Minimum Milk Feeding Frequency for Non-Breastfed Children

Outcome

% of non-breastfed children 6 - 23 months of age who consumed at least two milk feeds during the previous day

Milk and other dairy products are important sources of calcium and other nutrients for non-breastfed children. This indicator assesses the proportion of non-breastfed children aged 6–23 months who consumed at least two milk feeds during the previous day.

There are two main ways to determine the indicator’s value. Both require conducting individual interviews with caregivers of a representative sample of children aged 6–23 months. The indicator is then calculated among children who were not fed breast milk during the previous day:

 

1) Using Data from Minimum Acceptable Diet

When measuring Minimum Acceptable Diet (MAD), the WHO/UNICEF questionnaire also records the data required for this indicator. For non-breastfed children, MAD includes minimum milk feeding frequency as one of its criteria. In the WHO/UNICEF 2021 guidance (see below), use Question 4 on current breastfeeding, Questions 6B–6D on infant formula, animal milk and yoghurt drinks, and Question 7A on yoghurt eaten as a food (pages 25–29).

 

2) Asking About Milk Feeds Only

If you do not want to administer the full WHO/UNICEF questionnaire, use the following questions only:

Ask separately about each of the following milk-feed types. Before data collection, adapt the examples and local terms for formula, animal milk, yoghurt drinks and other fermented milk products to the survey context.

Q1: Yesterday, during the day or at night, was [child’s name] given any breast milk?

Q2: Yesterday, during the day or at night, did [child’s name] drink any infant formula, such as [insert locally common formula names]? If yes, how many times?

Q3: Yesterday, during the day or at night, did [child’s name] drink any animal milk, such as fresh, tinned or powdered milk? If yes, how many times?

Q4: Yesterday, during the day or at night, did [child’s name] drink any animal milk-based yoghurt drinks or other drinkable fermented milk products, such as [insert locally common examples]? If yes, how many times?

Q5: Yesterday, during the day or at night, did [child’s name] eat any yoghurt made from animal milk, other than yoghurt drinks? If yes, how many times?”

A1-A5: Record yes / no / does not know. For Q2-Q5, if yes, record the number of times consumed. If the number of times is not known, record does not know.

To calculate the indicator’s value, add the reported frequencies of infant formula, animal milk, yoghurt drinks or other drinkable fermented animal-milk products, and yoghurt eaten as a food. A non-breastfed child aged 6-23 months meets the indicator criterion if the total is at least two feeds during the previous day. Divide the number of children meeting this criterion by the total number of non-breastfed children aged 6-23 months and multiply by 100.

For WHO/UNICEF-standard calculation, a child is classified as non-breastfed if the response to Q1 is anything other than ‘yes’. Milk-feed frequency questions that were skipped because the item was not consumed, or where the frequency is missing or unknown, are scored as zero rather than excluded from the denominator.

This data can be disaggregated by child sex and age group, and, if relevant and feasible, also by household wealth and geographical area. Where the sample size is adequate, age groups of 6–11, 12–17 and 18–23 months can be used. Because the denominator includes only non-breastfed children, check that enough non-breastfed children were surveyed before presenting results for smaller subgroups.

1) According to WHO/UNICEF guidance (see below), “milk feeds” include any formula (e.g. infant formula, follow-on formula or “toddler milk”), animal milk other than human breast milk (e.g. cow milk, goat milk, evaporated milk or reconstituted powdered milk), semi-solid yoghurt, yoghurt drinks, and other drinkable fermented products made from animal milk. Sweetened condensed milk and non-dairy creamers do not count as milk feeds.

 

2) This indicator measures milk-feeding frequency, not the volume of milk consumed or the adequacy of the child’s overall diet. Meeting the indicator should therefore not be interpreted as proof of adequate milk intake or an adequate overall diet.

 

3) Milk-feeding practices can vary by season or during periods that substantially affect food availability or feeding practices. For comparisons over time, collect survey rounds in the same season where feasible and document important contextual differences. Do not exclude a child’s data simply because their food or drink intake on the previous day was unusual. Consider rescheduling data collection only when there is good reason to expect highly unusual feeding patterns among a large proportion of the target population.

 

4) If the caregiver is taking care of two children aged 6 - 23 months (from the same household) and household sampling has been used, then data should be collected for both children. If a list method has been used and children have been identified as the primary sampling unit, then data should only be collected for the sampled child.

Because this indicator includes only non-breastfed children aged 6–23 months, its sample size can be much smaller than the total number of children surveyed. Where breastfeeding is common, relatively few children may therefore be included in the calculation. When planning the survey, take the expected proportion of non-breastfed children into account, as a larger overall sample may be needed. WHO/UNICEF advises, as a general rule, not presenting an estimate when fewer than 25 children are included in the denominator.

 

5) This indicator relies on an accurate age assessment. Since people often do not remember the exact dates of their children’s birth, the enumerators should always verify the child’s age. This can be done by reviewing the child’s birth certificate, vaccination card or other document; however, since many caregivers do not have such documents (and since they can include mistakes), it is essential that the enumerators are able to verify the child’s age by using local events calendars. Read FAO’s Guidelines (see below) to learn how to prepare local events calendars and how to train enumerators in their correct use.

Also consider using the following indicators:

• Minimum Acceptable Diet (includes minimum milk feeding frequency as a required component for non-breastfed children)

• Minimum Meal Frequency (assesses overall feeding frequency and includes milk feeds for non-breastfed children)

• Minimum Dietary Diversity - Children (assesses dietary variety and complements the indicator’s focus on milk feeding)