New Resources

Complementary Feeding of Young Children in Developing Countries

--UNICEF, U of California, Davis, ORSTOM. WHO, Geneva, 1998

Over 500 scientific articles are reviewed to “develop scientifically sound feeding recommendations and appropriate intervention programmes to epitomize children’s dietary intake and enhance their nutritional status.” This excellent review focuses in particular on the needs of children in low-income settings and is also relevant in industrialized countries.

Some interesting observations about the importance of breastfeeding and the appropriate age of introduction of complementary foods.

• Avoids displacement of breastmilk by other foods and fluids. Other foods and fluids are at a nutritional disadvantage. Even when frequency of feeding is maintained, the caloric intake from breastmilk is decreased. The nutrient density of cereal-based foods is far lower than breastmilk (e.g., vitamin A, riboflavin, and calcium). Thus even when the energy need is met, the nutritional intake may be compromised.
• In both the developing countries and the developed countries, the introduction of complementary foods leads to an early cessation of breastfeeding.
• Introduction of other foods leads to an early return of maternal fertility. The decreased sucking has a negative impact on the suppression of ovulation.
• Bioavailability of key nutrients is interfered with when other foods are introduced, e.g., iron and zinc.
• An infant’s energy needs does not “outstrip” the mother’s milk supply. Rather it is the introduction of other foods that affect and reduce the breastmilk supply.
• Growth rates of fully breastfed infants are similar in developing and developed countries. No studies showed a growth advantage of complementary feeding prior to the age of six months.
• The risk of developing diarrhoeal disease in poor countries is 3 to 13 per cent higher when breastfed infants are given complementary foods between 4 to 6 months compared to those exclusively breastfed for that time.

Evidence for the ten steps to successful breastfeeding

Family and Reproductive Health
Division of Child Health and Development
WHO, Geneva, 1998

The “Ten Steps to Successful Breastfeeding” are the basis for the Baby-Friendly Hospital Initiative and the Innocenti Declaration. This interesting and informative document not only reviews the scientific basis for the Ten Steps but also lays out the policies and practices for its implementation.

Making the Ten Steps real has been a major stumbling block for Canadian hospitals. Satisfying the need for evidence when important changes are made, this document will most certainly be of major assistance for those wanting the BFHI designation for their institutions.

Interesting research is cited. On the need for strong breastfeeding policies, the US hospital research by Reiff and Essock-Vitale is quoted. This shows routine educational and support programmes to be inadequate without policies to limit the use of a single brand infant formula used by the hospital. Although 66 per cent of mothers had indicated a desire to exclusively breastfeed prior to delivery, when interviewed at two weeks, only 23 per cent were breastfeeding without formula supplements. Interestingly 93 per cent of mothers supplementing knew the hospital brand and 88 per cent were using it.

Copies available from INFACT Canada.