Complementary Foods 111
2
available iron such as meat, or supplements. The
most suitable strategy will vary with the circum-
stances; cow’s milk is a very poor source of iron,
and it is generally recommended that it should not
be used as the main drink before 12 months of age.
Salt and Sugar
High intakes of salt in infancy may be associated
with later higher blood pressure [6]. Further-
more, infants may become accustomed to a salty
taste, which could affect subsequent food prefer-
ences. Hence, salt should not be added to comple-
mentary foods. Sugar is associated with the devel-
opment of dental caries. Its use should be restrict-
ed, and good dental hygiene practices introduced
early.
Gluten
In contrast to data from previous observational
studies, the findings from two recent randomised
trials have shown that the age at introduction of
gluten does not influence the risk of developing
coeliac disease. Both trials also concluded that the
risk was not influenced by breastfeeding at the
time of introduction of gluten [7, 8].
Vegetarian Diets
If infants receive a vegetarian diet, it is important
that the diet includes a sufficient amount of milk
(about 500 ml/day) and dairy products. Vegan di-
ets should be discouraged in infancy, particularly
because of the risk of vitamin B 12 deficiency,
which can affect neurodevelopment.
Allergy
Certain foods, including egg, fish, nuts and sea-
food, are potentially allergenic. However, the evi-
dence that delaying the introduction of such
foods reduces the risk of developing food allergy
is not convincing. Allergy may be increased if sol-
ids are introduced before 3–4 months of age, but
also by delayed introduction of certain allergens
[9]. Furthermore, the exclusion of fish and eggs
from the diet could itself have undesirable nutri-
tional consequences.Taste and Food Acceptance
Children are predisposed to like high-energy
foods, to prefer sweet and salty tastes and to re-
ject new foods, but these predispositions may be
modified by early dietary experience and feed-
ing practices. A feeding style typified by emo-
tional warmth and responsiveness but high ex-
pectations for children’s dietary adequacy and
behaviour – accompanied by practices such as
parents leading by example, making fruit and
vegetables available within the home, moder-
ately restricting unhealthy alternative snack
foods and encouraging children to try vegeta-
bles and fruits – is associated with better con-
sumption in the childhood years [10]. Hence,
parents play an important role in establishing
good dietary habits.Conclusions- Complementary foods should not be intro-
duced 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 (mini-
mum 25% fat), and that the diet includes good
sources of protein, iron and zinc. Strategies
used to achieve this will vary with the environ-
ment - The complementary feeding period is impor-
tant for establishing good eating habits and
food preferences. Sugar and salt should not be
added to complementary foods
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