Optimal nutritional care of young children requires application of feeding guidelines based on scientific knowledge of children's nutrient requirements and the ability of breastmilk and other foods to satisfy these nutritional needs. This paper reviews recent information on the appropriate duration of exclusive breastfeeding and timing of introduction of complementary foods; the relationship between frequency of feeding, dietary energy density, and total daily energy consumption; and the importance of nutrient composition and selected organoleptic characteristics of complementary foods as determinants of dietary intake. The role of child appetite is also discussed Finally, programmatic options for the promotion of enhanced complementary feeding and relevant practical experiences in Peru are reviewed.
References
1.
WaterlowJ.C.Observations on the suckling's dilemma -a personal view. J Hum Nutr1981; 35: 85–98.
2.
UnderwoodB.A., HofvanderY.Appropriate timing for complementary feeding of the breast-fed infant. Acta Paediatr Scand1982; Suppl 294: 1–32.
3.
UnderwoodB.A.Weaning practices in deprived environment: the weaning dilemma. Pediatrics1985; 75(suppl): 194–8.
4.
RowlandM.G.M.The weanling's dilemma: are we making progress?Acta Paediatr Scand1986; 323: 3342.
5.
LutterC.Recommended length of exclusive breast feeding, age of introduction of complementary foods, and the weanling dilemma. (WHO/CDD/EDP/92.5).Geneva: WHO, 1992.
6.
World Health Organization.Energy and protein requirements: report of a joint FAO/WHO/UNU expert consultation. Technical Report Series 724.Geneva: WHO, 1985.
7.
ButteN.F., GarzaC., SmithE.O., NicholsB.L.Human milk intake and growth in exclusively breast fed infants. J Pediatr1984; 104: 187–95.
8.
ButteN.F., SmithE.O., GarzaC.Energy utilization of breastfed and formula-fed infants. Am J Clin Nutr1990; 51: 350–8.
9.
HeinigM.J., NommsenL.A., PeersonJ.M., LonnerdalB., DeweyK.G.Energy and protein intakes of breastfed and formula-fed infants during the first year of life and their association with growth velocity: the DARLING study. Am J Clin Nutr1993; 58: 152–61.
10.
DeweyK.G., PeersonJ.M., BrownK.H., KrebsO.F., MichaelsonK.F., PerssonL.A., SalmenperaL., WhiteheadR.G., YeungD.L., WHO Working Group on Infant Growth. Growth of breastfed infants deviates from current reference data: a pooled analysis of US, Canadian, and European data sets. Pediatrics1995; 96: 495503.
11.
DeweyK.G., LonnerdalB.Infant self-regulation of breast milk intake. Acta Pediatr Scand1986; 75: 893–8.
12.
DeweyK.G., HeinigM.J., NommsenL.A., LonnerdalB.Maternal vs infant factors related to breast milk intake and residual milk volume: the DARLING study. Pediatrics1991; 87: 829–37.
13.
DeweyK.G., HeinigM.J., NommsenL.A., PeersonJ.M., LonnerdalB.Growth patterns of breastfed and formulafed infants in the DARLING study: relationships to growth velocity, morbidity and activity levels. Pediatrics1992; 89: 1035–41.
14.
DeweyK.G., HeinigM.J., Nommsen-RiversL.A.Differences in morbidity between breastfed and formula-fed infants. J Pediatr1995; 126(5 Pt 1): 696–702.
15.
CohenR.J., BrownK.H., CanahuatiJ., RiveraL.L., DeweyK.G.Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake and growth: a randomized intervention study in Honduras. Lancet1994; 344: 288–93.
16.
BrownK.H., BlackR.E., Lopez de RomanaG., KanashiroH.C.Infant-feeding practices and their relationship with diarrhea! and other diseases in Huascar (Lima), Peru. Pediatrics1989; 83: 31–40.
DeweyK.G., CohenR.J., Landa RiveraL., CanahuatiJ., BrownK.H.Does delaying the introduction of complementary foods until six months affect appetite, food acceptance, or growth of breastfed infants from 6–12 months in a low-income Honduran population?FASEB J1994; 8: A4049.
19.
BrownK., PeersonJ., KanashiroH., Lopez de RomanaG., BlackR.The relationship between diarrhea! prevalence and growth of poor infants varies with their age and usual energy intake. FASEB J1991; 5: A1079.
20.
DeweyK.G., PeersonJ.M., HeinigM.J., NommsenL.A., LonnerdalB., Lopez de RomanaG., Creed de KanashiroH., BlackR.E., BrownK.H.Growth patterns of breastfed infants in affluent (United States) and poor (Peru) communities: implications for timing of complementary feeding. Am J Clin Nutr1992; 56: 1012–8.
21.
BrownK.H., StallingsR.Y., Creed de KanashiroH., Lopez de RomanaG., BlackR.E.Effects of common illnesses on infants’ energy intakes from breast milk and other foods during longitudinal community-based studies in Huascar (Lima), Peru. Am J Clin Nutr1990; 52: 1005–13.
22.
RowlandM.G.M., Goh RowlandS.G.J., ColeT.J.Impact of infection on the growth of children from 0 to 2 years in an urban west African community. Am J Clin Nutr1988; 47: 134–8.
23.
DeweyK.G., CohenR.J., Landa RiveraL., RiveraA., BrownK.H.Anemia among breastfed infants at six months of age in Honduras. FASEB J1993; 7: A2971.
24.
BrownK.H., DeweyK.G.Relationships between maternal nutritional status and milk energy output of women in developing countries. In: Picciano ME, Lonnerdal B. eds. Mechanisms regulating lactation and infant nutrient utilization.New York: Wiley-Liss, 1992: 77–95.
25.
BrownK.H., Sanchez-GriñanM., PerezF., PeersonJ.M., GanozaL., SternI.S.Effects of dietary energy density and feeding frequency on total daily energy intakes by recovering malnourished children. Am J Clin Nutr1995; 62: 13–8.
26.
BrownK.H., BentleyM.E.Improved nutritional therapy of diarrhea: a guide for program planners and decision makers.Washington, DC: PRITECH, 1988.
27.
ChavezA., MartinezC., BourgesH., CoronadoM., LopezM., BastaS.Child nutrition problems during lactation in poor rural areas. In: Chavez A, ed. Proceedings of the Ninth International Congress of Nutrition.Basel and New York: S Karger, 1975: 90–105.
28.
HennartP., VisH.L.Breast feeding and post-partum amenorrhea in Central Africa. J Trop Pediatr1980; 26: 177–82.
29.
PrenticeA., PaulA., BlackA., ColeT., WhiteheadR.Cross-cultural differences in lactational performance. In: Hamosh M, Goldman AS, eds. Human lactation. 2. Maternal and environmental factors.New York: Plenum Press, 1986: 13–44.
30.
BrownK.H., AkhtarN.A., RobertsonA.D., AhmedM.G.Lactational capacity of marginally nourished mothers: relationships between maternal nutritional status and quantity and proximate composition of milk. Pediatrics1986; 78: 920–7.
31.
Creed-KanashiroH., BrownK.H., Lopez de RomanaG., LopezT., BlackR.E.Consumption of food and nutrients by infants in Huascar (Lima), Peru. Am J Clin Nutr1990; 52: 995–1004.
32.
DickinK.L., BrownK.H., FagbuleD., AdedeoyinM., GittelsohnJ., EsreyS.A., OniG.A.Effect of diarrhea on dietary intake by infants and young children in rural villages of Kwara State, Nigeria. Eur J Clin Nutr1990; 44: 307–17.
33.
MarquisG.S., LopezT., PeersonJ.M., BrownK.H.Effect of dietary viscosity on energy intake by breast-fed and non-breast-fed children during and after acute diarrhea. Am J Clin Nutr1993; 57: 218–23.
34.
CameronM., HofvanderY.Manual on feeding infants and young children.Oxford: Oxford University Press, 1983.
BirchL.L., McPheeL., SullivanS.Children's food intake following drinks sweetened with sucrose or aspartame: time course effects. Physiol Behav1989; 45: 387–95.
37.
Sanchez-GriñanM.I., PeersonJ.M., BrownK.H.Effect of dietary energy density on total ad-libitum energy consumption by recovering malnourished children. Eur J Clin Nutr1992; 46: 197204.
38.
BrownK.H., BeginF.Malnutrition among weanlings of developing countries: still a problem begging for solutions. J Pediatr Gastroenterol Nutr1993; 17: 132–8.
39.
GopaldasT., MehtaP., PatilN., GandhiH.Studies on reduction in viscosity of thick rice gruels with small quantities of an amylase-rich cereal malt. Food Nutr Bull1986; 8: 42–7.
40.
SvanbergUS-O, FredrikzonB., Gebre-HiwotB., TaddesseW.W.Sorghum in a mixed diet for preschool children. I. Good acceptability with and without simple reduction of dietary bulk. J Trop Pediatr1987; 33: 181–5.
41.
AlnwickD., MosesS., SchmidtO.G. eds. Improving young child feeding in Eastern and Southern Africa: household level food technology.Ottawa: International Development Research Centre, 1988.
42.
HellströmÅ, HermanssonA.M., KarlssonA., LjungqvistB., MellanderO., SvanbergU.Dietary bulk as a limiting factor for nutrient intake-with special reference to the feeding of preschool children. II. Consistency as related to dietary bulk-a model study. J Trop Pediatr1981; 27: 127–35.
43.
JohnC., GopaldasT.Reduction in the dietary bulk of soya-fortified bulgur wheat gruels with wheat-based amylase-rich food. Food Nutr Bull1988; 10: 50–3.
44.
StephensonD M., Meeks-GardnerJ.M., WalkerS P.Ash worth A. Weaning food viscosity and energy density: their effects on ad libitum consumption and energy intakes in Jamaican children. Am J Clin Nutr1994; 60: 465–9.
45.
AshworthA., DraperA.The potential of traditional technologies for increasing the energy density of weaning foods. (WHO/CDD/EDP/92.4).Geneva: WHO, 1992.
46.
FomonS., ZieglerE.E.Sweetness of diet and food consumption by infants. Proc Soc Exp Biol Med1983; 173: 190–3.
47.
BrownK.H., Sanchez-GriñanM.I., PerezF., PeersonJ.M., SternJ.S.Effect of dietary starch and sugar contents on total daily energy intakes by recovering malnourished children. FASEB J1994; 8: A155.
48.
FomonS.J., ThomasL.N., FilerL.J.Acceptance of unsalted strained foods by normal infants. J Pediatr1970; 76: 242–6.
49.
AllenL.H., BackstrandJ.R., StanekE.J., PeltoG.H., Chávez MolinaE., CastilloJ.B., MataA.The interactive effects of dietary quality on the growth and attained size of young Mexican children. Am J Clin Nutr1992; 56: 353–64.
50.
AllenL.H.Nutritional influences on linear growth: a general review. Eur J Clin Nutr1994; 48: S75–89.
51.
BrownK.H.The importance of dietary quality versus quantity for weanlings in less-developed countries: a framework for discussion. Food Nutr Bull1991; 13: 8694.
52.
MalcolmL.A.Growth retardation in a New Guinea boarding school and its response to supplementary feeding. Br J Nutr1970; 24: 297–305.
53.
VaughnJ.P., ZumrawiF., WaterlowJ.C., KirkwoodB.R.An evaluation of dried skim milk on children's growth in Khartoum province, Sudan. Nutr Res1981; 1: 243–52.
54.
DagnelieP.C., van StaverenW.A., VergoteFJVRA, BuremaJ., van's HofM.A., van KlaverenJ.D., HautvastJGAJ. Nutritional status of infants aged 4 to 18 months on macrobiotic diets and matched omnivorous control infants: a population-based mixed-longitudinal study. Eur J Clin Nutr1989; 43: 325–38.
55.
HofvanderY., UnderwoodB.A.Processed supplementary foods for older infants and young children, with special reference to developing countries. Food Nutr Bull1987; 9: 1–7.
56.
BrownK.H.Appropriate diets for the rehabilitation of malnourished children in the community setting. Acta Paediatr Scand1991; Suppl 374: 151–9.
57.
Lopez de RomanaG., BrownK.H., BlackR.E.Health and growth of infants and young children in Huascar, Peru. Ecol Food Nutr1987; 19: 213–29.
58.
Lopez de RomanaG., BrownK.H., BlackR.E., KanashiroH.C.Longitudinal studies of infectious diseases and physical growth of infants in Huascar, an underprivileged peri-urban community of Lima, Peru. Am J Epidemiol1989; 129: 769–84.
59.
BlackR.E., Lopez de RomanaG., BrownK.H., Grados BazalarO., KanashiroH.C.Incidence and etiology of infantile diarrhea and major routes of transmission in Huascar, Peru. Am J Epidemiol1989; 129: 785–99.
60.
MataL.J., KromalR.A., UrrutiaJ.J., GarciaB.Effect of infection on food intake and the nutritional status: perspectives as viewed from the village. Am J Clin Nutr1977; 30: 1215–27.
61.
MartorellR., YarbroughC., YarbroughS., KleinR.E.The impact of ordinary illnesses on the dietary intake of malnourished children. Am J Clin Nutr1980; 33: 34550.
MollaA.M., MollaA., SarkerS.A., RahamanM.M.Food intake during and after recovery from diarrhea in children. In: Chen LC, Scrimshaw NS, eds. Diarrhea and malnutrition.New York: Plenum Press, 1983: 113–23.
64.
BrownK.H., BlackR.E., RobertsonA.D., BeckerS.Effects of season and illness on the dietary intake of weanlings during longitudinal studies in rural Bangladesh. Am J Clin Nutr1985; 41: 343–55.
65.
CromptonD.W.T.Influence of parasitic infection on food intake. Fed Proc1984; 43: 239–45.
66.
Stephensonis, LathamM.C., AdamsE.J., KinotiS.N., PertetA.Physical fitness, growth and appetite of Kenyan school boys with hookworm. Trichuris trichiura and Ascaris lumbricoides infections are improved four months after a single dose of albendazole. J Nutr1993; 123: 1036–46.
67.
KrebsN.P., HambidgeK.M., WalravensP.A.Increased food intake of young children receiving a food supplement. Am J Dis Child1984; 138: 270–3.
68.
LathamM.C., Stephensonis, KinotiS.N., ZamanM.S., KuizK.M.Improvements in growth following iron supplementation in young Kenyan school children. Nutrition1990; 6: 159–65.
69.
DettwylerK.A.Styles of infant feeding: parental/caretaker control of food consumption in young children. Am Anthropol1989; 9: 696–703.
70.
ZeitlinM.P., GhassemiH., MansourM.Positive deviance in child nutrition: with emphasis on psycho social and behavioral aspects and implications for development.Tokyo: United Nations University Press, 1990.
71.
BrownK.H., PeersonJ.M., Lopez de RomanaG., Creed de KanashiroH., BlackR.E.Validity and epidemiology of reported poor appetite among Peruvian infants from a low-income, peri-urban community. Am J Clin Nutr1995; 61: 26–32.
72.
RowlandM.G.M., BarrelR.A.E., WhiteheadR.G.Bacterial contamination in traditional Gambian weaning foods. Lancet1978; 1: 136–8.
73.
BlackR.E., BrownK.H., BeckerS., Abdul AlimA.R.M., MersonM.H.Contamination of weaning foods and transmission of enterotoxigenic E. coli diarrhea in children in rural Bangladesh. Trans R Soc Trop Med Hyg1982; 76: 259–64.
74.
World Health Organization.Contaminated food: major cause of diarrhea and malnutrition among infants and young children. Papers on Food and Nutrition, no. 3. Geneva: WHO, April 1993.
75.
OniG.A., BrownK.H., BentleyM.E., DickinK.L., KayodeB., AladeI.Feeding practices and prevalence of hand-feeding of infants and young children in Kwara State, Nigeria. Ecol Food Nutr1990; 24: 1–11.
76.
MensahP.P.A., TomkinsA.M., DrasarB.S., HarrisonT.J.Effect of fermentation of Ghanaian maize dough on the survival and proliferation of four strains of Shigella flexneri. Trans R Soc Trop Med Hyg1988; 82: 635–6.
77.
MensahP.P.A., TomkinsA.M., DrasarB.S., HarrisonT.J.Fermentation of cereals for reduction of bacterial contamination of weaning foods in Ghana. Lancet1990; 336: 140–3.
78.
SvanbergU., SjorgrenE., LorriW., SvennerholmA.M., KaijserB.Inhibited growth of common enteropathogenic bacteria in lactic-fermented cereal gruels. W J Micro Biot1992; 8: 601–6.
79.
LorriW., SvanbergU.Lower prevalence of diarrhea in young children fed lactic acid-fermented cereal gruels. Food Nutr Bull1994; 15: 57–63.
80.
HarperJ.M., TribelhornR.E.Comparison of relative energy costs of village-prepared and centrally processed weaning foods. Food Nutr Bull1985; 7: 54–60.
81.
Creed-KanashiroH., FukumotoM., JacobyE., VerzosaC., BentleyM., BrownK.H.Use of recipe trials and anthropological techniques for the development of a home prepared weaning food in the central highlands of Peru. J Nutr Educ1991; 23: 30–5.
82.
GriffithsM., PiwozE., FavinM., Del RossoJ.Improving young child feeding during diarrhea: a guide for investigators and program managers. The Weaning Project. Manoff International Inc.Rosslyn, Va, USA: PRITECH, 1988.
83.
JacobyE.R., BenavidesB., BartlettJ.C., FigueroaD.Effectiveness of two methods of advising mothers on infant feeding and dietetic management of diarrhoea at an outpatient clinic in Peru. J Diarrhoeal Dis Res1994; 12: 59–64.
84.
del AguilaR., Creed de KanashiroH., MejiaE.Preparación y distribución de comida para ninos en edad de destete en pueblos jóvenes de Lima. Final report to IDRC.Ottawa: IDRC, 1993.
85.
GuptillK.S., EsreyS.A., OniG.A., BrownK.H.Evaluation of a face-to-face weaning food intervention in Kwara State, Nigeria: knowledge, trial, and adoption of a home-prepared weaning food. Soc Sci Med1993; 36: 665–72.
