Determinants of complementary feeding behaviour

Peer-reviewed | Manuscript received: March 03, 2015 | Revision accepted: January 27, 2016

Part 1: Review of European literature

Recommendations for timing the introduction of complementary food

The 2001 recommendation of the World Health Organization (WHO) to breastfeed exclusively until the end of the 6^th month of life [1] was supplemented in 2008 by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), which specified an optimum window for the introduction of complementary food¹: earliest at the beginning of the 5^th month (17^th week) and latest at the end of the 6^th month (26^th week) [2].

The Austrian and German recommendations for complementary feeding leave the ESPGHAN recommendations slightly open by also taking into account the individual development of the infant [3, 4]. However, the 2014 S3-Guideline on Allergy Prevention recommends introducing complementary food immediately after the end of the 4th month. From the perspective of allergy prevention, there is currently no verified evidence in support of an early introduction of complementary food before the 17^th week of life or a delayed introduction after the beginning of the 5^th month. Infants should be breastfed exclusively during the first 4 months of life [5]. According to a statement by the German Nationale Stillkommission (National Breastfeeding Committee), this disagreement in the recommendations leads to uncertainty for health professionals and parents. The National Breastfeeding Committee rejects the fixed timing for the introduction of complementary food as specified in the S3-Guideline on Allergy Prevention [6]. All organisations recommend that mothers continue breastfeeding along with the introduction of complementary food. Breastmilk and infant formula remain an important source of nutrients in the first year of life even after the introduction of complementary food [1–5].

Summary

The first two years of life are regarded as a “window of opportunity” to positively influence children’s health. As quality-assured nutritional information, national recommendations on complementary feeding should assist parents in providing their child with the best possible start in life. The question of what factors influence parental behaviour in relation to complementary feeding are examined in this study. Through research of the relevant literature, factors that influence unfavourable complementary feeding behaviour were identified, i.e. behaviour that deviates from the recommendations in the guidelines. The research focused primarily on European findings. In addition to level of education, a low socio-economic status and/or a migrant background were identified as primary risk factors for unfavourable complementary feeding behaviour.

Keywords: infant nutrition, complementary feeding, migration, socio-economic status, health behaviour

Full text PDF (free access)