Abstract
BackgroundThe early introduction of solid foods before 4 months of age has been associated with an increased risk of diarrhoea in infancy and a greater risk of wheeze and increased percentage body fat and weight in childhood. The purpose of this study was to identify the level of compliance with national recommendations related to the timing of the introduction of solid foods and to describe the maternal and infant characteristics associated with the timing of the introduction of solids.MethodsSubjects were 519 participants in the second longitudinal Perth Infant Feeding Study (PIFS II) recruited from two maternity hospitals in Perth, Western Australia in 2002/3. Data collected prior to, or shortly after discharge from hospital, and at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum included timing of the introduction of solid foods and a variety of maternal and infant characteristics associated with the introduction of solid foods. Multivariate logistic regression was used to identify those factors associated with the risk of introducing solid foods early, which for the purposes of this study was defined as being before 17 weeks.ResultsThe median age of introduction of solid foods was 17.6 weeks. In total, 44% of infants had received solids before 17 weeks and 93% of infants had received their first solids before 26 weeks of age. The strongest independent predictors of the early introduction of solids were young maternal age, mother smoking prior to pregnancy and not fully breastfeeding at 4 weeks postpartum. In general, mothers introduced solids earlier than recommended because they perceived their baby to either need them or be ready for them.ConclusionThis study showed a high level of non-compliance among Australian mothers with the infant feeding recommendation related to the timing of solids that was current at the time. In order to improve compliance health professionals need to be aware of those groups least likely to comply with recommendations and their reasons for non-compliance. Infant feeding recommendations need to be evidence-based, uniformly supported by professionals and widely, clearly and consistently articulated if higher rates of compliance are to be achieved in the future.
Highlights
The early introduction of solid foods before 4 months of age has been associated with an increased risk of diarrhoea in infancy and a greater risk of wheeze and increased percentage body fat and weight in childhood
The current World Health Organization (WHO) infant feeding recommendations have the primary aim of reducing morbidity in developing countries [1] and are based on the findings of a systematic review [2], which concluded that there was no significant difference in growth between infants exclusively breastfed for 3-4 months versus 6 months and that later introduction of solids was associated with reduced gastrointestinal infection as reported in a Belarusian study [3]
Following the release of the current WHO infant feeding recommendations the National Health and Medical Research Council of Australia, in recognition that there is some need to accommodate individual variation, recommended in 2003 that "Exclusive breastfeeding until around six months should be the aim for every infant"[11] More recently in 2008, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Nutrition Committee recommended that "complementary feeding should not be introduced before 17 weeks and not later than 26 weeks"[12]
Summary
The early introduction of solid foods before 4 months of age has been associated with an increased risk of diarrhoea in infancy and a greater risk of wheeze and increased percentage body fat and weight in childhood. While the early introduction of solids before 4 months of age has been associated in industrialised populations with an increased risk of diarrhoea in infancy [4] and a greater risk of wheeze and increased percentage body fat and weight in childhood [5], there is considerable debate [68] as to whether sufficient evidence exists to support the change from the earlier WHO recommendation [9] that solids be introduced after the 4th month but before the 6th month of life. At each interview information was collected on infant feeding practices including breastfeeding, the use of infant formula and the introduction of complementary foods including other fluids and solid foods
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