Energy Intake by Young Children in Developing Countries

The period of complementary feeding refers to the stage of life when foods and/or liquid milks are fed to infants and young children in addition to breast milk; non-breast-milk food items consumed at this time are defined as complementary foods. Complementary foods may be either prepared specially for the young child, both to meet age-related nutritional needs and to mitigate immaturity in chewing and swallowing, or they may be selected from the same foods consumed by the remainder of the family. Depending on the nature of complementary foods, and their nutritional content, hygienic characteristics, and age of introduction, they may be either beneficial or harmful for the young child in particular circumstances. The optimal age for introduction of complementary foods has been somewhat controversial. Until recently, most international agencies and national and regional paediatric societies have suggested that they should be started during the period from 4 to 6 months of age. However, recent evidence suggests that children who are exclusively breast-fed by reasonably-well-nourished mothers may not benefit from these foods before 6 months (Cohen et al. 1994). Because the introduction of these foods carries an elevated risk of diarrhoea and other infections (Brown et al. 1989; Popkin et al. 1990; De Zoysa et al. 199 l), it is not advisable to initiate them before the period of demonstrable nutritional benefit. The World Health Assembly in 1994 urged member states to ‘promote sound infant nutrition by fostering appropriate complementary feeding practices from the age of about six months’. The period of complementary feeding is of particular concern in low-income countries because it is often accompanied by considerable growth faltering with respect to international reference data (Waterlow, 1988; Allen, 1994). The possible reasons for poor growth include low food intake; inadequate content, balance or bio-utilization of specific nutrients; and high rates of infections. The present paper will focus on some of the factors that influence food intake in these settings.