Complementary foods Answers. Hans van Goudoever

Transcription

1 Sophia Children s Hospital Sophia Kinderziekenhuis Complementary foods Answers Hans van Goudoever j.vangoudoever@erasmusmc.nl

2 Sophia Children s Hospital Sophia Kinderziekenhuis 1. I am still breast feeding the baby, but it is hard since I want to get back to work. How long should I continue? WHO and ESPGHAN recommend exclusive breast feeding up to 6 months. It reduces gastro-intestinal infections, but not respiratory infections. (Kramer et al AJCN 2003) j.vangoudoever@erasmusmc.nl

3 Sophia Children s Hospital Sophia Kinderziekenhuis 2. My baby is growing good and is looking quite big already. When can I start with complementary feeding? j.vangoudoever@erasmusmc.nl

4 Introduction of complementary feedings in Sweden Cohort study of Swedish children (born ) (Brekke HK et al. BMJ 2005;94:377-82)

5 Which factors contribute to the timing of introduction Significant factors (p<0.001) Smoking mother 2 wks earlier Breast feeding up to 4 wks later Heavy infants Complementaryfoods 1 wk earlier Young mothers Complementaryfoods 1,5 wks earlier (Fewtrell MS et al. Arch Dis Child Fetal Neonatal Ed 2003;88:F )

6 When is complementary feeding introduced? (Fewtrell MS et al. Arch Dis Child Fetal Neonatal Ed 2003;88:F ) Human milk Formula milk

7 Sophia Children s Hospital Sophia Kinderziekenhuis 3. I am allergic. Should I avoid special products in the complementary foods? Agostoni,Desci, Fewtrell van Goudoever. JPGN 2008;46: j.vangoudoever@erasmusmc.nl

8 Timing of solid food introduction and atopy (Zutavern A et al. Pediatrics 2008;121:e44-52) LISA prospective birth cohort study group 3097 healthy germen newborns (*11/1997-1/1999) Questionnaires at 0.5, 1, 2, 4, and 6 years Physical examination and blood drawn at 2 and 6 years Analysis at 6 years Data of subgroup of 2073 children (67%) Higher parental education and fewer parental allergies Information on food and inhalant sensitization at 6 years for 1123 children Sophia Children s Hospital

9 Prevalence of doctor diagnosed atopy (Zutavern A et al. Pediatrics 2008;121:e44-52) Early (<6 mo) skin or allergic symptoms 795/2057 (38.5%) 1 st introduction of any solids 0-4 mo 32% 5-6 mo 49.3% >6 mo 18.8% Solids 4 mo No solid food 69.6% 1-2 groups 17.3% 3-8 groups 13.1% Sophia Children s Hospital

10 Solid food introduction and eczema prevalence (Zutavern A et al. Pediatrics 2008;121:e44-52) All children No early atopy Sophia Children s Hospital

11 Sophia Kinderziekenhuis Children s Hospital 3. Should I avoid special products in the complementary foods? There is no evidence that any specific food should be delayed, even not in high risk infants. The most effective dietary measure for prevention of allergic diseases is exclusive breast feeding for 4-6 months Agostoni,Desci, Fewtrell van Goudoever. JPGN 2008;46:99-110

12 Sophia Kinderziekenhuis Children s Hospital 4. What kind of drink should the baby get next to the complementary feeding? What are the risks of the different drinks? a. Continued breast feeding b. Infant formula or follow-on formula During complementary feeding period, >90% of the iron requirement of a breast-fed infant must be met by complementary foods. Cow s milk does not contain enough iron. Agostoni,Desci, Fewtrell van Goudoever. JPGN 2008;46:99-110

13 Sophia Children s Hospital Sophia Kinderziekenhuis 5. Do you think my baby will grow fat when I start complementary feeding now? j.vangoudoever@erasmusmc.nl

14 DIFS Weightgain (Forsyth JS et al. BMJ 1993;306:1572-6) 10 Compl feeds <8wk Weight[kg] Compl feeds 8-12wk Compl feeds >12 k Age [Weeks] Sophia Children s Hospital

15 Weight gain in comparison with the group receiving complementaryfeeding > 12 weeks 0,400 0,350 0,300 0,250 0,200 0,150 0,100 0,050 0,000-0,050-0,100 p<0,05 Compl feeds < 8. wks Compl feeds at 8-12 wks Compl feeds after 12 wks Age [Weeks] (Forsyth JS et al. BMJ 1993;306:1572-6) Sophia Children s Hospital

16 Does early complementaryfeeding protects against adiposity at age 7 yrs? (n=252) 0,1 0,05 P< ,05-0,1 solids >15 wks solids <15 wks -0,15-0,2-0,25 Bottle W-SDS Exl BF W-SDS Wilson CW et al. BMJ 1998;316:21-5 Sophia Children s Hospital

17 Does early complementary feeding protects against adiposity at age 7 yrs? (n=252) 19 18,5 18 P< , ,5 16 solids >15 wks solids <15 wks 15, ,5 bottle body fat% Excl BF body fat % Wilson CW et al. BMJ 1998;316:21-5 Sophia Children s Hospital

18 Conclusions: Sophia Children s Hospital Sophia Kinderziekenhuis 1. Exclusive breast feeding for about 6 months 2. No difference for breast or formula fed infants 3. Avoidance or delayed introduction of specific complementary foods does not reduce risks of allergies 4. After 6 months, human milk fed infants should get iron from complementary feeding 5. Cow s milk is a poor iron source j.vangoudoever@erasmusmc.nl