The Introduction of Complementary Feeding

BSNA members recognise that current NHS start4life weaning recommendations are that weaning or complementing feeding should start ‘around’ 6 months, alongside breast milk or infant formula, and once an infant is displaying the signs of developmental readiness.[1]  

Baby foods are labelled so that parents can decide when it’s right to start complementary feeding within a timeframe that is safe and nutritionally appropriate.  We believe the best time to introduce complementary foods is when babies are showing the signs of developmental readiness.

UK legislation, as set out in EU Regulations[2], recognises that baby foods can be fed from 4-6 months and requires that where companies offer products for infants from 4-6 months, the following statement on pack is consistently included: ‘Breastfeeding is recommended for the first 6 months of life. Please speak with a healthcare professional before introducing solid foods.’

In 2009 the European Food Safety Authority (EFSA) Panel concluded that introducing complementary food into the diet of healthy term infants, between the age of 4 and 6 months, is safe and does not pose a risk for adverse health effects – both in the short-term, including infections and delayed or excessive weight gain, and possible long-term effects such as allergy and obesity.[3] On 17 April 2019, EFSA published a draft Scientific Opinion for consultation regarding the introduction of complementary feeding into an infant’s diet. This is an extensive European opinion which has assessed the latest scientific evidence base.

In this it states that: ‘According to EFSA’s findings, data do not allow for the determination of a precise age at which complementary foods should be introduced to all infants in Europe. According to EFSA, the appropriate age depends on the individual’s characteristics and developments (in particular in pre-term infants). In most infants, this age is between about 3-4 months and around 6 months.’

Professional bodies, including the British Society for Allergy and Clinical Immunology (BSACI), support the inclusion of allergens from 4 months alongside other foods and in 2018, the UK’s Scientific Advisory Committee on Nutrition (SACN), recommended that there should be some flexibility in the advice around the introduction of complementary feeding, but that it should not be introduced before 17 weeks of age.[4]

A recent review by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) also states that ‘allergenic foods may be introduced when complementary food is commenced any time after 4 months’.[5] This view is supported by Allergy UK and BSACI.

We always recommend that parents speak with a healthcare professional before introducing solid foods and we ensure that the presence of any allergens is clearly indicated on all baby food labels. 

 

The position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition states:3

  • Gastrointestinal and renal functions are sufficiently mature by approximately 4 months (17 weeks, beginning of the 5th month) to enable term infants to process complementary foods, and by 4 to 6 months (26 weeks, beginning of the 7th month) they will have attained the necessary motor skills to cope safely with complementary foods.
  • It is important for developmental and nutritional reasons to give age-appropriate foods of the correct consistency and by a method appropriate for the infant's age and development.
  • Exclusive breastfeeding by a healthy mother can meet the nutrient requirements of healthy-term infants for most nutrients for approximately 6 months, although the lack of evidence from random control trials means that it is not certain whether this applies to all mothers and infants. Some infants may require additional energy or iron before 6 months.
  • More prolonged exclusive breast feeding may be associated with a reduced risk of gastrointestinal and respiratory infections, and hospitalization for infections, including for infants living in high-income countries.
  • There may be an increased risk of allergy if solids are introduced before 3 to 4 months. There is, however, no evidence that delaying the introduction of allergenic foods beyond 4 months reduces the risk of allergy, either for infants in the general population or for those with a family history of atopy.
  • Infants at high risk of peanut allergy (those with severe eczema, egg allergy, or both as defined in the LEAP study) should have peanut introduced between 4 and 11 months, following evaluation by an appropriately trained professional.
  • The timing of the introduction of complementary foods at 4 or 6 months has not been shown to influence growth or adiposity during infancy or early childhood, although introduction before 4 months may be associated with increased later adiposity.


The British Society for Allergy and Clinical Immunology (BSACI) advice is to introduce complementary foods (solids) – including foods known to cause food allergies – alongside continued breastfeeding, from around 6 months of age (but not before 4 months).  Excluding egg and peanut from your baby’s diet may increase their risk of food allergy.[6]

Allergy UK state that there is no evidence to support delaying the introduction of foods, which are more commonly associated with food allergies, beyond six months of age. Delaying their introduction past 12 months may actually increase a child’s risk of developing an allergy to that food.[7]

 


References

[1] NHS start4life. What is weaning? Available at: https://www.nhs.uk/start4life/weaning

[2] Commission Directive 2006/125/EC of 5 December 2006 on processed cereal-based foods and baby foods for infants and young children

[3] European Food Safety Authority (EFSA). Scientific Opinion on the appropriate age for introduction of complementary feeding of infants. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). (2009) 7(12): 1423

[4] Scientific Advisory Committee on Nutrition (SACN) (2018) Feeding in the first year of life. (p5)

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/725530/SACN_report_on_Feeding_in_the_First_Year_of_Life.pdfn

[5] Fewtrell M, Bronsky J, Campoy C et al (2017) Complementary Feeding: A Position Paper by the

European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. JPGN 64(1):p119-132

[6] The British Society for Allergy and Clinical Immunology (BSACI). Preventing food allergy in your baby: A summary for parents. May 2018. Available at: https://www.bsaci.org/pdf/Infant-feeding-and-allergy-prevention-PARENTS-FINAL-booklet.pdf

[7] AllergyUK. Your quick guide to weaning… Weaning – introducing your baby to solid foods. Available at: https://www.allergyuk.org/assets/000/002/342/Weaning_%E2%80%93_Introducing_your_baby_to_solids_original.pdf?1547805087