This article provides an overview of child feeding recommendations and how these relate to actual practice and dietary adequacy, primarily in developing countries. From birth to 6 months, recommendations focus on optimal breastfeeding practices, although these are still suboptimal in about one third of infants in developing countries. From 6 months of age, breast milk can no longer meet all the nutrient requirements of the child, so from 6 months through at least 24 months, the recommendation is to continue breastfeeding but gradually introduce complementary foods. In poorer populations, the available foods for complementary feeding are primarily cereals and legumes, to which small amounts of fruits and vegetables are added, and even less animal source foods. Based on intake data from infants and preschoolers, it is evident that usual diets typically fall far short of supplying micronutrient needs. By adding more fruits, vegetables, and animal source foods the diet can be improved. Intervention studies show that increasing animal source food intake improves growth, muscle mass, and cognitive function of school children. Milk and dairy product intakes are correlated with greater child growth in many studies, even in industrialized countries. However, for many families, substantially improving children’s diets by providing higher quality foods is often financially unrealistic. Newer approaches to home fortification of children’s foods using micronutrient powders or lipid-based nutrient supplements hold great potential to prevent micronutrient deficiencies at reasonable cost, thus preventing the adverse consequences of these deficiencies for child development.

Keywords:
Breastfeeding, Children, Developing countries, Diets, Health, Infants, Micronutrients
1.
UNICEF: The State of the World’s Children. New York, 2012.
2.
Martorell R, Khan LK, Schroeder DG: Reversibility of stunting: epidemiological findings in children from developing countries. Eur J Clin Nutr 1994;48(suppl 1):S45–S57.
3.
Mendez MA, Adair LS: Severity and timing of stunting in the first two years of life affect performance on cognitive tests in late childhood. J Nutr 1999;129:1555–1562.
4.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS: Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008;371:340.
5.
Neumann CG, Bwibo NO, Murphy SP, Sigman M, Whaley S, Allen LH, Guthrie D, Weiss RE, Demment MW: Animal source foods improve dietary quality, micronutrient status, growth and cognitive function in Kenyan school children: background, study design and baseline findings. J Nutr 2003;133:3941S–3949S.
6.
WHO: The Optimal Duration of Exclusive Breastfeeding. Report of an Expert Consultation. Geneva, World Health Organization, 2001.
7.
Lutter CK, Daelmans BM, de Onis M, Kothari MT, Ruel MT, Arimond M, Deitchler M, Dewey KG, Blossner M, Borghi E: Undernutrition, poor feeding practices, and low coverage of key nutrition interventions. Pediatrics 2011;128:e1418–e1427.
8.
Allen LH: B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function. Adv Nutr 2012;3:362–369.
9.
Allen LH, Graham J: Assuring micronutrient adequacy in the diets of young infants; in Delange FM, West KPJ (eds): Micronutrient Deficiencies in the First Months of Life. Basel, Karger, 2003, pp 55–88.
10.
PAHO: Guiding Principles for Complementary Feeding of the Breastfed Child. Washington, DC, PAHO, 2003.
11.
Penny ME, Creed-Kanashiro HM, Robert RC, Narro MR, Caulfield LE, Black RE: Effectiveness of an educational intervention delivered through the health services to improve nutrition in young children: a cluster-randomised controlled trial. Lancet 2005;365:1863–1872.
12.
WHO/UNICEF, Brown K, Allen L, Dewey K (eds): Complementary Feeding of Young Children in Developing Countries: A Review of Current Scientific Knowledge. Geneva, World Health Organization, 1998.
13.
Brown K, Peerson J, Kimmons J, Hotz C: Options for achieving adequate intake from home-prepared complementary foods in low-income countries; in Black R, Michaelsen KF (eds): Public Health Issues in Infant and Child Nutrition. Nestle Nutrition Workshop Series, Pediatric Program. Philadelphia, Vevey, Lippincott Williams & Wilkins, 2002.
14.
Allen LH: How common is vitamin B-12 deficiency? Am J Clin Nutr 2009;89:693S–696S.
15.
Fox MK, Reidy K, Novak T, Ziegler P: Sources of energy and nutrients in the diets of infants and toddlers. J Am Diet Assoc 2006;106:S28–S42.
16.
Wilson TA, Adolph AL, Butte NF: Nutrient adequacy and diet quality in non-overweight and overweight Hispanic children of low socioeconomic status: the Viva la Familia Study. J Am Diet Assoc 2009;109:1012–1021.
17.
Popkin BM, Adair LS, Ng SW: Global nutrition transition and the pandemic of obesity in developing countries. Nutr Rev 2012;70:3–21.
18.
Murphy SP, Gewa C, Liang LJ, Grillenberger M, Bwibo NO, Neumann CG: School snacks containing animal source foods improve dietary quality for children in rural Kenya. J Nutr 2003;133:3950S–3956S.
19.
Anderson VP, Cornwall J, Jack S, Gibson RS: Intakes from non-breastmilk foods for stunted toddlers living in poor urban villages of Phnom Penh, Cambodia, are inadequate. Matern Child Nutr 2008;4:146–159.
20.
Murphy SP, Allen LH: Nutritional importance of animal source foods. J Nutr 2003;133:3932S–3935S.
21.
Allen LH, Dror DK: Effects of animal source foods, with emphasis on milk, in the diet of children in low-income countries. Nestle Nutr Workshop Ser Pediatr Program 2011;67:113–130.
22.
Arimond M, Ruel MT: Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. J Nutr 2004;134:2579–2585.
23.
Allen LH: The nutrition CRSP: what is marginal malnutrition, and does it affect human function? Nutr Rev 1993;51:255–267.
24.
Siekmann JH, Allen LH, Bwibo NO, Demment MW, Murphy SP, Neumann CG: Kenyan school children have multiple micronutrient deficiencies, but increased plasma vitamin B-12 is the only detectable micronutrient response to meat or milk supplementation. J Nutr 2003;133:3972S–3980S.
25.
McLean ED, Allen LH, Neumann CG, Peerson JM, Siekmann JH, Murphy SP, Bwibo NO, Demment MW: Low plasma vitamin B-12 in Kenyan school children is highly prevalent and improved by supplemental animal source foods. J Nutr 2007;137:676–682.
26.
Dror DK, Allen LH: The importance of milk and other animal-source foods for children in low-income countries. Food Nutr Bull 2011;32:227–243.
27.
Pettifor JM: Vitamin D and/or calcium deficiency rickets in infants and children: a global perspective. Indian J Med Res 2008;127:245–249.
28.
Hoppe C, Andersen GS, Jacobsen S, Molgaard C, Friis H, Sangild PT, Michaelsen KF: The use of whey or skimmed milk powder in fortified blended foods for vulnerable groups. J Nutr 2008;138:145S–161S.
29.
Molgaard C, Larnkjaer A, Arnberg K, Michaelsen KF: Milk and growth in children: effects of whey and casein. Nestle Nutr Workshop Ser Pediatr Program 2011;67:67–78.
30.
Vossenaar M, Solomons NW: The concept of ‘critical nutrient density’ in complementary feeding: the demands on the ‘family foods’ for the nutrient adequacy of young Guatemalan children with continued breastfeeding. Am J Clin Nutr 2012;95:859–866.
31.
Binetti V, Dewey K: Identifying Micronutrient Gaps in the Diets of Breastfed 6- to 11-Month Old Infants in Bangladesh, Ethiopia and Viet Nam Using Linear Programming. Washington, DC, Alive & Thrive, 2012.
32.
Faber M, Spinnler Benade A: Breastfeeding, complementary feeding and nutritional status of 6–12 month old infants in rural KwaZulu Natal. S Afr J Clin Nutr 2007;20.
33.
Pelto GH, Armar-Klemesu M: Balancing nurturance, cost and time: complementary feeding in Accra, Ghana. Matern Child Nutr 2011;7(suppl 3):66–81.
34.
Christofides A, Asante KP, Schauer C, Sharieff W, Owusu-Agyei S, Zlotkin S: Multi-micronutrient Sprinkles including a low dose of iron provided as microencapsulated ferrous fumarate improves haematologic indices in anaemic children: a randomized clinical trial. Matern Child Nutr 2006;2:169–180.
35.
Ciliberto MA, Sandige H, Ndekha MJ, Ashorn P, Briend A, Ciliberto HM, Manary MJ: Comparison of home-based therapy with ready-to-use therapeutic food with standard therapy in the treatment of malnourished Malawian children: a controlled, clinical effectiveness trial. Am J Clin Nutr 2005;81:864–870.
36.
Phuka JC, Maleta K, Thakwalakwa C, Cheung YB, Briend A, Manary MJ, Ashorn P: Postintervention growth of Malawian children who received 12-mo dietary complementation with a lipid-based nutrient supplement or maize-soy flour. Am J Clin Nutr 2009;89:382–390.
37.
Daelmans B, Dewey K, Arimond M: New and updated indicators for assessing infant and young child feeding. Food Nutr Bull 2009;30:S256–S262.
© 2013 S. Karger AG, Basel
2013
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