WHO's current infant-feeding recommendation
WHO's current infant-feeding recommendation may be summarised as follows:
The World Health Organization recommends that infants should be fed exclusively on breast milk from birth to 4 to 6 months of age; that is, they should be given no other liquids or solids than breast milk, not even water, during this period. Given the worldwide variation in growth velocity, an age range is an essential element of this feeding recommendation.
After this initial 4-to-6-month period of exclusive breast-feeding, children should continue to be breast-fed for up to 2 years of age or beyond, while receiving nutritionally adequate and safe complementary foods. Starting complementary feeding too early or too late are both undesirable. Ideally, the decision when precisely to begin will be made by a mother, in consultation with her health worker, based on her infant's specific growth and development needs.
WHO's current infant-feeding recommendation was based initially on the technical review and discussion undertaken in 1979 in connection with a joint WHO/UNICEF meeting on infant and young child feeding. The meeting's statement and recommendations were subsequently endorsed in their entirety by the World Health Assembly. Important additional scientific evidence including, most recently in 1995, from the WHO Expert Committee on the use and interpretation of anthropometry, underscores the reliability of the earlier review.
Reported change in WHO's recommendation
Some observers point to resolution WHA47.5, which the World Health Assembly adopted in May 1994, as evidence of a change in WHO's infant-feeding recommendation. In fact, operative paragraph 2(1)(d) of this resolution merely restates that portion of the recommendation dealing with complementary feeding:
2. URGES Member States to take the following measures:
(1) to promote sound infant and young child nutrition… through coherent effective intersectoral action, including:
(d) fostering appropriate complementary feeding practices from the age of about six months,emphasizing continued breast-feeding and frequent feeding with safe and adequate amounts of local foods (emphasis added);
The significance of the words “about six months” is reinforced when viewed in the context of an earlier resolution (WHA45.34, 1992) where the entire recommendation is summarized as follows:
Reaffirming that during the first four to six months of life no food or liquid other than breast milk, not even water, is required to meet the normal infant's nutritional requirements, and that from the age of about six months infants should begin to receive a variety of locally available and safely prepared foods rich in energy, in addition to breast milk, to meet their changing nutritional requirements (emphasis added);
Conclusion
WHO maintains a continual review of the scientific evidence relating to the optimal duration of exclusive breastfeeding, and thus the optimal timing of the start of complementary feeding. Based on the best available evidence, this is currently considered to be between 4 and 6 months of age for most infants. Given the worldwide variation in growth velocity, an age range is an essential element of WHO's feeding recommendation. The wording “about 6 months” for the start of complementary feeding, which reflects this range, is identical in both the 1992 and 1994 Assembly resolutions.
