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Do the opinions of pediatricians influence their recommendations on complementary feeding? Preliminary results


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.

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Baby-led weaning


Complementary feeding


Developmental readiness


European Society for Paediatric Gastroenterology Hepatology and Nutrition


Good nutritional practice


Nutritional needs


Responsive feeding


Società Italiana delle Cure Primarie Pediatriche (Italian Society of Family Pediatricians)


World Health Organization


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Author information




Concept of the manuscript: P.B. and C.A.

Study conduction: M.G., M.P., G.B., P.B.

Statistical analysis: R.B.

Drafting of the manuscript: P.B.

Critical revision of the study and manuscript: G.P.M. and C.A.

Final manuscript: all authors have approved the final draft as submitted.

Corresponding author

Correspondence to Carlo Agostoni.

Ethics declarations

The study has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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The authors declare that they have no conflict of interest.

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Communicated by Mario Bianchetti

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Brambilla, P., Giussani, M., Picca, M. et al. Do the opinions of pediatricians influence their recommendations on complementary feeding? Preliminary results. Eur J Pediatr 179, 627–634 (2020).

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  • Prevention
  • Nutritional advice
  • Responsive feeding
  • Developmental readiness
  • Salt consumption