[Guideline Summary] BDA Policy Statement on Complementary Feeding

Background:

The British Dietetic Association (BDA) updated its policy statement on complementary feeding in 2013, to provide advice for healthcare professionals on the introduction of solid food to both healthy and preterm infants.
 

Summary of BDA recommendations:

Continue breastfeeding throughout complementary feeding

• Breastfeeding mothers need appropriate nutritional advice including advice on vitamin D supplementation

Timing of introduction of solid food

• Each infant should be managed individually according to their developmental rates.
• For healthy infants: should commence no later than 6 months (26 weeks) of age, but not before 4 months (17 weeks) of age.
• For preterm infants: may delay until after 3 months from their estimated date of delivery (EDD).

Nutrient supplementation

• Breastfed infants whose mothers did not take vitamin D supplements throughout pregnancy could be given vitamin drops with vitamin D from the age of 1 month.
• All children aged from 6 months onwards should be given a supplement that contains vitamins A, C and D, unless they are drinking 500 mL of infant formula (has vitamins added) a day.
• Young children may continue to be given vitamin supplements until they are 5 years old.

Support to parents

• Parents should be given appropriate advice to ensure that all infants are fed safely and are receiving a nutritionally adequate diet.

Current debate and emerging evidence on complementary feeding:

The current debate on the duration of exclusive breastfeeding, age of introduction of complementary foods mainly focused on the potential health benefits and risk of micronutrient deficiency in infants, etc.

Table 1. Policy statements of different authorities

1. WHO. The optimal duration of exclusive breastfeeding: report on an expert consultation. 2001.
2. ESPGHAN Committee on Nutrition. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. 2008.
3. EFSA. Scientific opinion on the appropriate age for introduction of complementary of infants. 2009.
    

Important notice:
The World Health Organization (WHO*) has recommended that pregnant women and new mothers be informed on the benefits and superiority of breast-feeding – in particular the fact that it provides the best nutrition and protection from illness for babies.
Mothers should be given guidance on the preparation for, and maintenance of, lactation, with special emphasis on the importance of a well-balanced diet both during pregnancy and after delivery. Unnecessary introduction of partial formula feeding or other foods and drinks should be discouraged since it will have a negative effect on breast-feeding. Similarly, mothers should be warned of the difficulty of reversing a decision not to breast-feed.
Before advising a mother to use an infant formula, she should be advised of the social and financial implications of her decision: for example, if a baby is exclusively formula-fed, more than 400g per week will be needed, so the family circumstances and costs should be kept in mind. Mothers should be reminded that breast-milk is not only the best, but also the most economical food for babies. If a decision to use an infant formula is taken, it is important to give instructions on correct preparation methods, emphasizing that unboiled water, unsterilized bottles or incorrect dilution can all lead to illness.
*See: International Code of Marketing of Breast Milk Substitutes, adopted by the World Health Assembly in Resolution WHA 34.22, May 1981.

Reference

The British Dietetic Association. Complementary feeding: introduction of solid food to an infant’s diet. April 2013.

WYE-EM-004-JAN-15