Introduction of complementary feeding for infants: a dilemma for parents and caregivers

Abstract

Data are scarce with respect to infant iron status, but at least in developing country settings where newborn iron stores may be suboptimal, exclusive breastfeeding without iron supplementation through 6 months may compromise hematologic status (WHO 2002). Our objective was to systematically review the scientific literature regarding iron and hematologic status among infants breastfed exclusively to 6 months, stratified by developed versus developing countries.MethodsAn electronic search of the MEDLINE database was conducted for studies of iron deficiency (ID) and (IDA) in infants exclusively breastfed in developed and developing countries. Prevalence estimates were calculated as weighted averages, and compared using a 2‐sided test of proportions.ResultsTwenty nine observational studies and three of eight RCTs met the inclusion criteria. All RCTs were conducted in developing countries. The prevalence estimates for healthy exclusively breastfed infants living in developed (n=769) and developing (n=642) countries, respectively, was 21.9% and 14.1% for ID (p = 0.0001), and 12.2% and 18.2% (p= 0.0019).ConclusionA substantial proportion of exclusively breastfed infants develop ID, IDA, and compromise hematologic status in both developed and developing countries. Data to support the current recommendation of solid commencement at six months is limited regarding irons status. Larger randomized controlled trials, perhaps in multi centre design, are needed to investigate the advantages and disadvantages of introduction of solids before and after six months of age.