Breastfeeding and complementary foods

At about six months

or some years now the World Health Organization (WHO) has recognized the need to address the question of appropriate age of introduction of complementary foods. The 49th World Health Assembly (WHA) in its preamble and the unanimous acceptance of Resolution 3(1) in May 1996 underscores the importance of breastfeeding as the sole source of nutrition for infants up to the age of about six months. This important resolution re-affirms previous recommendations made in 1994 and 1990 (see box).

Thus the member states agreed unanimously to endorse infant feeding policies that would promote exclusive breastfeeding (with no other food or drink) for about six months, and the continuation of breastfeeding, with the addition of nutritious local family food from about six months to around 24 months. Moreover the marketing of complementary foods should not undermine the period of exclusive breastfeeding and continued breastfeeding.

Some recent scientific studies are showing that starting complementary foods at four months does not enhance infant growth and can be detrimental to the health and nutritional status of both the infant and mother.

What science says

I. Infant growth and nutrition

When complementary foods are introduced, breastmilk is replaced. Studies have shown that early introduction of complementary foods neither enhances growth nor the nutritional status of infants. Since breastfed infants self-regulate their intakes to meet their energy needs, there may be no advantage to introducing other foods before six months. Most complementary foods, especially commercial foods, do not have the nutritional density nor the bioavailability that human milk has.

A Honduran study ¹ of infants exclusively breastfed for four months compared infants who continued exclusive breastfeeding to six months to infants who were given complementary foods at four months with continued breastfeeding. Infants receiving solid foods significantly reduced their breastmilk intake. The researchers concluded that exclusive breastfeeding to six months of age can be recommended even in low-income populations of a developing country and that the advantages of exclusive breastfeeding to age six months outweigh the disadvantages.

II. Maternal health-child spacing

Delaying complementary feeding to about six months delays pregnancy and increases the health of both the mother and the infant.

The Lactational Amenorrhea Method (LAM)^2,3 of child spacing reduces the possibility of a subsequent pregnancy by 98% and remains the cheapest and most effective means of pregnancy suppression in most countries.

III. Exposure to pathogenic organisms

The early introduction of complementary foods increases the risks of diarrheal disease as well as respiratory illness. Two studies^4,5 show that the risk of diarrheal morbidity in poor populations is 3 to 13 times higher when breastfed infants are given complementary foods between four and six months than when they are exclusively breastfed.

IV. Risk of allergies

Delayed introduction of solid foods to about six months also reduces the risk of allergy development. When mothers ⁶ of newborns with a family history of atopic disease were encouraged to exclusively breastfeed for at least six months, incidence of atopic disease was reduced. The authors concluded that "prolonged breastfeeding...exerts a prophylactic effect."

V. Nutritional status

Although complementary foods do add nutrients to the infants intake, there is likely no gain as this is offset by losses from the reduced bioavailability of nutrients from breastmilk. Some may argue that maternal nutrition is at risk with exclusive breastfeeding, but the supplementation of the maternal diet in such cases is a less risky intervention than the use of complementary foods. Policy makers and position statements often site the need for iron as justification for starting of solid foods from four to six months. Again research supports optimal iron status for exclusively breastfed infants.⁷

References

1. Cohen, R.J. et al. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomized intervention study in Honduras. Lancet 343:283-293, 1995 Back

2. Kennedy, K. I. Visness, C.M. Contraceptive efficacy of lactational amenorrhea. Lancet 339:227-230, 1992 Back

3. Kennedy et al. Consensus Statement on the use of breastfeeding as a family planning method. Contraception 39:477-496, 1989 Back

4. Brown, H.K. et al. Infant feeding practices and their relationship with diarrheal and other diseases. Pediatrics, 83:31-40, 1989 Back

5. Popkin, B.M. et al. Breastfeeding and diarrheal morbidity. Pediatrics, 86:874-882, 1990 Back

6. Halken, S. et al. [Prevention of allergy in infants. A prospective study of 159 high-risk children.] Ugesk, Laeger, 156:308-312, 1994 Back

7. Piscane, A. et al. Iron status in breastfed infants. J. Pediatr 127:429-431, 1995 Back