Timing of complementary feeding and associations with maternal and infant characteristics: A Norwegian cross-sectional study

Exploring global mothers' knowledge, attitudes, and practice of complementary feeding: A scoping review

Complementary feeding refers to the practice of providing solid foods and liquids in addition to breast milk when a baby reaches 6 mo of age. This becomes necessary to meet a baby's nutritional needs because of the potential nutrient insufficiency of breast milk alone. This review serves as an effective means to comprehensively understand the intricate and evolving nature of complementary feeding practices, often influenced by cultural, regional, and parental factors, from a literature perspective that acknowledges the dynamic aspects of complementary feeding. The data in this study were extracted and presented according to the recommendations from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, as guidelines. The studies were conducted using digital databases such as PubMed, Springer Link, and Science Direct from 2014 to 2022. A total of 1205 eligible studies were retrieved from the three databases searched, with 17 articles finally reviewed for data extraction. Overall, there remains a gap between mothers' knowledge, attitudes, and practices regarding complementary feeding. Addressing these disparities within and between countries necessitates targeted interventions and educational programs to enhance mothers' understanding, align attitudes with guidelines, and promote healthier practices for the well-being of children.

Secular trends in infant feeding practices during the first year of life in Norway: findings from 1998 to 2019 - the Spedkost surveys

The aims of the present study were to assess secular trends in breast-feeding and to explore associations between age at introduction of solid foods and breast-feeding duration. Data from three national dietary surveys in Norway were used, including infants born in 1998 (Spedkost 1, n 1537), 2006 (Spedkost 2, n 1490) and 2018 (Spedkost 3, n 1831). In all surveys, around 80 % of the infants were breastfed at 6 months of age. At 12 months of age, breast-feeding rate was 41 % in Spedkost 1, increasing to 48 % in Spedkost 2 and 51 % in Spedkost 3. Compared with earlier introduction, introduction of solid foods at ≥ 5 months of age was associated with a lower risk of breast-feeding cessation during the first year of life in the two most recent Spedkost surveys. In Spedkost 2, the adjusted hazard ratio for breast-feeding cessation during the first year of life for those introduced to solid foods at ≥ 5 months of age was 0·43 (95 % CI (0·31, 0·60)), P < 0·001, while the corresponding number in Spedkost 3 was 0·44 (95 % CI (0·29, 0·67)), P < 0·001. In conclusion, breast-feeding at infant age 12 months increased over time. Introduction of solid foods at ≥ 5 months of age was positively associated with breast-feeding duration in the two most recent Spedkost surveys. As breast-feeding contributes to numerous health benefits for infant and mother, and possibly improved dietary sustainability in infancy, findings point to the importance of continued protection, support and promotion of breast-feeding.

Maternal mental health is associated with children's frequency of family meals at 12 and 24 months of age

Diet during the child's first years is important for growth and development. In toddlerhood, higher diet quality is reported among children eating meals together with family. Although previous literature has documented several associations between maternal mental health and early child feeding practices, less is known about the relationship between maternal mental health and child frequency of shared family meals. This study explores associations between maternal symptoms of anxiety and depression, measured by The Hopkins Symptoms Checklist (SCL-8), and toddler participation in family meals. We used cross-sectional data from the Norwegian study Early Food for Future Health, in which participants responded to questionnaires at child age 12 (n = 455) and 24 months (n = 295). Logistic regression was used to explore associations between maternal mental health and child having regular (≥5 per week) or irregular (<5 per week) family meals (breakfast and dinner), adjusting for relevant child and maternal confounding variables. Children of mothers with higher scores of anxiety and depression had higher odds of Irregular family meals at both timepoints; (OR: 2.067, p = 0.015) and (OR: 2.444, p = 0.023). This is one of few studies exploring associations between maternal mental health and child frequency of shared family meals in early childhood, a period where the foundation for life-long health is shaped. Given the high prevalence of mental ailments and disorders, these findings are important and may inform future public health interventions. Further exploration of this relation is needed, including longitudinal research to test predictive associations and qualitative studies to increase insight and understanding.

Mind-mindedness and preschool children's behavioral difficulties: The moderating role of maternal parenting distress

Mind-mindedness (MM) is a caregiver's tendency to appreciate their infant's internal mental states. This longitudinal study investigated whether maternal MM (10 months) was linked with children's later behavioral problems (51 months) and the moderating role of maternal parenting distress (PD; 36 months) in a sample of 91 mother-infant dyads. Appropriate MM comments were coded from video-recorded, semi-structured play interactions between mothers and their infants; PD was obtained from maternal completion of the PD subscale of the Parenting Stress Index - Short Form (PSI-SF); and child internalizing and externalizing behavior problems were gathered from maternal report on the Strengths and Difficulties Questionnaire (SDQ). Moderated regression analyses revealed higher early appropriate MM was associated with significantly fewer internalizing emotional problems at 51 months among mothers with lower PD at 36 months, and higher early appropriate MM was associated with lower conduct problems at 51 months in mothers with higher PD at 36 months. Findings demonstrated the importance of considering nuanced contexts such as at-risk mothers and differential presentations of child difficulties in the analysis of the relationship between MM and child behavioral difficulties and the development of MM interventions.

Are Complementary Feeding Practices Aligned with Current Recommendations? A Narrative Review

The complementary feeding introduction period (introduction of solid foods alongside breastmilk or formula) is defining in children's health; however, it appears that many parents do not follow complementary feeding guidelines. Our aim was to describe current parental feeding practices during complementary feeding in relation to current recommendations and explore determinants of adherence to guidelines. We included any relevant studies published within the last decade in French or English and summarized findings by recommendation category. The timing of complementary food introduction varied widely across and within continents (earlier in North America and often delayed in Asia). The introduction of allergenic foods tended to be delayed globally. Although some parents now begin complementary feeding with solid foods (i.e., baby-led weaning), delayed introduction of lumpy textures was still prevalent in the United States and in Europe. The consumption of iron-rich foods was predominantly low in Africa. Added sugars were globally introduced early, especially in America. Evidence for the prevalence of responsive feeding practices among parents is unclear due to the small number of studies. Determinants of complementary feeding practices included parental characteristics, such as age, education, socio-economic status, and race/ethnicity. Interventions aiming to increase adherence to complementary feeding guidelines must account for parental characteristics.

Maternal-Infant Attachment and its Relationships with Postpartum Depression, Anxiety, Affective Instability, Stress, and Social Support in a Canadian Community Sample

As a crucial component of child development, maternal-infant attachment influences a child's cognitive, psychological, and social development. Maternal depression, anxiety, stress, and social support have been identified as risk factors for poor maternal-infant attachment in some studies, while others did not find such relationships. The aim of this study was to examine the associations of maternal-infant attachment with depression, anxiety, affective instability, stress, social support, and other variables in a community sample of Canadian postpartum women. A total of 108 Canadian postpartum women participated in this cross-sectional study. The Depression, Anxiety, and Stress Scale-21 (DASS-21) assessed depression, anxiety, and stress, and the Affective lability Scale-18 measured affective instability (AI). Multiple linear regression was conducted to examine the association between maternal-infant attachment and other variables. The findings revealed a significant association of maternal-infant attachment with postpartum depression, and infant temperament, while anxiety, AI, stress, and social support were not identified as predictors for maternal-infant attachment. The results implicate the importance of addressing maternal depression and maternal-infant attachment, consequently decreasing the risk for childhood psychopathology.

Prevalence and maternal determinants of early and late introduction of complementary foods: results from the Growing Up in New Zealand cohort study

A nationally generalisable cohort (n 5770) was used to determine the prevalence of non-timely (early/late) introduction of complementary food and core food groups and associations with maternal sociodemographic and health behaviours in New Zealand (NZ). Variables describing maternal characteristics and infant food introduction were sourced, respectively, from interviews completed antenatally and during late infancy. The NZ Infant Feeding Guidelines were used to define early (≤ 4 months) and late (≥ 7 months) introduction. Associations were examined using multivariable multinomial regression, presented as adjusted relative risk ratios and 95 % confidence intervals (RRR; 95% CI). Complementary food introduction was early for 40·2 % and late for 3·2 %. The prevalence of early food group introduction were fruit/vegetables (23·8 %), breads/cereals (36·3 %), iron-rich foods (34·1 %) and of late were meat/meat alternatives (45·9 %), dairy products (46·2 %) and fruits/vegetables (9·9 %). Compared with infants with timely food introduction, risk of early food introduction was increased for infants: breastfed < 6months (2·52; 2·19-2·90), whose mothers were < 30 years old (1·69; 1·46-1·94), had a diploma/trade certificate v. tertiary education (1·39; 1·1-1·70), of Māori v. European ethnicity (1·40; 1·12-1·75) or smoked during pregnancy (1·88; 1·44-2·46). Risk of late food introduction decreased for infants breastfed < 6 months (0·47; 0.27-0·80) and increased for infants whose mothers had secondary v. tertiary education (2·04; 1·16-3·60) were of Asian v. European ethnicity (2·22; 1·35, 3·63) or did not attend childbirth preparation classes (2·23; 1·24-4·01). Non-timely food introduction, specifically early food introduction, is prevalent in NZ. Interventions to improve food introduction timeliness should be ethnic-specific and support longer breast-feeding.

The association between early introduction of tiny tastings of solid foods and duration of breastfeeding

BACKGROUND

Conflicting advice and non-evidence-based recommendations have a negative effect on breastfeeding. Since 2011, the National Food Agency in Sweden has informed parents that they can introduce tiny tastings (1 mL of solid food, i.e. other sources of nutrition than breastmilk/formula) to infants from four months of age. It is unknown how national recommendations, which differ from the Word Health Organisation's recommendation, affect breastfeeding. We hypothesised that introduction of tiny tastings of solid foods would shorten the duration of continued breastfeeding.

METHODS

This retrospective study utilises data from the longitudinal 'Swedish Pregnancy Planning Study', in which mothers were recruited at antenatal clinics on a national level. The participants completed three questionnaires up to one year after birth (n = 1,251). Linear regression models were used to analyse the association between the introduction of solid foods and the duration of breastfeeding.

RESULTS

As hypothesised, introduction of tiny tastings shortened the duration of continued breastfeeding. Half of all infants (48%) were fed with tiny tastings already in the fourth month. The correlation analysis showed that the earlier the infants started with tiny tastings, the earlier they ate larger amounts of solid food. In a multivariate linear regression analysis, five factors were identified as having a negative effect on the duration of breastfeeding: low infant age upon introduction of tiny tastings, low maternal age, low level of maternal education, high maternal BMI and twin birth.

CONCLUSIONS

Early introduction of tiny tastings of solid foods shortened the duration of breastfeeding. It is difficult to influence most conditions that affect breastfeeding, for example, the mother's educational level, BMI, age and if she has given birth to twins. In contrast, national guidelines can always be updated. Recommendations from the Swedish authorities should adhere to the WHO's recommendation, which states exclusive breastfeeding for six months and continued breastfeeding for at least two years or longer.

Correlates of Sub-Optimal Feeding Practices among under-5 Children amid Escalating Crises in Lebanon: A National Representative Cross-Sectional Study

Sub-optimal feeding practices among under-5 children are the major drivers of malnutrition. This study aims to assess the prevalence of malnutrition and the factors affecting exclusive breastfeeding, bottle feeding, and complementary feeding practices among under 5 children amid the COVID-19 pandemic as well as the economic and the political crises in Lebanon. A nationally representative stratified random sample of mother-child dyads (n = 511) was collected from households using a stratified cluster sampling design. The survey inquired about infant's feeding and complementary feeding practices using a valid questionnaire. Anthropometric measurements of the mother and child were collected. Multivariate logistic regression was conducted to explore the determinants associated with under-5 children's practices. The prevalence of underweight, stunting, wasting, overweight and obese children was 0.5%, 8.4%, 6.7%, 16.8% and 8.9%, respectively. In total, among under-5 children, the prevalence of ever breastfeeding, exclusive breastfeeding, and bottle feeding at birth was 95.1%, 59.1% and 25.8%, respectively. Half the children in this study started solid foods between 4 and 6 months. Regression analysis showed that supporting breastfeeding at hospital (aOR = 8.20, 95% CI (3.03-22.17)) and husband's support (aOR = 3.07, 95% CI (1.9-4.92)) were associated with increased breastfeeding odds. However, mother's occupation (aOR = 0.18, 95% CI (0.55-0.58)) was inversely associated with breastfeeding practices. Male children (aOR = 2.119, 95% CI (1.37-3.27), mothers diagnosed with COVID-19 (aOR = 0.58, 95% CI (0.35-0.95)), and bottle feeding at hospital (aOR = 0.5, 95% CI (0.32-0.77)) were more likely to induce early initiation of solid foods at 4 months of age. This study demonstrated non-negligible rates of malnutrition, low prevalence of exclusive breastfeeding, and high rates of early introduction of formula feeding and solid foods among Lebanese under-5-children amid escalating crises.

Associations between infant and maternal characteristics measured at child age 5 months and maternal feeding styles and practices up to child age two years

Facilitating positive feeding practices from infancy may be an important strategy to prevent childhood overweight and obesity. Since the feeding situation early in life constitutes a bidirectional relationship, it is important to understand the impact of both maternal and infant characteristics on maternal feeding practices to intervene in a customized and tailored way. Few studies have concurrently examined associations between maternal and infant characteristics in relation to early maternal feeding practices. The aim of the present study was to explore potential associations between infant and maternal characteristics measured at child age five months, and maternal feeding styles and practices during the child’s first two years. Cross-sectional data from a Norwegian randomized controlled trial in which participants responded to questionnaires at child age 5 months (n = 474), 12 months (n = 293) and 24 months (n = 185) were used to explore potential associations. All maternal and child predictor variables were collected at child age five months. Maternal feeding styles and practices were mapped using subscales from the Infant Feeding Questionnaire at child age 5 and 12 months and the Child Feeding Questionnaire and the Parental Feeding Style Questionnaire at child age 24 months. The subscale-scores were split into roughly equal tertiles, and the upper or lower tertile for the outcome of interest were used to create binary outcome variables. Multivariable binary logistic regression models were conducted for each outcome. We found that maternal education and mental health symptoms as well as infant weight, temperament and feeding mode were associated with maternal feeding styles and practices over time. Our findings indicate that risk factors which may have long-term implications for child weight and health outcomes can be identified early. Larger, population-based studies with a longitudinal design are needed to further explore these pathways.

Complementary Feeding Practices and Influencing Factors Among Children Under 2 Years of Age: A Cross-Sectional Study in Indonesia

PURPOSE

This study aimed to analyze the practice of complementary feeding and its influencing factors in children under 2 years of age in Indonesia.

METHODS

This cross-sectional study used data obtained from the 2017 National Socioeconomic Survey. The sample totaled 1,751 households with children under 2 years of age, who received complementary feeding in urban and rural communities. Furthermore, the practice of complementary feeding was evaluated on the basis of the variations in provided food grouped into two categories: complete and incomplete. This study applied bivariate and multivariate analytical methods. Multivariate analysis was performed using binary logistic regression.

RESULTS

The proportion of children under 2 years of age who received complementary feeding with complete variant food was 15.9%, while that with incomplete variant food was 84.1%. Furthermore, the factor influencing the practice of complementary feeding among the children was the mother's educational level (odds ratio: 1.481, 95% confidence interval: 0.245-0.943).

CONCLUSION

Complete complementary feeding, which involves a variety of food sources, is the best approach to improve the nutritional status of infants. Therefore, the source of food for complementary feeding must be accessible to all communities.

Exploring Physicians' Perspectives on the Introduction of Complementary Foods to Infants and Toddlers

Complementary feeding is the subject of many recommendations regarding the benefits of its use, illustrating its crucial impact on further health. However, it still poses a significant problem for caregivers, and thus for doctors. This survey focused on nutritional problems faced by the parents of infants and toddlers, as well as how physicians deal with these problems. Based on the responses from 303 doctors, it was determined that the time and sequence of introducing complementary foods raise the greatest doubts in parents. This study also found that at least one-third of pediatricians experience difficulties in providing effective nutritional counseling. Increasing the nutritional awareness of physicians can allow them to provide more appropriate support to parents.

Infant feeding in diverse families; the impact of ethnicity and migration on feeding practices

OBJECTIVE

To investigate differences in infant feeding practices and styles by maternal migration status.

DESIGN

Prospective cohort study.

SETTING

Maternity unit of a large hospital in Northern England PARTICIPANTS: Women recruited to the Born in Bradford longitudinal cohort study MEASUREMENTS: Breastfeeding initiation; breastfeeding at six months; breastfeeding at twelve months; timing of introduction of complementary feeding; maternal feeding style at twelve months.

FINDINGS

Migrant women were more likely to initiate breastfeeding and continue breastfeeding for longer compared to native women. Native women also introduced complementary feeding earlier than migrant women. There was evidence of feeding practices among second= generation migrants becoming increasingly more aligned with those of native women, with lower breastfeeding rates and earlier introduction of complementary feeding compared to first-generation migrants. Migrant women were more likely to adopt a 'Demanding' feeding style, with the strongest associations seen in first-generation migrants.

KEY CONCLUSIONS

Migration status is an important factor to consider in reference to infant feeding practices. This is particularly important in considering intergenerational changes in families with migration backgrounds and the potential of culture to impact on family practices.

IMPLICATIONS FOR PRACTICE

Interventions to maintain cultural norms around infant feeding in families with migration backgrounds would be beneficial, due to the observed higher rates of breastfeeding in first-generation migrants. Targeted interventions to improve breastfeeding in white British native women should consider the role that culture can play in encouraging positive health behaviours.

Infant processed food consumption and their interaction to breastfeeding and growth in children up to six months old

BACKGROUND

Evidences suggest that early processed food (PF) consumption may cause harm to infant health. During the first 6 months of life, it is not known whether the timing and quantity of this food group can impact breastfeeding and growth. The aim of the study was to analyze the associations between time of introduction and quantity of infant PF consumption with duration of breastfeeding and infant growth at 6 months of age.

METHODS

Data were longitudinally collected in six interviews, from birth to 6 months, in a sample of Brazilian newborns with adverse intrauterine environments. PF consumption was calculated by gravity score of processed foods (GSPF) in relation to feeding supply quality and time. For the analysis, the scores were divided into tertiles, making scores severities: Null, Mild, Moderate, and Severe. The interaction between GSPF and breastfeeding (exclusive and non-exclusive) and growth parameters (analyzed in Z-scores, by weight for height, weight for age, and body mass index for age) was tested.

RESULTS

A total of 236 infants were included in the study. Greater GSPF were associated with better rates of breastfeeding practices and higher growth indicators scores in the sixth month of infants. These findings were confirmed after adjustment for family income, maternal age, pre-gestational body mass index, and growth z scores at birth.

CONCLUSION

The harms of eating PF in relation to breastfeeding and infant growth are more evident the greater and earlier they are consumed. Future studies should explore interventions to reduce and delay the consumption of these foods to prevent adverse health outcomes in later life.

Complementary Feeding Practices and Parental Pressure to Eat among Spanish Infants and Toddlers: A Cross-Sectional Study

The introduction of complementary foods is a crucial stage in the development and determination of infants’ health status in both the short and longer-term. This study describes complementary feeding practices among infants and toddlers in Spain. Also, relationships among sample characteristics (both parents and their child), feeding practices (timing, type of complementary food), and parental pressure to eat were explored. Cognitive interviewing with 18 parents was used to refine the survey questions. Responses from a national random sample of 630 parents, who were responsible for feeding their infants and toddlers aged 3–18 months, were obtained. Solids, often cereals and/or fruits first, were introduced at a median age of five months. Fish and eggs were introduced around the age of nine and ten months. Almost all children were fed with home-prepared foods at least once per week (93%), and in 36% of the cases, salt was added. Interestingly, higher levels of parental pressure to eat were found in female infants, younger parents, parents with a full-time job, the southern regions of Spain, and in infants who were not fed with home-prepared foods. Our insights underline the importance of clear feeding recommendations that can support health care professionals in promoting effective strategies to improve parental feeding practices.

Timely Initiation of Complementary Feeding and Associated Factors among Mothers of Children Aged 6-24 Months in Dessie Referral Hospital, Northeast Ethiopia, 2019

Background

Timely, appropriate, safe, adequate, and frequent feeding is essential during the transition period for optimal growth and development as well as vulnerability of the child. The age of initiation of complementary feeding needs to be strongly addressed. Thus, the aim of this study was to determine timely initiation of complementary feeding and associated factors among mothers of children aged 6–24 months in Dessie Referral Hospital.

Methods

Institutional-based cross-sectional study was conducted among 280 mothers of children aged 6–24 months. A systematic random sampling technique was employed for selection of study participants by considering the 1st comer as a starting point and then at every 5th interval till the sample size was saturated at exit time. Data were collected using pretested and validated structured interviewer-administered questionnaire. Data were entered to Epi data version 3.1 and exported to SPSS version 20.0 software for analysis. Descriptive statistics and binary logistic regression model were used.

Results

Overall response rate was 98.2%. Among 275 mothers with children aged 6–24 months, 36 (13.1%), 179 (65.1%), and 60 (21.8%) mothers started giving complementary feeding for their children early (before six months), timely (at six months), and late (after six months), respectively. Mothers' educational status of grade 9–12 and college and above [AOR = 3.03; 95% CI (1.13–8.14), and AOR = 3.74; 95% CI (1.19–11.70), respectively], getting counsel [AOR = 2.83; 95% CI (1.54–5.21)], and poor knowledge [AOR = 0.37; 95% CI (0.19–0.72)] were found to be independent predictors.

Conclusions

Prevalence of timely initiation of complementary feeding was high as compared to the national prevalence. Mothers' educational status, getting counsel about complementary feeding, and knowledge were factors associated with timely initiation of complementary feeding. Therefore, awareness creation, counseling, and health education should be done on society by concerned bodies to improve timely introduction of complementary feeding level more than this result.

The Role of Early Programming and Early Nutrition on the Development and Progression of Celiac Disease: A Review

Experimental and epidemiological evidence has shown that modifications of the intrauterine environment can have deleterious consequences for individuals, expressed as an increased risk of suffering non-communicable pathologies in adult life, which is known as the hypothesis of the early origin of diseases or fetal programming. On the other hand, changes in gene expression patterns through epigenetic modifications can be the basis for long-term maintenance of the effects of fetal programming. In this sense, epigenetics comprises the study of intrauterine disturbances, which develop diseases in the adult, including celiac disease (CD). In addition, early feeding practices could influence the risk of CD development, such as breastfeeding timing and duration and age of gluten introduction in the diet. Gluten acts as a trigger for CD in genetically predisposed subjects, although approximately 30% of the world population has HLA DQ2 or DQ8, the prevalence of the disease is only 1–3%. It is not known what factors act to modify the risk of disease in genetically at-risk subjects. Taking into account all these considerations, the aim of the current review is to elucidate the role of early programming and the effect of early nutrition on the development and progression of CD. It is logical that attention has been paid to gluten as a key element in preventing the disease. However, there is no strong evidence in favor of the protective factor of breastfeeding, timing of introduction of gluten during lactation, and the development of CD. Diet, genetic risk, microbiota, and environmental interaction are possible triggers of the change in tolerance to an immune response to gluten, but large-scale cohort studies are needed. Emerging scientific concepts, such as epigenetics, may help us establish the role of these factors.

Introduction to complementary feeding in the first year of life and risk of overweight at 24 months of age: changes from 2004 to 2015 Pelotas (Brazil) Birth Cohorts

Complementary feeding (CF) and overweight relationships during early childhood are inconsistent in the literature. We described the association of CF during the first year of life with risk of overweight at 24 months of age in the population-based 2004 and 2015 Pelotas (Brazil) Birth Cohorts (2004c and 2015c). CF introduction was evaluated at the 3 and 12 months' follow-ups by asking mothers using a list of foods. Risk of overweight at 24 months of age was BMI-for-age z-score above +1sd from the median of the WHO 2006 growth standards. Our analyses included 3823 (2004c) and 3689 (2015c) children. Early introduction CF (before 6 months of age) prevalence in 2004c was 93·3 (95 % CI 92·5, 94·1) % and in 2015c was 87·2 (95 % CI 86·1, 88·2) %. Tea was the item introduced earlier in both 2004c (68·8 %) and 2015c (55·7 %). At 6 months of age, vegetable mash was the most introduced food in 2004c (33·5 %) and 2015c (47·9 %). Between 2004c and 2015c, the introduction of fresh milk decreased 82·1 to 60·5 % and yogurt from 94·4 to 78·1 % during the first year. Risk of overweight prevalence at 24 months was 33·0 (95 % CI 31·6, 34·5) % in 2004c and 32·0 (95 % CI 30·5, 33·5) % in 2015c. In 2015c, the adjusted odds of risk of overweight at 24 months were increased 1·66 and 1·50 times with the early introduction of fresh/powdered milk: plus water, tea or juice, and plus semi-solid/solid food groups, respectively. It is essential to reinforce the adherence to global recommendations on timely feeding introduction and encourage exclusive breast-feeding until 6 months of age to prevent child overweight.

Complementary feeding practice and associated factors among children aged 6 to 12 months attending governmental health facilities in Addis Ababa: Ethiopia

BACKGROUND: Inappropriate feeding practices, coupled with high rates of infectious diseases, are the proximate causes of malnutrition during the first two years of life. Around 10 million under-five children died annually of which over one-third were due to inappropriate complementary feeding. OBJECTIVE: To assess factors associated with timely initiation of complementary feeding among children aged 6 to 12 months in public health care facilities of Addis Ababa Ethiopia. METHODS: An institutional-based cross-sectional study design was conducted. Data was collected using a pretested structured questionnaire. Binary and multivariable logistic regressions analyses were performed. Variables with p-value ≤0.05 were considered as statistically significant. RESULTS: The proportion of timely initiation of complementary feeding was 65.2% (95% CI = 60.8, 69.5). Being married [AOR = 2.622, 95% CI: 1.182–5.817], belongs to 18–24 years age at first marriage [AOR = 1.671, 95% CI: 1.019–2.742], being grade 9 and above [AOR = 1.910, 95% CI: 1.401–2.258], average income > 1500 Ethiopian birr [AOR = 2.138, 95% CI: 1.762–2.347], and postnatal care follow up [AOR = 1.641, 95% CI:1.435–3.224] were significantly associated with complementary feeding. CONCLUSIONS: In this study, the magnitude of timely initiation complementary feeding was higher as compared to the country level figure. Implementing nutrition strategy which scales-up mother’s living standards improve complementary feedings practices.

Factors Influencing the Age of Complementary Feeding-A Cross-Sectional Study from Two European Countries

The timing of introducing complementary feeding affects nutritional status and children's health. The aim of this study was to determine sociodemographic and birth-related factors associated with the age of introducing complementary foods. This cross-sectional study investigated parents (n = 5815) of children aged 12-36 months from Poland (n = 4065) and Austria (n = 1750) using a single online questionnaire. During the study, detailed data about sociodemographic characteristics, variables related to pregnancy, and early feeding practices were collected. Univariate and multivariate logistic regression models were used to investigate factors associated with the introduction of complementary feeding before 4 completed months, between 4 and 6 months, and after 6 completed months separately for both countries. Complementary foods were introduced before 4 months in 3.0% of infants (2.4% in Poland and 4.3% in Austria), between 4 and 6 months in 65.0% (60.5% in Poland and 75.3% in Austria), and after 6 completed months in 32.1% of infants (37.1% in Poland and 20.4% in Austria). The factors related to earlier introduction of complementary feeding were lower maternal age (in Austria 25-29 years: aOR 2.21 (95% CI 1.06-4.65)) and education level (in Poland and Austria primary and vocational: aOR 14.49 (95% CI 3.73-56.35), aOR 2.13 (95% CI 1.10-4.11), respectively), preterm birth (in Poland and Austria: aOR 10.21 (95% CI 5.73-18.20); aOR 4.45 (95% CI 2.42-8.18), respectively), never breastfeeding (Poland: aOR 2.73 (95% CI 1.29 - 5.76)) and receiving an infant formula after hospital discharge (in both countries: aOR 3.73 (95% CI 2.06-6.75); aOR 3.65 (95% CI 1.87-7.12), respectively). These factors should be taken into account by health professionals in identifying mothers who are least likely to follow nutritional recommendations.