Pediatric Feeding Recommendations Need Reevaluation
Jessica Tomaszewski, MD
Nemours duPont Pediatrics
Tomaszewski J. Pediatric feeding recommendations need reevaluation. Pediatrics Consultant. Published online October 7, 2020.
Samady W, Campbell E, Aktas ON, et al. Recommendations on complementary food introduction among pediatric practitioners. JAMA Netw Open. 2020;3(8):e2013070. doi:10.1001/jamanetworkopen.2020.13070
Solid food introduction is recommended by the American Academy of Pediatrics1 (AAP) and the Centers for Disease Control and Prevention2 (CDC) starting at 6 months of age. The organizations also recommend waiting 3 to 5 days between the introduction of new complementary foods for infants aged 4 to 11 months. Newer literature, though, suggests that a diverse diet in the first year of life reduces risks of atopy, among other benefits. With this possible discordancy in mind, Dr Samady and colleagues3 examined results from a survey to determine which guidance pediatric practitioners are actually providers to families.
The survey on complementary food introduction among infants was sent electronically to 2215 physicians, resident physicians, and nurse practitioners who provide care to infants. The main outcome measure was recommendations on age of food introduction and waiting periods between initiation of new foods.
The final analysis included 563 surveys. Overall, 38.6% (217 practitioners) recommended waiting 3 days or longer between food introduction, 19.9% (112 practitioners) recommended waiting 2 days, and 27.4% (154 practitioners) recommended waiting 1 day.
There was also significant variation in when to initiate complimentary foods—47.6% (268 practitioners) recommended food introduction at 6 months for exclusively breastfed infants, 34.3% (193 practitioners) recommended food introduction at 6 months for non-exclusively breastfed infants, 31.8% (179 practitioners) recommended food introduction at 4 months for exclusively breastfed infants, and 42.5% (239 practitioners) recommended starting foods at 4 months for non-exclusively breastfed infants. More than half of respondents (310 practitioners, 55.1%) identified a need for additional training in the area of complementary food introduction.
The results of this study seem to indicate that a large percentage of providers are not following the AAP’s recommendations to wait 3 days or longer between introducing new foods. This may be due to several reasons, including limitations on infant food diversity and early allergen introduction. It also may reflect the lack of data that supports the current model of recommendations. It does seem prudent to reevaluate these guidelines and educate pediatric practitioners in this central tenet of pediatric primary care.
- Infant Food and Feeding. American Academy of Pediatrics. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/HALF-Implementation-Guide/Age-Specific-Content/Pages/Infant-Food-and-Feeding.aspx
- When, What, and How to Introduce Solid Foods. Centers for Disease Control and Prevention. Reviewed October 17, 2019. https://www.cdc.gov/nutrition/infantandtoddlernutrition/foods-and-drinks/when-to-introduce-solid-foods.html
- Samady W, Campbell E, Aktas ON, et al. Recommendations on complementary food introduction among pediatric practitioners. JAMA Netw Open. 2020;3(8):e2013070. doi:10.1001/jamanetworkopen.2020.13070