Adherence to complementary feeding recommendations for infants and implications for public health

Abstract

Objective: The current study investigates (i) the extent to which breast-feeding and non-breast-feeding mothers follow the Canadian Nutrition for Healthy Term Infants (NHTI) recommendations; (ii) the first complementary foods given and the differences by breast-feeding status; (iii) whether any breast-feeding is associated with earlier introduction to complementary foods relative to non-breast-feeding, after controlling for potentially confounding factors; and (iv) the need for improvements in timing and resources of interventions by examining breast-feeding rates over time and information sources used by mothers.

Design: Longitudinal data from the Kingston, Frontenac, and Lennox & Addington (KFL&A) Infant Feeding Survey were used. Mothers completed a survey at the end of their hospital stay and were interviewed by telephone at 2, 4, 6 and 12 months thereafter.

Setting: The study took place in the KFL&A region of Ontario, Canada.

Subjects: The sample consisted of 325 mothers who gave birth to a live infant of at least 36 weeks' gestation and a birth weight of at least 1500 g at Kingston General Hospital between January and July of 2008.

Results: Four in five mothers introduced complementary foods prior to 6 months. Mothers not breast-feeding at 6 months introduced water, juice, infant cereals, fruit and vegetables, and foods not recommended by Canada's Food Guide sooner than breast-feeding mothers. Breast-feeding mothers were more likely to introduce milks appropriately, but had low adherence to giving their infants vitamin D supplements.

Conclusions: To support adherence to NHTI recommendations, interventions should be conducted during early infancy and deliver consistent, evidence-based recommendations.

Keywords: Breast-feeding; Complementary food; Infant; Infant feeding; NHTI recommendations; Public health.

Fig. 1

Distribution of infant age at which liquids only (), solids only (), and either liquids or solids () were first introduced; Kingston, Frontenac, and Lennox & Addington (KFL&A) Infant Feeding Survey, Ontario, Canada, 2008

Fig. 2

First introduction to complementary foods by breast-feeding (BF) status (, BF; , non-BF) at 6 months; Kingston, Frontenac, and Lennox & Addington (KFL&A) Infant Feeding Survey, Ontario, Canada, 2008. Data are presented as box-and-whisker plots in which the large circle indicates the median age at first introduction; the left and right edge of the box represent the 25th and 75th percentile, respectively (i.e. interquartile range); the left and right whisker represent the minimum and maximum age at first introduction, respectively; and small dots indicate the outliers. Non-BF includes mothers who were not breast-feeding when infant was 6 months old and BF includes mothers who were breast-feeding to any extent (‘any breast-feeding’) when infant was 6 months old. Significant difference between groups: *P<0·05, ***P<0·001

Fig. 3

Breast-feeding trends during the first 6 months after birth (, exclusive breast-feeding from birth; , any breast-feeding); Kingston, Frontenac, and Lennox & Addington (KFL&A) Infant Feeding Survey, Ontario, Canada, 2008