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Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition

Agostoni, Carlo*; Decsi, Tamas; Fewtrell, Mary‡,3; Goulet, Olivier§; Kolacek, Sanja; Koletzko, Berthold||,1; Michaelsen, Kim Fleischer**,3; Moreno, Luis††; Puntis, John‡‡; Rigo, Jacques§§; Shamir, Raanan¶¶; Szajewska, Hania||||,2; Turck, Dominique***; van Goudoever, Johannes†††ESPGHAN Committee on Nutrition:

Journal of Pediatric Gastroenterology and Nutrition: January 2008 - Volume 46 - Issue 1 - p 99–110
doi: 10.1097/
Medical Position Paper

This position paper on complementary feeding summarizes evidence for health effects of complementary foods. It focuses on healthy infants in Europe. After reviewing current knowledge and practices, we have formulated these conclusions: Exclusive or full breast-feeding for about 6 months is a desirable goal. Complementary feeding (ie, solid foods and liquids other than breast milk or infant formula and follow-on formula) should not be introduced before 17 weeks and not later than 26 weeks. There is no convincing scientific evidence that avoidance or delayed introduction of potentially allergenic foods, such as fish and eggs, reduces allergies, either in infants considered at increased risk for the development of allergy or in those not considered to be at increased risk. During the complementary feeding period, >90% of the iron requirements of a breast-fed infant must be met by complementary foods, which should provide sufficient bioavailable iron. Cow's milk is a poor source of iron and should not be used as the main drink before 12 months, although small volumes may be added to complementary foods. It is prudent to avoid both early (<4 months) and late (≥7 months) introduction of gluten, and to introduce gluten gradually while the infant is still breast-fed, inasmuch as this may reduce the risk of celiac disease, type 1 diabetes mellitus, and wheat allergy. Infants and young children receiving a vegetarian diet should receive a sufficient amount (∼500 mL) of breast milk or formula and dairy products. Infants and young children should not be fed a vegan diet.

*San Paolo Hospital, University of Milano, Milano, Italy

Department of Paediatrics, University of Pecs, Hungary

Institute of Child Health, London, UK

§Hôpital Necker Enfants-Malades, University of Paris Descartes, Paris, France

Children's Hospital, Zagreb Medical University, Croatia

||Dr von Hauner Children's Hospital, University of Munich, Germany

**Department of Human Nutrition, University of Copenhagen, Denmark

††Escuela Universitaria de Ciencias de la Salud, Universidad de Zaragoza, Zaragoza, Spain

‡‡Leeds General Infirmary, Leeds, UK

§§CHR Citadelle, University of Liege, Liege, Belgium

¶¶Meyer Children's Hospital of Haifa, Ruth and Bruce Rappaport School of Medicine, Technion, Haifa, Israel

||||Medical University of Warsaw, Poland

***University of Lille, Lille, France

†††Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands

1Committee Chair;

2Committee Secretary;


Received 9 October, 2007

Accepted 9 October, 2007

Address correspondence and reprint requests to Carlo Agostoni, MD, Dept of Pediatrics, San Paolo Hospital 8 Via A di Rudinì, I - 20142 Milano, Italy (e-mail:

Declaration of conflicts of interest of members of the Committee on Nutrition (CoN) are submitted yearly to the CoN secretary and are available on request.

© 2008 Lippincott Williams & Wilkins, Inc.