Infant & Young Child Nutrition
1. WHO Guideline for complementary feeding of infants and young children 6–23 months of age, (Oct 2023).
Complementary feeding, defined as the process of providing foods in addition to milk when breast milk or milk formula alone are no longer adequate to meet nutritional requirements, generally starts at age 6 months and continues until 23 months of age, although breastfeeding may continue beyond this period. This is a developmental period when it is critical for children to learn to accept healthy foods and beverages and establish long-term dietary patterns. It also coincides with the peak period for risk of growth faltering and nutrient deficiencies. The immediate consequences of malnutrition during these formative years – as well as in utero and the first 6 months of life – include impaired growth, significant morbidity and mortality, and delayed motor, cognitive, and socio-emotional development. It can later lead to an increased risk of noncommunicable diseases (NCDs). In the long term, undernutrition in early childhood leads to reduced work capacity and earnings and, among girls, reduced reproductive capacity. Inappropriate complementary feeding can result in overweight, type 2 diabetes and disability in adulthood. The first two years of life are also a critical period for brain development, the acquisition of language and sensory pathways for vision and hearing, and the development of higher cognitive functions.
Mary Fewtrell, et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition (2017).
This position paper considers different aspects of complementary feeding (CF), focussing on healthy term infants in Europe. After reviewing current knowledge and practices, we have formulated these recommendations: Timing: Exclusive or full breast-feeding should be promoted for at least 4 months (17 weeks, beginning of the 5th month of life) and exclusive or predominant breast-feeding for approximately 6 months (26 weeks, beginning of the 7th month) is a desirable goal. Complementary foods (solids and liquids other than breast milk or infant formula) should not be introduced before 4 months but should not be delayed beyond 6 months. Content: Infants should be offered foods with a variety of flavours and textures including bitter-tasting green vegetables. Continued breast-feeding is recommended alongside CF. Whole cows’ milk should not be used as the main drink before 12 months of age. Allergenic foods may be introduced when CF is commenced at any time after 4 months. Infants at high risk of peanut allergy (those with severe eczema, egg allergy, or both) should have peanuts introduced between 4 and 11 months, following evaluation by an appropriately trained specialist. Gluten may be introduced between 4 and 12 months, but consumption of large quantities should be avoided during the first weeks after gluten introduction and later during infancy. All infants should receive iron-rich CF including meat products and/or iron-fortified foods. No sugar or salt should be added to CF and fruit juices or sugar-sweetened beverages should be avoided. Vegan diets should only be used under appropriate medical or dietetic supervision and parents should understand the serious consequences of failing to follow advice regarding supplementation of the diet. Method: Parents should be encouraged to respond to their infant's hunger and satiety queues and to avoid feeding to comfort or as a reward.