longer an issue.The property rights
of displaced persons must be respected so children and families can rebuild
their lives.
As communities begin to re-establish and reconstruct after an emergency,
attention should be given to providing social services, including health and
education, to children, women and families.
Humanitarian workers who provide aid to civilians should minimize
opportunities for violence, exploitation and abuse. Any activity by
humanitarian workers that exploits the population should be reported
immediately to the agency concerned and the authorities.
KEY MESSAGE
2. Girls and boys and their families and communities should plan ahead and
take simple steps to prepare for emergencies – at home, at school and in
the community.
Within the household, the whole family can prepare for an emergency
brought about by a disaster or conflict. Everyone should be aware of the
different dangers of fire, earthquakes, floods, storms and other hazards
and the risks during conflicts.The response can be more effective when
everyone in the family and community knows how to reduce their risks and
understands their responsibilities.
The possible dangers and safe areas in and around a community should be
identified. If possible they should be shown on a local map. Everybody in
the community should be involved and informed. Plans should include how
young children, older people and people who are unwell would be assisted.
Community warning systems and evacuation routes for escaping from
danger should be well identified and communicated. Communities can hold
simulated drills of safety measures with boys and girls in schools and with
families in neighbourhoods.
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Communities should ensure that health facilities are well built to withstand
emergencies and function in their wake. Health-care staff must be trained so
they are prepared to act in emergency situations.
It is important for schools to be located in a safe place, close to where
children live and away from disaster-prone areas, such as where flooding or
mudslides might occur. Schools should be well constructed to ensure the
safety of children and teachers.They should be carefully organized to protect
children from attacks, abduction or other forms of violence.
Teachers and school administrators can help children, their families and
communities to:
● understand natural hazards and other emergency risks
● know how to prevent disaster
● know what to do in an emergency.
Families, including children, should be encouraged to recognize a warning
and understand what to do when they see or hear it. A warning or signal can
be as simple as a whistle, horn or coloured flag. Safe locations where families
can meet should be identified. Safe places for domestic animals should also
be identified.These precautions help to prevent family separation.
Children can be trained to memorize their name and the names of
their relatives and their village or town.They can be trained to identify
geographical indicators or landmarks that might locate their community if
they get separated from their families.
A family emergency bag prepared in advance can be life-saving. It should
include a torch (flashlight), batteries, candles, matches, radio, water container
and first aid kit.The packet should be checked periodically and ready at
all times.
Birth certificates and other important family documents should be kept in a
safe, easily accessible place. Storing them in plastic wrap helps protect them
from water and damage.

KEY MESSAGE
3. Measles, diarrhoea, pneumonia, malaria, malnutrition and neonatal
complications are major causes of child deaths, particularly during
emergencies.
Infectious diseases spread easily in crowded emergency conditions.To reduce
the risks:
● ensure that all children 6 months to 15 years of age are appropriately
immunized, especially against measles, at the first point of contact
or settlement
● continue to seek health-care services to prevent and treat illnesses.
(Refer to the chapters on Safe Motherhood and Newborn Health,
Immunizations, Coughs, Colds and More Serious Illnesses, and Malaria.)
Malnutrition is more common in emergencies due to shortages of food,
increased disease and disruption of caring practices. It is therefore important
to ensure that children:
● breastfeed and receive adequate amounts of age-appropriate nutritious
foods and drinks
● receive micronutrient supplements in addition to fortified foods.
Children who are very thin and/or swollen (usually the feet and legs) need
to be taken to a trained health worker or health facility for immediate
assessment and treatment and further management in accordance with
their status.
(Refer to the chapters on Breastfeeding, and Nutrition and Growth.)
In emergencies, lack of safe water, sanitation and hygiene can cause disease
that may turn into an epidemic. Cholera can occur where there is poor
sanitation and overcrowding. Basic steps to follow include:
● continue to wash hands frequently with soap and water or a substitute,
such as ash and water
● dispose of faeces and garbage safely
● practise safe food preparation
● use safe water sources or employ home-based water treatment, such as
boiling, filtering, adding chlorine or disinfecting with sunlight
● store safe water in clean, covered containers.
(Refer to the chapters on Hygiene and Diarrhoea.)
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KEY MESSAGE
4. An epidemic (or outbreak) of disease can cause an emergency because of the
severity of the disease or responses to it. In the case of pandemic influenza
and other diseases spread by close personal contact, those who are ill should
be kept separated from others.
The impact of a disease outbreak depends on the severity of the disease as
well as the responses by governments, communities and individuals.
An influenza pandemic, involving a new virus, can spread rapidly through a
population that has little or no immunity against the new virus.The influenza
might be moderate or severe in terms of the illness and death it causes. The
outbreak can come and go repeatedly over time. Its level of severity can
change over the course of the pandemic, making it unpredictable. It generally
has a greater impact than regular seasonal influenza outbreaks.
Annual or seasonal influenza causes most deaths in people over 65 years
of age. An influenza pandemic causes more severe illness and deaths in
younger age groups. In both seasonal and pandemic influenza, pregnant
women and children under 2 years old are at increased risk of complications
and death. Older children have the highest rates of infection but tend not to
have severe outcomes.
Influenza symptoms include high fever, cough, sore throat, body aches,
headache, chills, fatigue, vomiting and diarrhoea. In some cases, influenza
can lead to pneumonia and breathing difficulties.
During an outbreak of influenza or other infection, some general steps to help
protect children and families include:
● stay home if sick, and stay apart from others
● know the symptoms and danger signs, and what to do and where to go to
get help if the illness becomes severe
● wash hands with soap and water often, and keep surfaces clean
● cough or sneeze into an elbow or a tissue, and dispose safely of tissues
● do not spit near children or in public.
In an outbreak of an infection that has serious consequences, it is important
to reduce close contact with others:
● stay at least one metre apart from others, especially if they are coughing
or sneezing or look unwell
● stay at home as much as possible and avoid public gatherings and travel.

In an extensive outbreak, some individuals may need to be isolated in a
hospital setting for treatment or to prevent the spread of the infection. But for
many people access to care may be limited.
To care for sick people at home and to prevent the spread of the infection in
the household:
● give sick people a separate space at home
● assign a single caregiver to a sick person
● give plenty of fluids and foods to the sick person.
KEY MESSAGE
5. Mothers, even malnourished mothers, can still breastfeed even under the
stressful conditions of emergencies.
People often believe that during emergencies many mothers can no longer
breastfeed due to stress or inadequate nutrition.This is a misconception –
it is not correct. Mothers who lack food or who are undernourished can
still breastfeed adequately.They should be given extra fluids and foods to
protect their health and well-being and that of the child. Fathers and other
family members can support breastfeeding mothers with food preparation
and childcare.
Stress can temporarily interfere with the flow of breastmilk. But it does not
need to stop breastmilk production, if mothers and infants remain together
and are supported in initiating and continuing breastfeeding. Safe havens, as
in refugee camps and shelters, can be established where women can go to
receive support.
In some cases breastfeeding is not possible.These include children
temporarily or permanently separated from their mothers, mothers who are
very sick, mothers who have stopped breastfeeding for some time, mothers
who have not been able to restart breastfeeding, and HIV-positive mothers
who have chosen not to breastfeed.
In these situations, for children under 12 months, the most appropriate food
is a high-quality breastmilk substitute (infant formula). Safe preparaton of the
breastmilk substitute requires fuel, safe water and equipment, and preferably
the guidance of a trained health worker. The breastmilk substitute should be
stored and prepared under hygienic conditions with water from a safe source,
using a cup, not a bottle.
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Breastmilk substitutes should never be distributed in an uncontrolled manner
alongside food aid and without attention to the conditions required for safe
preparation.They should not displace breastfeeding, a baby’s best protection
against illness in an emergency situation.
KEY MESSAGE
6. Children have the right to be protected from violence in emergencies.
Governments, civil society, international organizations, communities and
families have the responsibility to protect them.
Protecting girls and boys during conflicts or disasters is critical since they can
be vulnerable to many kinds of violence.
Some violence is directly related to the emergency.This includes abduction,
torture, beating, harassment and injuries during fighting by soldiers or armed
groups or fighting in communities over limited resources. Emergencies
also increase the usual risks of violence in a community, such as domestic
violence, violence in schools or violence among children themselves.
Girls and women are at particular risk of trafficking and sexual violence,
including rape, which is sometimes used as a tactic of war. This is
unacceptable. All efforts should be taken by governments and local
authorities to make sure this never happens. Girls and women who are
subjected to this violence need health care, psychosocial support and
counselling. Some will need support in relocating and reintegrating into
their families.
In armed conflicts, children must be protected.They must not be recruited
by armed forces or armed groups or be allowed to take part in fighting.
If children are arrested, they should not be harmed.They should be kept
separate from adults (or with their family), and they must receive a fair trial.
If girls or boys are victims of violence, they have the right to seek justice that
takes their views into account.
It is important for children and families to report violations against children’s
rights to the authorities when it is safe to do so. Serious violations of
children’s rights, including killing children, using children as soldiers, sexual
violence against children and abduction of children, should be reported to
international humanitarian agencies.

KEY MESSAGE
7. It is generally preferable for children to be cared for by their parents or other
usual caregivers because it makes children feel more secure. If separation
occurs, every effort should be made to reunite the child with his or her family,
if it is in the child’s best interest.
In emergencies, it is the duty of the government or the authorities in charge to
ensure that children are not separated from their parents or other caregivers.
If separation occurs, the government or authorities in charge have the
responsibility to provide special protection and care for these children.They
should first register all unaccompanied, separated and orphaned children and
make sure their essential needs are met.
Every effort should then be made to find the child’s family and to reunite the
child with his or her family, if it is in the best interest of the child.
Interim care must be provided for children separated from their families.
Where possible this can be provided by the child’s extended family or by a
family from the child’s community until the child is reunited with parents or
relatives or placed with a foster family. Every effort should be made to keep
siblings together.
If a child is temporarily placed in a foster family, it is the duty of those
responsible for the placement to follow up on the child’s care and well-being.
They should also ensure that the foster family is provided with the means to
adequately care for the child.
Children who have become separated from their parents in an emergency
cannot be assumed to be orphans.They are not available for adoption. As
long as the fate of a child’s parents and/or other close relatives cannot be
determined, each separated child must be assumed to have parents and/or
close relatives who are still living.
Long-term care arrangements should not be made during an emergency.
After a suitable period of investigation, if parents or relatives cannot be
traced or are not available to care for the child, a foster family or domestic
adoptive family, preferably in the child’s community, should be found for the
child. Childcare institutions or orphanages should always be considered a
temporary measure and a last resort.
A move to a new community or country can be stressful, especially if the
child’s family has fled violence or a disaster. Displaced children sometimes
may have to learn a new language and culture. Often, schools and community
organizations can assist children and their families with the transition and
integration into their new community.
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KEY MESSAGE
8. The disruption and stress caused by disasters and armed conflict can frighten
and anger children. When such events occur, children need special attention
and extra affection.They should be kept as safe as possible and supported
in resuming normal activities. Children can be given age-appropriate
opportunities to participate in the responses to and decisions regarding the
emergency situation.
It is normal for children’s feelings and behaviours to be affected by
frightening, painful or violent experiences. Children react differently – they
may lose interest in daily life, become more aggressive or turn very fearful.
Some children who appear to be coping well are hiding their emotions
and fears.
Parents or regular caregivers, peers, teachers and community members
are an important source of support and security for children. Families and
communities can help children if they:
● listen to both girls and boys and provide them opportunities to express
their concerns, participate in decision-making and find solutions
● provide children with age-appropriate information, reassurance and
emotional support
● maintain familiar routines in daily life and resume normal activities as
soon as possible
● provide enjoyable age-appropriate activities for children such as cultural
activities, visits to friends and families, and sports
● encourage children to continue to play and socialize with others
● provide children with age-appropriate opportunities to participate in
meaningful ways in everyday activities and in the emergency response,
such as assisting with teaching and caring for young children
● maintain clear rules for acceptable behaviour and avoid physical
punishment
● provide safe spaces where children and parents can socialize, learn life
skills and access basic services
● help children learn how to manage their stress.
When children’s stress reactions are severe and last for a long time, they
need help from a qualified professional such as a counsellor, psychologist or
specialized nurse or doctor.

KEY MESSAGE
9. Children have the right to education, even during emergencies. Having
children attend a safe, child-friendly school helps to reinforce their sense of
normalcy and start the process of healing.
Regular routines, such as going to school and maintaining normal eating and
sleeping schedules, give children a sense of security and continuity.
Child-friendly schools and spaces can provide a protective and safe learning
environment for all children coping with an emergency.
With support from families and communities, teachers and school
administrators can help:
● provide a safe, structured place for children to learn and play
● identify children who are experiencing stress, trauma or family separation
and provide basic psychosocial support
● provide a daily routine and a sense of the future beyond the emergency
● ensure that children retain and develop basic literacy and numeracy skills
● provide children with life-saving health and security information and skills
to reduce their risks
● provide a place for expression through play, sports, music, drama and art
● facilitate integration of vulnerable children into the school and community
● support networking and interaction with and among families
● provide children with an understanding of human rights and skills for
living in peace
● build awareness with children on how to protect the environment and
develop their skills to reduce disaster risks
● encourage children to analyse information, express opinions and take
action on particular issues important to them.
Teachers require support and training to understand and deal with children’s
and their own stressful experiences, losses and reactions to emergencies.
They need to know how to give emotional, mental and spiritual support to
students and guide families on how to do the same with their children.
Schools and communities can also help to organize fun activities for children
outside of school time. Opportunities can be created for organized non-violent
play, sports and other forms of recreation. Communication and interaction
among peers should be encouraged and supported. Use of arts such as
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drawing, or playing with toys or puppets, can help young children express
their concerns and adjust to stressful experiences.
Parents and other caregivers should keep children who become sick with
the ﬂu or other infectious disease at home or in their place of residence if
displaced from their homes.
In case of a severe epidemic that spreads rapidly from person to person, local
authorities and education personnel need to make appropriate decisions
regarding how to protect children. As a public health measure, classes may
be suspended to reduce spread of the disease. In such cases, education can
still continue by using alternative strategies.This requires good planning and
follow-up by education personnel in collaboration with the students’ families.
KEY MESSAGE
10. Landmines and unexploded devices are extremely dangerous.They can
explode and kill or disable many people if touched, stepped on or disturbed
in any way. Children and their families should stay only in areas that have
been declared safe and avoid unknown objects.
Landmines are victim-activated explosive devices intended to kill or injure
people or destroy or damage vehicles. Unexploded ordnance (called UXO)
are any munitions, such as bombs, shells, mortars or grenades, that were
used but failed to detonate as intended.
Both landmines and UXO come in many different shapes, sizes and colours.
They can be buried underground, placed above ground or hidden in grass,
trees or water.They may be bright and shiny or dirty and rusty, but they are
always dangerous and must be avoided at all times.
Landmines are usually not visible. Special caution is needed near areas of
military action or abandoned or overgrown areas. Dangerous areas are often
designated by a marking such as a picture of a skull and crossbones, red-
painted stones or other common markings that draw attention and are easily
recognized as hazard warnings by the local population.
UXO are often easier to see than landmines.Their colour and shape make
them attractive to children, but they are extremely dangerous and unstable.
They can explode with the slightest touch or change in temperature.They kill
more often than do landmines.
Children should be taught not to touch unfamiliar objects.They need to learn
that if anything looks suspicious they should keep away and inform adults
they know or the authorities.

Since some roads may be mined or littered with explosive remnants of war, it
is important for families to ask local people which roads or paths are safe to
travel. Generally it is safer to travel on commonly used roads and paths.
Places likely to have mines, UXO or abandoned weapons and ammunition
include abandoned or destroyed buildings, unused paths or roads, untouched
and overgrown ﬁelds, current or former military bases, outposts, checkpoints,
trenches or ditches. Children and their families need to be informed to stay
away from these areas. Measures should be put in place to keep them away.
Children and their families need to learn what to do if they see a mine or
UXO.They should:
● stand still and tell others nearby to do the same
● avoid panicking
● avoid movement
● call for help
● if help does not come, carefully consider the options before moving to
retrace the original steps backwards very slowly.
If a landmine or UXO injury occurs:
● apply ﬁrm pressure to the bleeding area until the bleeding stops
● if the bleeding is not stopping, tie a cloth or piece of clothing (a
tourniquet) just above or as close to the wound as possible and send for
medical assistance
● if help is delayed more than one hour, loosen the tourniquet hourly to
check the bleeding; remove the tourniquet when the bleeding stops
● if the person is breathing but unconscious, roll the person onto his or her
side so the tongue does not block breathing
● seek follow-up medical care, as needed.
Governments and local authorities have the responsibility to make
communities safe for all children and families. Professional demining is the
best solution to ensure the safety of all.
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ACTs artemisinin-based combination therapies that treat Plasmodium falciparum
malaria, the most serious type of malaria, which causes nearly all malaria deaths
AIDS acquired immunodeficiency syndrome
ART antiretroviral therapy – a group of medicines used to treat HIV
anaemia a blood deficiency that results in poor health, commonly caused by lack of iron in
the diet
BCG Bacille Calmette-Guérin – an anti-tuberculosis vaccine
DTP or DPT diphtheria and tetanus toxoid with pertussis (whooping cough) vaccine
eclampsia an illness that sometimes occurs during the later stages of pregnancy, which
involves high blood pressure and can cause convulsions, sometimes followed by
a coma
expressed milk milk removed from the breast manually or by using a pump
FGM/C female genital mutilation/cutting is any procedure that involves partial or total
removal of the external female genitalia or other injury to the female genital
organs for non-medical reasons
fistula
(obstetric)
an abnormal opening between a woman’s vagina and her bladder and/or rectum,
through which urine and/or faeces continually leak; obstetric fistula is caused by
complications during childbirth
goitre an enlargement of the thyroid gland that causes a swelling of the neck and is a
sign of iodine deficiency in the person’s diet
HepB Hepatitis B vaccine
Hib Haemophilus influenzae type B vaccine
HIV human immunodeficiency virus
infibulation the most extreme type of female genital mutilation, involving excision of part or all
of the external genitalia and stitching or narrowing of the vaginal opening
micronutrients nutrients needed in very small amounts for normal growth and development, e.g.,
a vitamin or mineral
obstructed labour labour in which despite strong contractions of the uterus, the fetus cannot descend
through the pelvis because a barrier prevents its descent
opportunistic
infections
infections that take advantage of weakness in the immune system such as caused
by HIV
ORS oral rehydration salts
PCP
pneumonia
pneumocystis pneumonia – a common ‘opportunistic’ infection in children and
people living (infected) with HIV
pentavalent vaccine a five-in-one vaccine that combines the DTP (also referred to as DPT), HepB and
Hib vaccines
Plasmodium
falciparum malaria
the most serious type of malaria, which causes nearly all malaria deaths
PMTCT prevention of mother-to-child transmission of HIV
prolonged
labour
labour with a duration of more than 24 hours
respiratory
tract
the system in the body that takes in and distributes oxygen
STI sexually transmitted infection
stillbirth the birth of a fetus that has died in the womb
Facts for Life
GLOSSARY

(UNICEF)
UNICEF House
Tel: 1-212-326-7000; Fax: 1-212-303-7985
Email: pubdoc@unicef.org
Website: www.unicef.org
World Health Organization (WHO)
Avenue Appia 20
CH-1211 Geneva 27, Switzerland
Tel: 41-22-791-2111; Fax: 41-22-791-3111
Email: info@who.int
Website: www.who.int
United Nations Educational, Scientiﬁc
and Cultural Organization (UNESCO)
UNESCO House
7, place de Fontenoy
75352 Paris 07 SP, France
Tel: 33(0)1-4568-1000; Fax: 33(0)1-4567-1690
Email: bpi@unesco.org
Website: www.unesco.org
United Nations Population Fund
(UNFPA)
220 East 42nd Street
Tel: 1-212-297-5000; Fax: 1-212-370-0201
Email: HQ@unfpa.org
Website: www.unfpa.org
United Nations Development
Programme (UNDP)
Tel: 1-212-906-5000; Fax: 1-212-906-5001
Public enquiries:
www.undp.org/comments/form.shtml
Website: www.undp.org
Joint United Nations Programme on
HIV/AIDS (UNAIDS)
Avenue Appia 20
CH-1211 Geneva 27, Switzerland
Tel: 41-22-791-3666; Fax: 41-22-791-4187
Email: unaids@unaids.org
Website: www.unaids.org
World Food Programme (WFP)
Via Cesare Giulio Viola 68
Parco dei Medici
00148 Rome, Italy
Tel: 39-06-65131; Fax: 39-06-6513-2840
Email: wfpinfo@wfp.org
Website: www.wfp.org
The World Bank
1818 H Street, NW
Washington, DC 20433, USA
Tel: 1-202-477-1234; Fax: 1-202-477-6391
Website: www.worldbank.org
Facts for Life is a co-publication of the following agencies:

Published by UNICEF
Email: fﬂ@unicef.org
www.factsforlifeglobal.org
ISBN: 978-92-806-4466-1
Sales No.: E.09.XX.24
Price: $15.00
© United Nations Children’s Fund (UNICEF)
January 2010
Produced by UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and the
World Bank, Facts for Life can be found at www.factsforlifeglobal.org.The website
will be updated regularly and includes a link to an interactive site for posting
comments, sharing experiences and materials and discussing relevant issues.

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