title: ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence?
abstract: Since 2002, the World Health Organization and many governments and professional associations have recommended exclusive breastfeeding for 6 months followed by complementary feeding (giving solid foods alongside breast milk) as optimal infant feeding practice. Several articles have been published challenging this recommendation. Arguably, the most influential has been the 2008 commentary of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition, which recommended that complementary foods should be introduced to all infants between 17 and 26 weeks. We challenge the validity of ESPGHAN's position, questioning the adequacy of the literature search, the interpretation and evidence used to reach their conclusions and the balance of an approach that focuses on disease prevention, with scant consideration of growth and neuromotor development. We contend that ESPGHAN's position should be understood as an expert opinion that may be influenced by conflicts of interest. In our view, the ESPGHAN position paper is not evidence based and does not justify a change of the current public health recommendation for 6 months of exclusive breastfeeding. At an individual level, health professionals should understand that developmental readiness for starting solid foods has an age range like other developmental milestones; that fewer infants will probably be ready to start complementary feeding before, rather than after, 6 months; and that their role is to equip parents with the confidence and skills to recognise the signs of developmental readiness. This empowerment process for infants and parents should be preferred over the prescriptive ESPGHAN approach.
authors: Health Services Research, Epidemiology and International Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. cattaneo@burlo.trieste.it
authors: Adriano
authors: A
authors: Cattaneo
authors: Carol
authors: C
authors: Williams
authors: Carmen Rosa
authors: CR
authors: Pallás-Alonso
authors: Maria Teresa
authors: MT
authors: Hernández-Aguilar
authors: Juan José
authors: JJ
authors: Lasarte-Velillas
authors: Leonardo
authors: L
authors: Landa-Rivera
authors: Elien
authors: E
authors: Rouw
authors: Mónica
authors: M
authors: Pina
authors: Alessandro
authors: A
authors: Volta
authors: Anne Marie
authors: AM
authors: Oudesluys-Murphy
mesh_terms: D001942:Breast Feeding; D055317:Evidence-Based Practice; D006801:Humans; D007223:Infant; D007225:Infant Food; D007227:Infant Nutritional Physiological Phenomena; D008895:Milk, Human; D009752:Nutritional Status; D011634:Public Health; D015203:Reproducibility of Results; D014944:World Health Organization