Lactation Consultant Support from Late Pregnancy with an Educational Intervention at 4 Months of Age Delays the Introduction of Complementary Foods in a Randomized Controlled Trial

Abstract

Background: Although the WHO recommends that complementary feeding in infants should begin at 6 mo of age, it often begins before this in developed countries.

Objective: Our objective was to determine whether lactation consultant (LC) support, with educational resources given at 4-mo postpartum, can delay the introduction of complementary foods until around 6 mo of age.

Methods: A total of 802 mother-infant pairs were recruited from the single maternity hospital serving Dunedin, New Zealand (59% response rate) and randomly assigned to the following: 1) usual care (control group); 2) infant sleep education intervention (Sleep); 3) food, activity, and breastfeeding intervention (FAB); or 4) combination (both) intervention (Combo). Certified LCs delivered 3 intervention sessions (late pregnancy and 1-wk and 4-mo postpartum). The 4-mo contact used educational resources focused on developmental readiness for complementary foods. Age when complementary foods were introduced was obtained from repeated interviews (monthly from 3- to 27-wk postpartum).

Results: A total of 49.5% and 87.2% of infants received complementary foods before 5 and 6 mo of age, respectively. There was evidence of group differences in the number of infants introduced to complementary foods before 5 mo (P = 0.006), with those receiving support and resources (FAB and Combo groups combined; 55.6%) more likely to wait until at least 5 mo compared with controls (control and Sleep groups combined; 43.3%) (OR: 1.52; 95% CI: 1.08, 2.16). However, there was no evidence they were more likely to wait until 6 mo of age (P = 0.52). Higher maternal age, higher parity, and a less positive attitude toward breastfeeding were positively associated, and drinking alcohol during pregnancy was negatively associated, with later age of introduction of complementary foods.

Conclusions: Providing an LC and educational resources at 4-mo postpartum to predominantly well-educated, mainly European, women can delay the introduction of complementary foods until 5 mo of age, but not until the WHO recommendation of 6 mo. This trial was registered at clinicaltrials.gov as NCT00892983.

Keywords: 6 months of age; World Health Organization; complementary feeding; lactation consultant; randomized controlled trial.