2 Nutrition of Healthy Infants, Children and Adolescents
Key Words
Complementary feeding · Infant · Breastfeeding
Key Messages
- Complementary foods are defined by the WHO as
any food or liquid other than breast milk. However,
since many infants receive human milk substitutes
from the first weeks of life, other authorities have
suggested that the term ‘complementary foods’
should be applied to foods and liquids other than
breast milk or infant formulas - Complementary foods are required for nutritional
and developmental reasons. They should not be
introduced before 17 weeks of age, but all infants
should start complementary foods by 26 weeks of
age - It is important to ensure that complementary foods
provide adequate energy density (minimum 25%
fat), and that the diet includes good sources of pro-
tein, iron and zinc. Strategies used to achieve this
will vary in different environments
© 2015 S. Karger AG, Basel
Introduction
Complementary foods are defined by the WHO
as any food or liquid other than breast milk.
This definition means that infant formulas and
follow-on formulas (human milk substitutes,
HMS) are regarded as complementary foods,
which can be confusing, since many infants re-
ceive HMS from the first weeks of life. Other
authorities (European Society for Paediatric
Gastroenterology, Hepatology and Nutrition,
ESPGHAN [1] ) have suggested that the term
complementary food should be applied to foods
and liquids other than breast milk or infant for-
mulas.
Complementary foods are required during
the second part of the first year of life for both
nutritional and developmental reasons, and to
enable the transition from milk feeding to fam-
ily foods. From a nutritional point of view, the
ability of breast milk to continue to meet mac-
ro- and micronutrient requirements becomes
limited, whereas from a developmental per-
spective, infants develop the ability to chew and
start to show an interest in foods other than
milk.
Current WHO recommendations on the age
at which complementary foods should be intro-
duced are based on consideration of the optimal
duration of exclusive breastfeeding. However,
since HMS are defined by the WHO as comple-
mentary food, it is difficult to translate this rec-
ommendation to formula-fed infants. Following
a systematic review [2] and expert consultation
Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 109–112
DOI: 10.1159/000360327
2.4 Complementary Foods
Mary Fewtrell