II. Complementary feeding: a critical window of opportunity from six months onwards

Abstract

This paper aims to propose evidence-based, paediatric food-based dietary guidelines on the complementary feeding period, from six to 24 months, of South Africa. A growing body of evidence supports the World Health Organization recommendation that, following six months of exclusive breastfeeding, appropriate and adequate complementary foods should be introduced, with continued breastfeeding for up to two years of age and beyond. A literature search was done by searching electronic databases (PubMed, the Cochrane Library and Sabinet) and hand searching key reference lists from January 2004 to April 2012, including studies published prior to 2004. Relevant international and national documents from normative bodies, global health and infant feeding authorities, professional and scientific societies and government were identified. It has been established that, in South Africa, high levels of stunting, growing concerns about overweight and obesity and the poor intake of certain micronutrients in the critical six- to 24-month period are, in part, a consequence of poor breastfeeding and complementary feeding practices, as well as the poor quality of the complementary diet. The introduction of semi-solid foods before four months of age is a common practice. The typical maize-based feeding pattern is low in food sourced from animals, vegetables and fruit and omega-3 fatty acids. Efforts by mothers to improve the quality of their children’s diets by adding energy-rich food to maize meal improves energy intake, but not micronutrient intake. Low nutrient-dense liquid, such as tea and coffee, energy-dense sugar-sweetened drinks, an excessive intake of fruit juice and high-fat and salty snacks exacerbate poor nutrient intake and displace nutrient-dense food in the diet. Healthcare workers should provide consistent, evidence-based messages and guidelines to caregivers of future generations. Interventions must be implemented and strengthened at a programme level. These could include nutrition education to improve caregiver practices, the use of high-quality, locally available foods, the use of enriched complementary foods, and exceptional support of food-insecure populations.