Complementary Feeding

  • Report of the global consultation convened jointly by the Department of Child and Adolescent Health and Development and the Department of Nutrition for Health and Development Geneva, 10-13 December 2001
  • and

  • Summary of guiding principles for complementary feeding of the breastfed child

A teljes dokumentum a WHO oldalán található.
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Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods

Audrey J. Naylor, Ardythe L Morrow
Wellstart International and the LINKAGES Project/Academy for Educational Development, Washington, D.C. 2001.

Introduction and Background

This review of the developmental readiness of normal full term infants to progress from exclusive breastfeeding to the introduction of complementary foods has been undertaken as a result of the international debate regarding the best age to introduce complementary (semi-solid and solid) foods into the diet of the breastfed human infant. Since 1979 the World Health Organization has recommended that normal full term infants should be exclusively breastfed for „four to six months.” Over the two decades since this recommendation was established further evidence regarding the benefits of breastmilk and breastfeeding has accumulated.
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Effects of Exclusive Breastfeeding for Four versus Six Months on Maternal Nutritional Status and Infant Motor Development

Kathryn G. Dewey, Roberta J. Cohen, Kenneth H. Brown and Leonardo Landa Rivera

Journal of Nutrition. 2001;131:262-267.


To examine whether the duration of exclusive breastfeeding affects maternal nutrition or infant motor development, we examined data from two studies in Honduras: the first with 141 infants of low-income primiparous women and the second with 119 term, low birth weight infants.

In both studies, infants were exclusively breastfed for 4 mo and then randomly assigned to continue exclusive breastfeeding (EBF) until 6 mo or to receive high-quality, hygienic solid foods (SF) in addition to breast milk between 4 and 6 mo. Maternal weight loss between 4 and 6 mo was significantly greater in the exclusive breastfeeding group (EBF) group than in the group(s) given solid foods (SF) in study 1 (-0.7 ± 1.5 versus -0.1 ± 1.7 kg, P < 0.05) but not in study 2.
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Cows’ Milk in Complementary Feeding


If breastfeeding is continued at a high rate into the second year of life, and if the complementary diet contains reasonable amounts of animal protein from meat, fish, or eggs, most infants will thrive without cows’ milk. This is the situation in some traditional societies, where milk is not available or where there is no tradition for feeding cows’ milk. However, in most populations in the world there is a strong tradition of using cows’ milk as an important part of the complementary diet. This article will discuss different aspects of the use of cows’ milk in complementary feeding and will highlight areas where there is a need for further research.
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Complementary Feeding and Breastfeeding


A key question that has been inadequately explored is: to what extent does or might complementary feeding affect breast milk intake and total breastfeeding duration? We assume that maintaining breastfeeding is desirable, but in designing interventions to improve complementary feeding, the potential impact on breastfeeding frequency and breast milk intake is often ignored.
PEDIATRICS Vol. 106 No. 5 Supplement November 2000, pp. 1301

A cikk a Pediatrics oldalán olvasható.
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Vannak-e negatív hatásai a túlzott fehérjebevitelnek?

A csecsemők testsúlykilogrammra számított fehérjeszükséglete – elsősorban a nagyobb mértékű növekedésnek köszönhetően – nagyobb, mint az idősebb gyermekeké és a felnőtteké. Az újabb becslések szerint egy 6-9 hónapos baba esetében a biztonságos fehérjebevitel 1,09 g/kg, 9-12 hónapos gyermek esetén 1,02 g/kg, míg egy felnőtt számára 0,8 g/kg.

A testsúlykilogrammra számított energiaszükséglet ehhez képest relatíve nagyobb. Egy 9-12 hónapos csecsemő energiaigénye 89 kcal/kg, ami majdnem háromszorosa egy közepes fizikai aktivitású felnőttének (kb. 30kcal/kg). Ily módon egy 9-12 hónapos csecsemő étrendje a teljes energiaszükséglet 5%-ának megfelelő mennyiségű fehérjét kell, hogy tartalmazzon ([1,02g fehérje*4kcal/g]/89kcal). 5E% az anyatej fehérjetartalma.
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Complementary Feeding and Enteropathies

Jacques Schmitz, MD

PEDIATRICS Vol. 106 No. 5 Supplement November 2000, pp. 1286


Since the discovery, in the early 1950s, that gliadin was the component of wheat responsible for celiac disease (CD), and, during the 1960s that cows’ milk proteins could also trigger severe enteropathies, it has been shown that early introduction of many other foreign proteins—from soy, rice, eggs, fish, and chicken—could have the same deleterious effect: a T-cell mediated immune reaction leading to mucosal inflammation with villous atrophy, diarrhea, and failure to thrive.

Research Priorities
1. At what age is the risk of developing a protein-induced enteropathy so low that feeding a foreign protein can be considered safe?
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Complementary Foods and the Development of Food Allergy

Berthold Koletzko, MD

PEDIATRICS Vol. 106 No. 5 Supplement November 2000, pp. 1285


The prevalence of allergic diseases in children is increasing in Western Europe and other developed countries. Allergic reactions to food components are of particular concern in infants and young children. In prospective studies the incidence of cows’ milk protein allergy in infancy has been estimated at about 2% to 3%. Allergic reactions are also frequently observed against egg white, fish, cereals, nuts, peanuts, and soybean and thus against complementary food products. In infants with documented allergy against complementary foods, the basic treatment is complete avoidance of the causal protein.
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Gastrointestinal Digestive and Absorptive Function

From a nutritional perspective, the gastrointestinal tract may be viewed as an organ of digestion and absorption, and the principal functions of each part; pregastric, gastric, small intestinal, pancreatic, hepatobiliary, and colonic, together operate in an integrated manner to assimilate complementary foods and transport nutrients across the intestinal mucosa. Intestinal motility and epithelial defense systems also play a part in this coordinated process, and a full understanding of the gut during weaning is a major challenge that can be addressed at all levels from molecular control to dietary balance. However, the relative importance of the functions of each part of the gut during the transition from milk-feeding to complementary diet is poorly understood, particularly in relation to the introduction of “new” nutrients, such as complex carbohydrates and nonhuman food proteins.
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Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants

Kathryn G Dewey, Roberta J Cohen, Kenneth H Brown and Leonardo Landa Rivera

American Journal of Clinical Nutrition, Vol. 69, No. 4, 679-686, April 1999


Background: The optimal age at which to introduce complementary foods is a topic of considerable debate.

This study was designed to evaluate this issue in a nutritionally vulnerable population in Honduras.

Design: Mothers of low-birth-weight (1500–2500 g) term (ie, small-for-gestational-age) infants were recruited in the hospital and assisted with exclusive breast-feeding during the first 4 mo. At 4 mo, mothers were randomly assigned to either continue exclusive breast-feeding to 6 mo (EBF; n = 59) or to feed complementary solid foods (jarred rice cereal, chicken, and fruit and vegetables) twice daily from 4 to 6 mo while continuing to breast-feed at their initial frequency (SF; n = 60).

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