Pediatric Nutrition in Practice

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

2