Introduction of complementary foods in Sweden and impact of maternal education on feeding practices

Abstract

Objective: To describe the introduction of complementary foods in a population-based cohort in relation to recommendations and explore the possible impact of maternal education on infant feeding practices.

Design: Prospective data from the All Babies in Southeast Sweden (ABIS) cohort study were used. The ABIS study invited all infants born in south-east Sweden during October 1997-October 1999 (n 21 700) to participate. A questionnaire was completed for 16 022 infants. During the infants' first year parents continuously filed in a diary covering introduction of foods.

Setting: Sweden.

Subjects: Infants (n 9727) with completed food diaries.

Results: Potatoes, vegetables, fruits/berries and porridge were the foods first introduced, with a median introduction between 19 and 22 weeks, followed by introduction of meat, cow's milk, follow-on formula and sour milk/yoghurt between 24 and 27 weeks. Early introduction of any food, before 16 weeks, occurred for 27 % of the infants and was more common in infants of mothers with low education. Overall, potatoes (14·7 %), vegetables (11·1 %), fruits/berries (8·5 %), porridge (7·4 %) and follow-on formula (2·7 %) were the foods most frequently introduced early. The majority of infants (≥70 %) were introduced to potatoes, vegetables, fruits/berries and porridge during concurrent breast-feeding, but introduction during concurrent breast-feeding was less common in infants of mothers with low education.

Conclusions: Most infants were introduced to complementary foods timely in relation to recommendations. Low maternal education was associated with earlier introduction of complementary foods and less introduction during concurrent breast-feeding. Still, the results indicated exposure to fewer foods at 12 months in infants of mothers with low education.

Keywords: Breast-feeding; Complementary food; Education; Food diary; Infant feeding.

Fig. 1

Cumulative proportion of infants introduced to different foods and food groups and the proportion of infants being breast-fed during the first 12 months, All Babies in Southeast Sweden (ABIS) study (n 9727): , breast-feeding; , infant formula; , potatoes/vegetables/fruits/berries; , porridge; , meat; , milk/sour milk/yoghurt; , follow-on formula; , bread; , rice/pasta; , fish; , cheese; , sugar-containing foods; , eggs

Fig. 2

Percentage of children introduced to complementary foods during the first 12 months by maternal education, All Babies in Southeast Sweden (ABIS) study (n 9727): , low education; , intermediate education; , high education. Hatching shows percentage introduced to complementary foods during breast-feeding (at least 30 d overlap)

Fig. 3

Cumulative proportion of infants introduced to infant formula and follow-on formula and the proportion of infants being breast-fed during the first 12 months by maternal education, All Babies in Southeast Sweden (ABIS) study (n 9727): , infant formula, low education; , follow-on formula, low education; , breast-feeding, low education; , infant formula, intermediate education; , follow-on formula, intermediate education; , breast-feeding, intermediate education; , infant formula, high education; , follow-on formula, high education; , breast-feeding, high education. Differences in proportions breast-fed, introduced to infant formula and follow-on formula across categories of maternal education at age 4 and 6 months, respectively, were tested and were significant at both ages for all variables (P<0·001)

Fig. 4

Cumulative proportion of infants introduced to fish, eggs and milk products during the first 12 months by maternal education, All Babies in Southeast Sweden (ABIS) study (n 9727): , fish, low education; , eggs, low education; , milk/sour milk/yoghurt, low education; , fish, intermediate education; , eggs, intermediate education; , milk/sour milk/yoghurt, intermediate education; , fish, high education; , eggs, high education; , mil/sour milk/yoghurt, high education. Differences in proportions introduced to milk, eggs and fish across categories of maternal education at age 4 and 6 months, respectively, were tested and were significant at both ages for milk products and fish (P<0·001) but not for eggs (P>0·001)