2017意见书:辅食添加
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Copyright © ESPGHAL and NASPGHAN. All rights reserved.ComplementaryFeeding:APositionPaperbythe
EuropeanSocietyforPaediatricGastroenterology,
Hepatology,andNutrition(ESPGHAN)Committeeon
Nutrition
ÃMaryFewtrell,yJiriBronsky,zCristinaCampoy,§MagnusDomello¨f,jjNicholasEmbleton,
ôNatasˇaFidlerMis,#IvaHojsak,ÃÃJessieM.Hulst,yyFlaviaIndrio,zz§§AlexandreLapillonne,
andjjjjôôChristianMolgaard
ABSTRACT
Thispositionpaperconsidersdifferentaspectsofcomplementaryfeeding
(CF),focussingonhealthyterminfantsinEurope.Afterreviewingcurrent
knowledgeandpractices,wehaveformulatedtheserecommendations:
Timing:Exclusiveorfullbreast-feedingshouldbepromotedforatleast
4months(17weeks,beginningofthe5thmonthoflife)andexclusiveor
predominantbreast-feedingforapproximately6months(26weeks,begin-
ningofthe7thmonth)isadesirablegoal.Complementaryfoods(solidsand
liquidsotherthanbreastmilkorinfantformula)shouldnotbeintroduced
before4monthsbutshouldnotbedelayedbeyond6months.Content:
Infantsshouldbeofferedfoodswithavarietyofflavoursandtextures
includingbittertastinggreenvegetables.Continuedbreast-feedingisrecom-
mendedalongsideCF.Wholecows’milkshouldnotbeusedasthemain
drinkbefore12monthsofage.AllergenicfoodsmaybeintroducedwhenCF
iscommencedanytimeafter4months.Infantsathighriskofpeanutallergy
(thosewithsevereeczema,eggallergy,orboth)shouldhavepeanut
introducedbetween4and11months,followingevaluationbyanappro-
priatelytrainedspecialist.Glutenmaybeintroducedbetween4and12
months,butconsumptionoflargequantitiesshouldbeavoidedduringthe
firstweeksafterglutenintroductionandlaterduringinfancy.Allinfants
shouldreceiveiron-richCFincludingmeatproductsand/oriron-fortified
foods.NosugarorsaltshouldbeaddedtoCFandfruitjuicesorsugar-
sweetenedbeveragesshouldbeavoided.Vegandietsshouldonlybeused
underappropriatemedicalordieteticsupervisionandparentsshouldunder-
standtheseriousconsequencesoffailingtofollowadviceregarding
supplementationofthediet.Method:Parentsshouldbeencouragedto
respondtotheirinfant’shungerandsatietyqueuesandtoavoidfeeding
tocomfortorasareward.
KeyWords:breast-feeding,complementaryfeeding,formulafeeding,
healthoutcomes,infant
(JPGN2017;64:
119–132)WhatIsKnown
Complementaryfoodsarenecessaryforbothnutri-
tionalanddevelopmentalreasons,andarean
importantstageinthetransitionfrommilkfeeding
tofamilyfoods.
Thecomplementaryfeedingperiodisoneofrapid
growthanddevelopmentwheninfantsaresusceptible
tonutrientdeficienciesandexcesses,andduringwhich
therearemarkedchangesinthedietwithexposuresto
newfoods,tastes,andfeedingexperiences.
Therelativelylimitedscientificevidencebaseis
reflectedinconsiderablevariationincomplementary
feedingrecommendationsandpracticesbetween
andwithincountries.
WhatIsNew
ThepositionpaperpublishedbythisCommitteein
2008hasbeenupdatedtoincludenewevidence,
includingdatafromrandomizedcontrolledtrialson
theintroductionofglutenandallergenicfoods.
Thearticleconsidersthetimingandcontentof
complementaryfeeding,themethodoffeeding,
andspecificdietarypractices,andmakesrecommen-
dations,focussingonhealthyterminfantsinEurope.
ReceivedOctober19,2016;acceptedOctober24,2016.FromtheÃChildhoodNutritionResearchCentre,UCLGreatOrmondStreetInstituteofChildHealth,London,UK,theyDepartmentofPaediatrics,UniversityHospitalMotol,Prague,CzechRepublic,thezDepartmentofPaediatrics,UniversityofGranada,Granada,Spain,the§DepartmentofClinicalSciences,Pediatrics,Umea˚University,Umea˚,Sweden,thejjNewcastleNeonatalService,NewcastleHospitalsNHSTrustandNew-castleUniversity,NewcastleuponTyne,UK,theôDepartmentofGas-troenterology,HepatologyandNutrition,UniversityChildren’sHospital,UniversityMedicalCentreLjubljana,Ljubljana,Slovenia,the#Univer-sityChildren’sHospitalZagreb,Zagreb,Croatia,theÃÃErasmusMC,SophiaChildren’sHospital,Rotterdam,TheNetherlands,theyyOspedalePediatricoGiovanniXXIII,UniversityofBari,Bari,Italy,thezzParisDescartesUniversity,APHPNecker-EnfantsMaladesHospital,Paris,France,the§§CNRC,BaylorCollegeofMedicine,Houston,TX,thejDepartmentofNutrition,ExerciseandSports,UniversityofCopenhagen,København,andtheôôPediatricNutritionUnit,Copenha-genUniversityHospital,Rigshospitalet,Denmark.AddresscorrespondenceandreprintrequeststoMaryFewtrell,MD,Child-hoodNutritionResearchCentre,UCLGreatOrmondStreetInstituteofChildHealth,30GuilfordSt,LondonWC1N1EH,UK(e-mail:m.fewtrell@ucl.ac.uk).Supplementaldigitalcontentisavailableforthisarticle.DirectURLcitationsappearintheprintedtext,andlinkstothedigitalfilesareprovidedintheHTMLtextofthisarticleonthejournal’sWebsite(www.jpgn.org).Theauthorsreportnoconflictsofinterest.Copyright#2016byEuropeanSocietyforPediatricGastroenterology,Hepatology,andNutritionandNorthAmericanSocietyforPediatricGastroenterology,Hepatology,andNutritionDOI: