Complementary feeding practices are debated among pediatricians, primarily regarding whether nutritional needs or developmental readiness should be prioritized in recommendations for starting complementary feeding. The aim of the present study was to analyze the timing of the start of complementary feeding and the related motivations with an 8-item online survey administered to active members of the Italian Society of Primary Care Pediatricians. The participation rate was 43.3% (350 of 808), and 213 (60.9%) and 137 (39.1%) of the participants chose items related to developmental readiness and nutritional needs, respectively, as the criteria for starting complementary feeding. Approximately 74% of the participants reported that they recommended starting complementary feeding between 5 and 6 months of age, 17% recommended starting before 5 months, and 8% recommended starting after 6 months. Predefined schemes were proposed by 38% of the participants, and a responsive feeding modality was proposed by 13%, while the majority (49%) recommended both modalities depending on family characteristics. Regarding recommendations based on nutritional needs, 89% of pediatricians reported providing indications concerning the quantity of meat consumed during the first year of life, and 91% reported recommending introducing added salt only after 12 months of age. Compared with pediatricians who emphasized developmental readiness, those who prioritized nutritional needs suggested earlier complementary feeding start and a higher use of predefined schemes and were more likely to make recommendations regarding meat quantity and added salt (p < 0.0001).
Conclusions: Pediatricians who used a developmental readiness criterion for starting complementary feeding may less frequently provide nutritional advice to parents, even if a trend to harmonize the different positions regarding complementary feeding start time is emerging.
|What is Known:|
• Pediatricians make suggestions for introducing complementary feeding based on scientific evidence, local traditions, and personal beliefs.
• Either infants’ nutritional needs or their developmental readiness currently is used as determinant for the timing of complementary feeding.
|What is New:|
• More than 60% of Italian pediatricians consider developmental readiness a priority for introducing complementary feeding.
• Pediatricians following the criterion of developmental readiness may less frequently give detailed nutritional advice.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
European Society for Paediatric Gastroenterology Hepatology and Nutrition
Good nutritional practice
Società Italiana delle Cure Primarie Pediatriche (Italian Society of Family Pediatricians)
World Health Organization
PAHO/WHO (2003) Pan American Health Organization, World Health Organization. Guiding principles for complementary feeding of the breastfed child. Available at www.who.int/nutrition/publications/guiding_principles_compfeeding_breastfed.pdf
WHO (2015) World Health Organization. Complementary feeding. Available at www.who.int/nutrition/topics/complementary_feeding/en
Fewtrell M, Bronsky J, Campoy C, Domellöf M, Embleton N, Fidler Mis N, Hojsak I, Hulst JM, Indrio F, Lapillonne A, Molgaard C (2017) Complementary feeding: a position paper by the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition. JPGN. 64:119–132. https://doi.org/10.1097/MPG.0000000000001454
EFSA NDA Panel (EFSA Panel on Dietetic Products, Nutrition and Allergies) (2013) Scientific opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA J 11:3408
Ministero della Salute. Corretta alimentazione ed educazione nutrizionale della prima infanzia F.A.Q. http://www.salute.gov.it/imgs/c_17_pubblicazioni_2520_allegato.pdf
Società Italiana di Nutrizione Umana. Livelli di Assunzione di Riferimento di Nutrienti ed Energia per la Popolazione Italiana; Società Italiana di Nutrizione Umana: Milano, Italy, 2012
Calamaro CJ (2000) Infant nutrition in the first year of life: tradition or science? Pediatr Nurs 26:211–215
Zuccotti GV, Cassatella C, Morelli A, Cucugliato MC, Catinello G, del Balzo V, Guidarelli L, Agostoni C, Mameli C, Troiano E, Bedogni G (2014 Aug 8) Nutrient intake in Italian infants and toddlers from North and South Italy: the Nutrintake 636 study. Nutrients. 6(8):3169–3186. https://doi.org/10.3390/nu6083169
Daniels L, Mallan KM, Fildes A, Wilson J (2015) The timing of solid introduction in an ‘obesogenic’ environment: a narrative review of the evidence and methodological issues. Aust NZ J Public Health 39:366–373. https://doi.org/10.1111/1753-6405.12376
Weber M, Grote V, Closa-Monasterolo R, Escribano J, Langhendries JP, Dain E, Giovannini M, Verduci E, Gruszfeld D, Socha P, Koletzko B; European Childhood Obesity Trial Study Group. European Childhood Obesity Trial Study Group. Lower protein content in infant formula reduces BMI and obesity risk at school age: follow-up of a randomized trial. Am J Clin Nutr 2014;99:1041–1051. doi: https://doi.org/10.3945/ajcn.113.064071
Robinson SM, Marriott LD, Crozier SR, Harvey NC, Gale CR, Inskip HM, Baird J, Law CM, Godfrey KM, Cooper C, Southampton Women’s Survey Study Group (2009) Variations in infant feeding practice are associated with body composition in childhood: a prospective cohort study. J Clin Endocrinol Metab 94:2799–2805. https://doi.org/10.1210/jc.2009-0030
Manno CJ, Fox C, Eicher PS, Kerwin MS (2005) Early oral motor interventions for pediatric feeding problems: what, when and how. JEIBI 2:145–159
Alvisi P, Brusa S, Alboresi S, Amarri S, Bottau P, Cavagni G, Corradini B, Landi L, Loroni L, Marani M, Osti IM, Povesi-Dascola C, Caffarelli C, Valeriani L, Agostoni C (2015) Recommendation on complementary feeding in healthy full-term infants. Ital J Pediatr 41:36. https://doi.org/10.1186/s13052-015-0143-5
Butte N, Cobb K, Dwyer J, Graney L, Heird W, Rickard K (2004) American Dietetic Association; Gerber Products Company. The start healthy feeding guidelines for infants and toddlers. J Am Diet Assoc 104:442–454. https://doi.org/10.1016/j.jada.2004.01.027
Cameron SL, Heath A-LM, Taylor RW (2012) How feasible is baby-led weaning as an approach to infant feeding? A review of the evidence. Nutrients 4:1575–1609. https://doi.org/10.3390/nu4111575
Fox MK (2006) Relationship between portion size and energy intake among infants and toddlers: evidence of self-regulation. J Am Diet Assoc 106(1 Suppl 1):S77–S83. https://doi.org/10.1016/j.jada.2005.09.039
DiSantis KI, Hodges EA, Johnson SL, Fisher JO (2011) The role of responsive feeding in overweight during infancy and toddlerhood: a systematic review. Int J Obes 35:480–492. https://doi.org/10.1038/ijo.2011.3
Carruth BR, Skinner JD (2002) Feeding behaviors and other motor development in healthy children (2-24 months). J Am Coll Nutr 21:88–96. https://doi.org/10.1080/07315724.2002.10719199
Birch LL, Doub AE (2014) Learning to eat: birth to age 2 y. Am J Clin Nutr 99:723S–728S. https://doi.org/10.3945/ajcn.113.069047
Corsello G, Ferrara P, Chiamenti G, Nigri L, Campanozzi A, Pettoello-Mantovani M (2016) The child health care system in Italy. J Pediatr 177S:S116–S126. https://doi.org/10.1016/j.jpeds.2016.04.048
Giovannini M, Banderali G, Radaelli G, Carmine V, Riva E, Agostoni C (2003) Monitoring breastfeeding rates in Italy: national surveys 1995 and 1999. Acta Paediatr 92:357–363. https://doi.org/10.1080/08035250310009301
Giovannini M, Riva E, Banderali G, Scaglioni S, Veehof SH, Sala M, Radaelli G, Agostoni C (2004) Feeding practices of infants through the first year of life in Italy. Acta Paediatr 93:492–497. https://doi.org/10.1080/08035250410025591
Williams Erickson L, Taylor RW, Haszard JJ, Fleming EA, Daniels L, Morison BJ, Leong C, Fangupo LJ, Wheeler BJ, Taylor BJ, Te Morenga L, McLean RM, Heath AM (2018) Impact of a modified version of baby-led weaning on infant food and nutrient intakes: the BLISS randomized controlled trial. Nutrients. 10:740. https://doi.org/10.3390/nu10060740
Liem DG (2017) Infants’ and children’s salt taste perception and liking: a review. Nutrients 9(9):pii: E1011. https://doi.org/10.3390/nu9091011
Rowan H, Lee M, Brown A (2019) Differences in dietary composition between infants introduced to complementary foods using baby-led weaning and traditional spoon feeding. J Hum Nutr Diet 32:11–20. https://doi.org/10.1111/jhn.12616
Morison BJ, Taylor RW, Haszard JJ, Schramm CJ, Williams Erickson L, Fangupo LJ, Fleming EA, Luciano A, Heath AL (2016) How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6-8 months. BMJ Open 6:e010665. https://doi.org/10.1136/bmjopen-2015-010665
Savage JS, Birch LL, Marini M, Anzman-Frasca S, Paul IM (2016) Effect of the INSIGHT responsive parenting intervention on rapid infant weight gain and overweight status at age 1 year: a randomized clinical trial. JAMA Pediatr 170:742–749. https://doi.org/10.1001/jamapediatrics.2016.0445
Paul IM, Savage JS, Anzman-Frasca S, Marini ME, Beiler JS, Hess LB, Loken E, Birch LL (2018) Effect of a responsive parenting educational intervention on childhood weight outcomes at 3 years of age: the INSIGHT randomized clinical trial. JAMA 320:461–468. https://doi.org/10.1001/jama.2018.9432
Cameron S, Taylor RW, Heath ALM (2013) Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviors in a survey on New Zealand families. BMJ Open 3:e003946. https://doi.org/10.1136/bmjopen-2013-003946
Metbulut AP, Özmert EN, Teksam O, Yurdakök K (2018) A comparison between the feeding practices of parents and grandparents. Eur J Pediatr 177:1785–1794. https://doi.org/10.1007/s00431-018-3244-5
Canziani BC, Uestuener P, Fossali EF, Lava SAG, Bianchetti MG, Agostoni C, Milani GP (2018) Clinical practice: nausea and vomiting in acute gastroenteritis: physiopathology and management. Eur J Pediatr 177(1):1–5. https://doi.org/10.1007/s00431-017-3006-9
The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.
Conflict of interest
The authors declare that they have no conflict of interest.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Communicated by Mario Bianchetti
About this article
Cite this article
Brambilla, P., Giussani, M., Picca, M. et al. Do the opinions of pediatricians influence their recommendations on complementary feeding? Preliminary results. Eur J Pediatr (2019). https://doi.org/10.1007/s00431-019-03548-9
- Nutritional advice
- Responsive feeding
- Developmental readiness
- Salt consumption