Exclusive breastfeeding should continue till an infant is 4 to 6 months old, says paediatric gastroenterologist Dr Christina Ong, who presented on the topic of complementary feeding during a symposium organized by the Singapore Paediatric Society and supported by FrieslandCampina Institute. Complementary feeding should not be introduced before 4 months of age and should not be delayed beyond 6 months old. Additionally, complementary foods should comprise of a wide variety of flavours and textures.
Timing to initiate complementary feeding
The World Health Organization recommends complementary foods be given in addition to breast milk from 6 months onwards (1). Both the Singapore Health Promotion Board and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPHGAN) recommends for nutritionally adequate and safe complementary foods to be introduced no later than 6 months but not before 4 months, to meet the evolving nutritional requirements of the infants (2,3).
Pointers for initiating complementary feeding (4-6)
- Ensure the following criteria are met before introducing complementary foods:
- Physiological: renal and gastrointestinal function should be mature and ready to metabolize nutrients from complementary foods by the age of 4 months.
- Neurodevelopmental: introduction of solid foods should be delayed until the infant is able to sit with support, and has good head and neck control.
- Parents and caregivers can modify their infant’s innate preferences
- Repeated exposure may be necessary
- Early exposure to the taste of certain vegetables enhance the infant’s liking of such vegetables for up to 6 years
- Wider variety of vegetables consumed during complementary feeding led to a wider variety of vegetables consumed at 6 years of age
Dr Ong recommended to avoid the following foods in complementary feeding
- Salt and sugar before 1 year of age
- Uncooked foods
- Unpasteurized milk products
- Honey before 1 year of age because of the risk of infant botulinum due to heat resistant spores of Clostridium botulinum
- Fish with high levels of mercury like shark, swordfish, marlin, tuna, king mackerel, orange roughy, yellowback seabream and dash-and-dot goatfish
- Food that can easily be a choking hazard such as:
- Small and hard pieces of food (e.g. nuts, and grapes)
- Crunchy or hard foods (e.g. uncooked vegetables)
- Fish and meat with bones
- Fruits with seeds
- Sticky rice
- World Health Organization. Complementary feeding. Available at https://www.who.int/nutrition/topics/complementary_feeding/en/
- Fewtrell M., et al. Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. Journal of Paediatric Gastroenterology and Nutrition 2017;64(1);119-32.
- The Sale of Infant Foods Ethics Committee Singapore (SIFECS) Code of Ethics. 5th Available at https://www.hpb.gov.sg/docs/default-source/default-document-library/5th-edition-of-the-sifecs-code_as-of-020119.pdf?sfvrsn=8249c572_2
- Remy E., et al. Repeated exposure of infants at complementary feeding to a vegetable puree increases acceptance as effectively as flavor-flavor learning and more effectively than flavor-nutrient learning. J Nutr 2013;143(7):1194-200.
- Pediatric Nutrition, 7th ed, Kleinman RE, Greer FR (Eds), AAP Elk Grove Village, IL 2014. p.123.
- Beauchamp GK, Moran M. Dietary experience and sweet taste preference in human infants. Appetite 1982;3(2):139-52.
Breastfeeding is the best nutrition for healthy growth and development of babies. Exclusive breastfeeding for six months is the optimal way of feeding infants. Thereafter infants should receive complementary foods with continued breastfeeding up to two years or beyond. Mothers should receive guidance on proper maternal nutrition in order to help sustain an adequate supply and quality of breast milk. Unnecessary introduction of bottle-feeding, partially or fully, or of other complementary foods and drinks may have a negative impact on breastfeeding, which may be irreversible. Mothers should consult their doctor and consider the social and financial implications before deciding to use breast milk substitutes or if they have difficulty breastfeeding. Usage, preparation and storage instructions of breast milk substitutes or of other complementary foods and drinks should be followed carefully as improper or unnecessary use may pose a health hazard.