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WHO guideline for complementary feeding of infants and young children 6–23 months of age

This is a summary of the following report: WHO (2023) WHO Guideline for complementary feeding of infants and young children 6–23 months of age.

 

The World Health Organization (WHO) has recently released a comprehensive guideline for the complementary feeding of infants and young children aged 6–23 months. Acknowledging the importance of appropriate complementary feeding in the early stages of life, this guideline provides 7 evidence-based recommendations to optimise the nutrition and health of this critical age group, whether they are breastfed or not.

First, the guideline stresses the importance of initiating complementary feeding for infants aged 6 months while continuing breastfeeding for up to 2 years or beyond. To achieve this, all breastfeeding women will require an enabling and supportive environment.

“Exclusive breastfeeding for the first 6 months remains a crucial recommendation.”

Second, it recommends that, for infants aged 6–11 months who are fed milks other than breastmilk, either milk formula or animal milk is appropriate. For young children aged 12–23 months, animal milk should be used and follow-up formulas are not recommended.

Third, the appropriate age for introduction of complementary foods is six months, while continuing to breastfeed, and mothers who are concerned about the adequacy of breast milk alone could benefit from lactation support.

Fourth, daily consumption of animal-source foods – meat, fish, or eggs – is recommended. Moreover, when animal-source foods were excluded from infant and young child diets for children aged six to eight months, nutrient needs in terms of iron, zinc, and vitamin B12 could not be met. Additionally, fruits and vegetables should be included in the daily diet. Frequent consumption of pulses, nuts, and seeds is also encouraged, especially where meat, fish, eggs, and vegetables are limited. The guideline underscores the importance of nutrient-dense foods over less nutritious starchy staple foods. Diversification of the diet is a key aspect of feeding to meet the nutritional needs of the growing child. 

Fifth, infants and young children should avoid unhealthy foods and beverages high in sugar, salt, trans fats, and non-sugar sweeteners, including sugar-sweetened beverages. Fruit juices should also be limited. Broad policy actions – including in regard to agriculture, front-of-package labelling, and marketing practices – are essential, and caregivers require counselling on the harms of unhealthy foods and beverages.

Sixth, in contexts where diverse, nutrient-rich complementary foods are not accessible, nutrient supplements and fortified food products can address gaps in children's nutrition. Multiple micronutrient powders, fortification of commercial cereals, and small-quantity lipid-based nutrient supplements are options, with guidance emphasising their supplementary nature – i.e., these products are not substitutes for a diverse, minimally processed diet. The guideline holds back from recommending fortified milk.

Seventh, the role of responsive feeding, through recognising and responding to the child’s hunger and feeding cues, is critical. This approach fosters a positive feeding environment, encouraging healthy eating habits, preventing overfeeding or underfeeding, and supporting cognitive, emotional, and social development.

To support the implementation of this guideline, WHO emphasises the need for education and awareness programmes targeting caregivers, healthcare professionals, and communities. Nevertheless, more studies with consistent research protocols across diverse regions and populations are needed. Most topics examined lacked robust, randomized controlled trials.
This guideline contributes to the global effort to improve child nutrition and support healthy growth and development. The guideline's practical recommendations and adaptability to various contexts make it a valuable tool for healthcare providers, policymakers, and caregivers worldwide. 

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WHO guideline for complementary feeding of infants and young children 6–23 months of age. Field Exchange 72, April 2024. www.ennonline.net/fex/72/who-guideline-for-complementary-feeding-of-infants-and-young-children

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