Complementary Feeding

Although breastfeeding accompanies many advantages to the health and general development of children, beyond the age of six months it is necessary to add complementary foods to provide enough nutrition to infants, and this transition is referred to as complementary feeding.^[1]

• Exclusive breastfeeding has the best long-term health effects and is associated with development of a healthy microbiome.^[1:1]

• Six months of exclusive breastfeeding is recommended for most children.^[1:2]

• Complementary foods are aimed to “supplement” continued breastfeeding with those nutrients whose intake has become limited or insufficient.^[1:3]

• Continued breastfeeding beyond six months contributes to the favorable colonization of the infant’s intestine, as it provides protective factors when complementary feeding begins.^[1:4]

• There is little data on the health effects of exclusive breastfeeding that is prolonged beyond the first 6 months, without the introduction of solid foods.^[1:5]

  • For example, in a prospective study between infants who were exclusively breastfed after the first 6 months of age and infants who were on a diet supplement after 6 months, there was a delay in the development of infants in the first group, who experienced a delay associated with inadequate energy intake and certain nutrients.^[1:6]

• Infant’s vitamin D, iron, zinc requirements cannot be met by breastfeeding alone.^[1:7]

• The risk of iron deficiency anemia at 6 months of age is increased by birth weight, male gender, and weight gain above the reference value from birth.

• Iron deficiency anemia is a major risk factor for long-term effects on motor, mental and social development in childhood.^[1:8]

• Rickets as a deficiency of vitamin D and a lack of zinc is observed in infants with nutritional deficiencies in complementary nutrition after 6 months.^[1:9]

• Breastfeeding can prevent the growth decline associated with the transition from exclusive breastfeeding to complementary feeding.^[1:10]

• An older study on the introduction of solids in infants, showed that compared to infants fed complementary foods <6 months under optimal feeding conditions, exclusively breastfed infants have similar developmental and morbidity outcomes.^[1:11]

• Infants who are exclusively breastfed for 6 months are less likely for incidence of gastrointestinal infection than those who are partially breastfed for 3 or 4 months.^[1:12]

• The introduction of food before the age of 4 months is not recommended.^[1:13]

• Infant nutrition can contribute to the development of islet autoimmunity.^[1:14]

• Exclusive breastfeeding and vitamin D supplementation in infancy are reported to provide a protection against beta cell autoimmunity and diabetes type 1.^[1:15]

• First exposure to cow milk proteins and cereals and high birth weight have been implicated as risk factors for diabetes type 1.^[1:16]

• Early food introduction can affect eating behavior in terms of eating preferences in the later life of the infant.^[1:17]

• Feeding difficulties have been observed in children who have undergone early solid food intake.^[1:18]

• There is an association between the introduction of root vegetables at the age of 4 months and type 1 diabetes, independently of the introduction of other nutrition and of some putative socio-demographic and perinatal confounding factors.^[1:19]

• Early introduction of potatoes and carrots in infancy was strongly related to advanced ß-cell autoimmunity.^[1:20]

  • The mean period of breastfeeding of those children was 1.4 months.^[1:21]

• There is a negative outcome of early introduction of solid foods on infants, on the development of obesity at the age of 3.^[1:22]

• In formula-fed infants who were never breastfed or who paused breastfeeding before the age of 4 months the intake of solids before the age of ≥4 months was linked with a sixfold increase in the risk of obesity later (3 years of age).^[1:23]

• Among infants who were breastfed for 4 months, the timing of the introduction of solid foods was not associated with obesity.^[1:24]

• The presence of fetal macrosomia, fetal musical education and cesarean delivery constitute risk factors for obesity in childhood.^[1:25]

• Furthermore, the introduction of solid foods before the age of 4 months was a major risk factor for obesity in childhood.^[1:26]

• Early introduction of solids in infants who were breastfeeding reduced the risk of peanut sensitization among infants with a parental history of allergies.^[1:27]

• Avoidance of food allergy through dietary manipulation remains challenge.^[1:28]

• Both early and late first exposure to any solid food predicted development of Type 1 diabetes.^[1:29]

• Early exposure to fruits and late exposure to rice or oat, predicted Type 1 diabetes.^[1:30]

• Breastfeeding at the time of exposure to wheat/barley remained protective against Type 1 diabetes.^[1:31]

• More breastfeeding months marginally decreased the risk for Type 1 diabetes.^[1:32]

• Early introduction of solid foods was associated with higher levels of total cholesterol levels in blood.^[1:33]

• Breastfeeding was not associated with childhood blood levels of lipids but was associated with higher C-peptide concentrations and insulin.^[1:34]