Complementary Feeding in Developed Countries: The 3 Ws (When, What, and Why?)

Abstract

While a wide knowledge exists on the effects of breast milk or infant formula on growth and infant development, less attention has been paid to the importance of complementary feeding (CF). This review focuses on current recommendations for optimal introduction of CF in healthy full-term European infants and discusses the potential impact of this type of feeding on health outcomes. Overall, exclusive breastfeeding is recommended at least for 4 months and preferable for 6 months, followed by the introduction of CF alongside breast milk; infants’ nutrient requirements must meet the differences between nutrients provided by breast milk and the estimated total needs. There is growing evidence that healthy feeding practices during the CF period have positive short- and long-term effects on optimal growth, body composition, neurodevelopment, healthy food preferences, and gut microbiota composition and function; adequate and healthy CF may also diminish the risk of infections, allergies, type 1 diabetes mellitus, as well as celiac and non-communicable diseases. Following the expert recommendations, the design of nutritional strategies must encourage parents to provide a healthy lifestyle for their offspring. Future research should aim to optimize timing, content, and methods of CF; furthermore, it is necessary to explore future CF-targeted health-promoting strategies in early life (appetite regulation, eating patterns, eating behavior, gut dysbiosis, etc.) to prevent growth/obesity outcomes, immune system related-diseases or non-communicable diseases in later life.

Introduction to complementary feeding in the first year of life and risk of overweight at 24 months of age: changes from 2004 to 2015 Pelotas (Brazil) Birth Cohorts

“…A high intake of foods such as sweet desserts, snack foods (e.g. chocolate, cookies and chips) and sugary beverages during infancy is associated with tooth decay, decline in the consumption of other nutritious foods, overweight/obesity and a high intake of these food types in later life (1,10,34,35) . Juice was introduced before the age of 3 months in half of the children and before the age of 12 months by 95•5 % in 2004c and 87•8 % in 2015c.…”

“…The first 12 months of life are a critical time for children to experience food, flavours and textures. There is a growing evidence that healthy infant feeding practices have positive short-and long-term effects on child growth, body composition, neurodevelopment, healthy food preferences and gut microbiota composition and function (10,35) . Furthermore, adequate and healthy complementary foods may also diminish the risk of infections, allergies, coeliac disease, type 1 diabetes, as well as of non-communicable diseases (35) .…”

“…There is a growing evidence that healthy infant feeding practices have positive short-and long-term effects on child growth, body composition, neurodevelopment, healthy food preferences and gut microbiota composition and function (10,35) . Furthermore, adequate and healthy complementary foods may also diminish the risk of infections, allergies, coeliac disease, type 1 diabetes, as well as of non-communicable diseases (35) . Our study revealed an increase in introduction prevalence of vegetable and a reduction in dairy products (yogurt and porridge) before 12 months of age from 2004c to 2015c.…”

Consensus of the Brazilian Association of Nutrology on Milky Feeding of Children Aged 1–5 Years Old

“…These interactions are part of children's learning about patterns of cultural and family behavior. 4 Thus, it is considered that the environment at mealtime should be free from distractions such as television, music, computer, etc. These bad practices can lead to future eating disorders.…”

“…Touching, smelling, playing, putting in the mouth and spitting new foods are normal exploratory behaviors that precede the acceptance of this new food. 4 These facts should be informed to the family, emphasizing that the failure of children to accept new foods is part of a development stage and, although frustrating, especially for the mother, should be experienced with knowledge, consistency and patience.…”