Complementary feeding is pivotal in developing infants and young children aged 6-23 months as they transition from breast milk or formula to solid foods. Typically, six months is fundamental for establishing healthy eating habits and ensuring optimal growth and nutrition.
This guideline offers evidence-based recommendations for complementary feeding, whether the child is breastfed or not, to promote healthy growth, avoid nutrient deficiencies, and support overall well-being.
Recommendations 1
► Breastfeeding and Milks
Recommendation 1: Extended Breastfeeding
Breastfeeding should be encouraged to continue for up to two years or beyond. To achieve this, we must create a supportive environment, which includes:
- Providing services such as onsite daycare, workplace breastfeeding rooms, and flexible work schedules to facilitate working mothers.
- Ensuring universal access to breastfeeding counseling services for addressing any concerns and challenges.
- Protecting pregnant women, mothers, families, and healthcare workers from the influence of exploitative marketing by manufacturers and distributors of breastmilk substitutes.
- Equipping healthcare providers with the necessary knowledge and skills to offer evidence-based care and support for breastfeeding mothers.
Recommendation 2: Age-Appropriate Milk
Milk options for infants aged 6-11 months who are not breastfed include milk formula or animal milk. Animal milk is recommended over follow-up formulas for young children aged 12-23 months not receiving breast milk. Emphasis should be placed on safe storage and handling practices, with full-fat milk being the choice for infants aged 6-11 months.
Recommendation 3: Diverse Dairy Products
Dairy products, including liquid animal milks, should be incorporated into a child’s diet. They are vital in ensuring nutritional adequacy, especially for non-breastfed children when other animal-source foods are limited. Recommended types of animal milks include pasteurized animal milk, reconstituted evaporated milk, fermented milk, and yogurt. Flavored or sweetened kinds of milk are discouraged.
► Age of Introduction of Complementary Foods
Recommendation 4: Timely Introduction
Infants should be introduced to complementary foods at 6 months, while continuing to breastfeed. This public health recommendation acknowledges that some infants, especially those at risk of iron deficiency, might benefit from earlier introduction, with the provision of lactation support when necessary.
Recommendation 5: Consideration for Iron Deficiency
Recognizing the bioavailability of iron in breast milk and addressing the risk of iron deficiency is essential, particularly in preterm or low birthweight infants. Even if non-fortified, early introduction of complementary foods is insufficient to prevent iron deficiency anemia in high-risk populations.
► Dietary Diversity
Recommendation 6: Diverse Nutrient Sources
Infants and children aged 6-23 months should consume a diverse diet. This diversity includes:
- Daily consumption of animal source foods such as meat, fish, or eggs.
- Daily intake of fruits and vegetables.
- Frequent consumption of pulses, nuts, and seeds, particularly when meat, fish, eggs, and vegetables are limited in the diet. These foods are essential for maintaining a nutrient-dense diet, while starchy staple foods should be minimized.
Recommendation 7: Prioritizing Nutrient Quality
When using cereal grains, whole grains should be favored over refined ones, as they provide higher quality proteins and essential nutrients such as iron, zinc, and Vitamin B12. Care should be taken to prepare pulses, nuts, and seeds in forms that do not pose choking hazards.
► Avoidance of Unhealthy Foods and Beverages
Recommendation 8: Avoiding Unhealthy Choices
Children should be protected from unhealthy foods high in sugar, salt, and trans fats. Consumption of sugar-sweetened beverages and non-sugar sweeteners should be discouraged. Furthermore, 100% fruit juice intake should be limited to prevent excessive sugar consumption. Public awareness and caregiver counseling about these foods’ short- and long-term consequences are crucial.
► Nutrient Supplements and Fortified Food Products
Recommendation 9: Nutrient Supplements
Children aged 6-23 months may benefit from nutrient supplements or fortified food products when nutrient requirements cannot be met with unfortified foods alone.These options include:
- Multiple micronutrient powders (MNPs) provide essential vitamins and minerals without replacing other foods.
- Fortification of commercial cereal grain-based complementary foods and blended flours, although consumption should not be encouraged.
- Small quantity lipid-based nutrient supplements (SQ-LNS) for populations facing significant nutritional deficiencies.
- It’s essential to emphasize that these products should not replace a diverse diet of healthy and minimally processed foods.
► Responsive Feeding
Recommendation 10: Encouraging Autonomy
Responsive feeding practices should be implemented, encouraging children aged 6-23 months to eat autonomously and in response to their physiological and developmental needs. This practice supports self-regulation in eating and fosters cognitive, emotional, and social development.
This intervention will require health care workers and others to guide caregivers and families. Caregivers need the time and resources to be present while young children eat or self-feed, minimizing food loss during self-feeding.
Future Implications
The recommended complementary feeding of infants and young children aged 6-23 months carries significant future implications. Firstly, adherence to these guidelines is expected to yield substantial health benefits for children, influencing their overall growth, cognitive development, and long-term well-being. As these guidelines become more widely adopted, they are likely to shape early dietary habits, instill healthier choices from a young age and reduce the risk of nutrition-related issues in later life. Furthermore, these recommendations will necessitate policy development and revisions to align with best practices, impacting food labeling, marketing, and caregiver education. Ongoing research may improve nutrient solutions, particularly in regions with limited resources. Healthcare providers and caregivers will require enhanced education to support young children better, ensuring the successful implementation of these guidelines. Globally, these recommendations promise to have a far-reaching influence on child nutrition and public health, fostering a healthier future for generations to come.
Conclusion
These evidence-based recommendations for complementary feeding provide caregivers, healthcare professionals, and policymakers with a comprehensive guide to promote optimal growth and nutrition in infants and young children aged 6-23 months. By ensuring the continuation of breastfeeding, introducing a diverse diet, avoiding unhealthy choices, considering nutrient supplements, and implementing responsive feeding practices, we can set the stage for lifelong healthy eating habits. These recommendations underscore the importance of creating supportive environments, caregiver education, and healthcare provider expertise to secure a healthy future for our children.
References
- Complementary Feeding of Infants and Young Children 6-23 Months of Age Guideline Summary [Internet]. Guideline Central. [published on 2023 Oct 13]. Available from: https://www.guidelinecentral.com/guideline/3304206/
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