In addition to the recent guidelines on infant feeding from the American Academy of Pediatrics, a group of European experts has also issued updated guidelines on starting solid food in infancy. The expert panel’s recommendations are based on the same research as the AAP guidelines and they come to basically the same conclusions.
There are some important differences, however, between the two reports. The AAP report focuses on preventing allergic and atopic diseases (asthma, eczema, and allergies). The European report, however, looks at the effect of complementary food on overall nutrition, growth, development, and the prevention of disease, including atopic diseases but also other diseases as well. It is more complete and comprehensive. The report makes the same major changes in regards to the introduction of foods that commonly cause food allergies.
Recommendations from the report include:
- Exclusive breastfeeding for 6 months is a desirable goal. There is continued disagreement among experts and research data as to the optimal length of exclusive breastfeeding and the risks and benefits of starting solids before 6 months or at 6 months.
- Complementary feeding (solids and liquids other than breastmilk or formula) should not be introduced before 17 weeks of age and started not later than 26 weeks of age. Earlier or later introduction both associated with health problems and disease.
- It is advisable to include good sources of iron (meat) and fatty acids (fish) during complementary feeding period.
- There is no evidence that delaying foods that commonly cause food allergies reduces the risk of allergies. This is true of infants at higher risk due to family history as well as infants at normal risk. New foods should be introduced one at a time, several days apart.
- Most of the iron requirements of breastfed infants after 6 months of age must be met with complementary foods.
- Cow’s milk should not be the main source of milk before 12 months old, although infants may have a small amount before 12 months added to complementary foods.
- Gluten should be introduced after 4 months and before 7 months of age. Early and late introduction increases the risk of celiac disease, type 1 diabetes, and wheat allergy.
- Gluten should be introduced gradually while infant is breast-fed, which has been shown to further reduce the risk of these diseases.
- Infants and young children receiving a vegetarian diet should receive at least 500 mL of breastmilk or formula, and dairy products
- Infants and young children should not be fed a vegan diet.
These guidelines represent the very best information we have on the healthiest diet for infants, a diet which optimizes growth, development, and overall nutrition, and which helps prevent disease and other problems later in life.
ESPGHAN Committee on Nutrition. Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition. JPGN 46:99–110, 2008. dx.doi.org/10.1097/01.mpg.0000304464.60788.bd
Also available at: http://espghan.med.up.pt/position_papers/con_28.pdf
