Complementary feeding "at about six months"
Mother breastfeeding her toddler
Photo: WHO/M. Crozel
Although breastfeeding rates are improving in many parts of the world,
exclusive breastfeeding for the first six months remains elusive. In Canada,
many communities are reaching new levels of breastfeeding initiation, some
well into the 90 per cent level, yet by 4 months many infants are receiving
foods or liquids in addition to breastmilk.
The introduction of solid foods sometime during the second half of the
first year for healthy full term infants has become a topic of considerable
discussion. Although the World Health Assembly Resolutions1
clearly recommend a gradual introduction "at about six months", Canada's
infant feeding position statement,2 drafted
by Health Canada, the Dietitians of Canada and the Canadian Paediatric
Society remains controversial in its suggestion to "introduce complementary
feeding at 4 to 6 months."
Canada's Statement claims to be based on available scientific evidence
and in the absence of "evidence" on accepted practice, yet little or no
evidence is cited to support the early introduction. No doubt the close
links between the Canadian Paediatric Society (CPS) and the infant foods
industry as demonstrated by the CPS endorsements of Heinz infant food
promotions (e.g. Starting Right) is instrumental in facilitating
unsubstantiated policies.
The Statement cites the common misconception that "complementary foods
should be introduced at this time to meet the energy and nutrient needs
which are no longer met by breastmilk." How valid is the belief that at 4 to
6 months the infant's energy requirement somehow outstrips the ability of
breastmilk to deliver adequate nutrients and energy? In fact the flexibility
of milk production in response to demand makes the argument of "outgrowing
energy supply" rather pointless.
Exclusive breastfeeding can adequately meet an infant's needs to about
six months.
Full term infants, aged 4 to 6 months with appropriate weight-for-age
require approximately 95 to 100 kcal/kg/day or 650 to 700 kcal/day. Infants
fed breastmilk exclusively consume the equivalent of about 600 to 700
kcal/day (FAO/WHO/UNU)3 recommended intakes
are based on healthy infants from affluent countries and includes a 5%
addition to cover any underestimation of breastmilk intake (others such as
Butte4 do not add in the 5% and have lower
recommendations of about 600 to 650kcal/day). It is after 6 months that a
theoretical gap begins to appear between the energy derived from exclusive
breastfeeding and the recommended requirements. At age 6 to 8 months this is
estimated to be about 270 kcal/day and increasing to 750 kcal during the
second year.
However, at the crucial growth period between 4 to 6 months, more than
energy is needed. When complementary foods are introduced at this time it is
important to note that the quantity and frequency of added feeds will
negatively impact on breastmilk intake. The question must be asked what is
the nutritional value of the foods replacing breastmilk?
Typical commercially prepared cereals and jarred baby foods are labelled
and marketed for early introduction. Product descriptions use terms such as
"starter foods" and "first foods" with no recommended age of introduction.
Since commercial cereals are promoted as the initial foods, a detailed look
at an infant cereal composition shows:
hydrolyzed rice cereal, rice flour, skim milk, skim milk powder (not
all products contain cow's milk), palm olein (oil), coconut oil,
milk fat, soybean oil, soy lecithin, ferrous fumarate (some products
contain elemental iron filings), thiamine mononitrate, riboflavin,
niacinamide.
The product recommended serving size of 5 tablespoons and 3 fl oz of
water will provide:
Energy -- 127kcal
CHO -- 19 g (76 kcal)
Protein -- 4 g (16 kcal)
Fat -- 3.9 g ( 35 kcal).
The skim milk, if present, is redundant and contravene's Canada's
Statement of no cow's milk before nine months of age.
The 3 added vitamins provide from 50 - 100 % of the recommended daily
intake (rdi) and are readily met by breastmilk.
One serving claims to provide 60% of iron rdi, yet research shows a very
low rate of absorption from infant cereals.
If at 4 months an infant's caloric needs are 600 to 700 kcal and about
130 kcal (20 per cent) are replaced with commercial cereal, important
nutrient deficiencies can occur.
- lower intakes of essential fatty acids, DHA and AA,
- lower levels of B vitamins not added to the commercial product,
- added iron has low bioavailability,5
interferes with lactoferrin and upsets normal mineral ratios,
- less than optimal amino acid patterns.
Also:
- reduced intakes of important immunological constituents,
- reduced digestibility and absorption,
- risks reduction in milk supply and earlier cessation of breastfeeding,
- the inclusion of cow's milk proteins in a cereal based commercial
complementary food presents additional problems,
- recent research from Australia (see Abstracts page 7) indicates that
exclusive breastfeeding should be continued for at least 4 months to
significantly reduce the incidence of childhood asthma,
- for the mother, early introduction of solids reduces the amount of
time she is amenorrheic.
|
