EFSA update: ‘No single age to introduce infant complementary feeding’

By Will Chu

- Last updated on GMT

The European Food Safety Authority (EFSA) says there is no single age to introduce complementary infant feeding in Europe, citing individual characteristics and development as deciding factors.

The Authority’s latest findings​ point to a lack of convincing evidence linking complementary food (CF) introduction with adverse health effects or benefits in infants less than one month to six months.

“For nutritional reasons, the majority of infants need CFs from around six months of age,”​ EFSA says.

“Infants at risk of iron depletion (exclusively breastfed infants born to mothers with low iron status,) may benefit from earlier introduction of CFs that are a source of iron.

“The earliest developmental skills relevant for consuming pureed CFs can be observed between 3 and 4 months of age. Skills for consuming finger foods can be observed in some infants at 4 months, but more commonly at 5–7 months.

In summing up, EFSA adds that while an infant may be ready from a neurodevelopmental perspective to progress to a more diversified diet before 6 months of age, it does not imply that there is a need to introduce CFs.

“There is no reason to postpone the introduction of potentially allergenic foods (egg, cereals, fish and peanut) to a later age than that of other CFs as far as the risk of developing atopic diseases is concerned. Regarding the risk of coeliac disease, gluten can be introduced with other CFs.”

2009 Opinion update

The Authority’s latest findings are an update to its Scientific Opinion of 2009, in which it recommends cereal‐based food and baby food must not be given to babies less than four months of age.

EFSA’s Panel on Nutrition, Novel Foods and Food Allergens (NDA) added that introducing complementary food for healthy term infants in the European Union (EU) between the age of 4 and 6 months was safe and did not pose a risk of adverse health effects.

The NDA Panel also pointed out that “available data on the risk of coeliac disease and type 1 diabetes mellitus (T1DM) also support the timing of the introduction of gluten‐containing food (preferably while still breastfeeding) not later than 6 months of age”.

In explaining the need for CFs for infants, the Panel points to a general agreement amongst scientists that breast milk does not contain sufficient vitamin D to prevent rickets in the breastfed infant.

The Panel explains that the vitamin D content of breast milk is not a determinant for the need to introduce CFs, because infants in the EU are routinely supplemented with vitamin D.

Additionally, B vitamins, iodine, selenium and fatty acids concentrations in breast milk are influenced by current maternal intake and in well‐nourished populations, not determinants to introduce CFs.

However, the report highlights literature that show exclusively breastfed infants following a strict vegan diet without taking supplements may exhibit cobalamin deficiency symptoms.

“The Panel concludes that exclusive breastfeeding is nutritionally adequate up to 6 months for the majority of healthy infants born at term from healthy well‐nourished mothers,”​ the Opinion states.

“However, some infants at risk of iron depletion may benefit from the introduction of CFs that are a source of iron, before 6 months of age in addition to breastfeeding.”

Broad consensus

EFSA’s latest statement falls in line with the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) on complementary feeding, gluten introduction and coeliac disease risk.

The Society’s main conclusions were that “complementary foods (solids and liquids other than breast milk or infant formula) should not be introduced before 4 months but should not be delayed beyond 6 months”.

Regarding the age of introduction of allergenic foods, their main conclusions were that “allergenic foods may be introduced when complementary food is commenced any time after 4 months”.

In addition, ESPGHAN considered that “infants at high risk of peanut allergy […] should have peanut introduced between 4 and 11 months, following evaluation by an appropriate trained specialist,​” and “gluten may be introduced between 4 and 12 months”.

ESPGHAN said, “Although breastfeeding should be promoted for its other well‐established health benefits, neither any breastfeeding nor breastfeeding during gluten introduction has been shown to reduce the risk of coeliac disease”.

Similarly, The World Health Organization (WHO) report on Feeding and Nutrition of Infants and Young Children concluded that “complementary foods should be introduced at about 6 months of age. Some infants may need complementary foods earlier, but not before 4 months of age”.

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