ESPGHAN Position Paper on Complementary Feeding

The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition has prepared a position paper on the complementary feeding of healthy, full term infants living in industrialised countries like Europe, during the first year of life .

Complementary foods are defined as all solid and liquid foods other than breast milk, infant formula and follow on formula. This differs from the World Health Organisation’s (WHO) definition where complementary foods include all foods other than breast milk (in order to promote breast feeding).   ESPGHAN did not include infant formula and follow on formula in their definition of complementary foods believing it was confusing, as many infants in industrialized countries are fed infant formula from birth.

Some of the conclusions are:-

• Aim to exclusively breast feed for about 6 months
• Complementary foods should not be given before 17 weeks and no later than 26 weeks, the exact timing depending on the infant’s nutritional and developmental needs.  This contrasts with the WHO recommendation of not introducing complementary foods till 6 months of age.  It should be noted that the WHO recommendation applies only to population groups of infants exclusively breast fed.  It does, however, acknowledge that not all mothers will be able to nor want to breast feed exclusively for 6 months.  The ESPGHAN committee decided to adopt the 17 week to 26 week time frame of introducing solids because it felt the scientific evidence on which the WHO recommendation was based was limited and at odds with current practise in many  industrialized countries.
• By around 4 months of age, the infant’s gastrointestinal and renal systems are mature enough to handle complementary foods. Lumpy foods should be introduced by 10 months to avoid difficulties in introducing them later.
• Cows milk should not be the main milk drink till after 12 months as it is low in iron. Small amounts can be used on other foods
• The scientific evidence is unconvincing that delaying the introduction of potentially allergic foods will reduce allergies in those at risk or those not at risk. Introduce foods one at a time to allow detection of reactions to individual foods.
• Avoid introducing gluten before 17 weeks and after 26 weeks. Give small amounts  gradually between 17 weeks and 26 weeks  while breast feeding as this  may reduce coeliac disease, type 1 diabetes and wheat allergy
• Vegan diets are unsuitable for infants

• Vegetarian infants need at least 500ml of breast milk or infant formula and dairy products daily

Reference

Agostini C, Decsi T, Fewtrell M  et al. Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition.  J Pediatr Gastroenterol Nutr 2008;46(1):99-110