Breast feeding and complementary feeding.

Experts at the World Health Organisation (WHO) / UNICEF Technical Consultation on Infant Feeding in March 2000, reached an informal consensus that the appropriate age for introduction of complementary feeding is "about six months."(1). There has recently been some confusion as to the ideal time to introduce complementary foods to an infant. The WHO has been suggesting that between 4 and 6 months is the best time, however recent reviews of appropriate literature suggest that there is no advantage in introducing complementary foods before six months of age, except in individually determined cases.

A number of studies have shown that there is no growth advantage in breastfed children being given complementary foods from four months of age, even with very high quality foods(2). Studies undertaken in Honduras, Bolivia, Congo and New Caledonia have shown this.

Complementary feeding also often results in displacement of breast milk. Infants regulate the amount of breast milk they consume, and if they are receiving other foods they will reduce the amount of breast milk they consume accordingly. The nutrients found in breast milk are often absent or less bio-available in complementary foods, such as calcium, protein, fatty acids, vitamins and minerals. After six months of age, the displacement of breast milk is reduced and is less important(3).

Breast feeding is recommended up to six months in areas where hygiene is difficult due to increases in illness. Introduction of complementary foods in these areas before six months has led to increased hospitalisation rates for pneumonia, and increased rates of diarrhoea.

Breast milk is the perfect food for infants in the first six months of life. It has all the nutrients an infant requires to maintain optimal health and growth. It also protects the baby from the two leading causes of infant death: respiratory infections and diarrhoea. Breast milk also stimulates the immune system and response to vaccinations(4) while containing hundreds of antibodies and enzymes. Breast fed children are less susceptible to pneumonia, allergies,
asthma, childhood diabetes, gastrointestinal illness, and infection, and have lower rates of childhood cancers such as leukaemia and lymphoma.

Breast milk is also easy and convenient as it requires no sterilisation or special equipment, or heating. Breast feeding saves money as the need for infant formula is reduced, it decreases the burden on the health care system through eliminating the expense of infant formula and reduced hospitalisation rates.

A report by the WHO is due for completion in November 2000, and a decision based on this report is expected to be made by early 2001.

References

Naylor A. 2000. Statement circulated at Technical Consultation on Infant Feeding, March 2000, and at the ACC/SCN working group on breastfeeding and complementary feeding, Washington.

Cohen RJ, Brown KH, Canahuati, J et al. 1994. Effects of age of introduction of complementary foods on infant breastmilk intake, total energy intake, and growth: a randomised intervention study in Honduras. Lancet; 334: 228-93.

Brown KH, Dewey KG, Allen LH. 1998 Complementary feeding of young children in developing countries: a review of current scientific knowledge. Geneva: WHO/NUT/98.1

UNICEF, 1999. Breastfeeding: Foundation for a healthy future.

Age of introduction of complementary foods. World Alliance for Breastfeeding Action. E-mail correspondence (8th August, 2000).

Last Updated: April 8, 2001.