母乳喂养的孩子添加辅食的原则_WHO_2009

GUIDINGPRINCIPLESFORCOMPLEMENTARYFEEDINGOFTHEBREASTFEDCHILD5FoodandNutritionTABLEOFCONTENTSIntroductionDurationofexclusivebreastfeedingandageofintroductionofcomplementaryfoodsMaintenanceofbreastfeedingResponsivefeedingSafepreparationandstorageofcomplementaryfoodsAmountofcomplementaryfoodneededFoodconsistencyMealfrequencyandenergydensityNutrientcontentofcomplementaryfoodsUseofvitamin-mineralsupplementsorfortifiedproductsforinfantandmotherFeedingduringandafterillnessUseoftheseGuidingPrinciples81012141618202122252628ACKNOWLEDGEMENTSThisdocumentwaswrittenbyKathrynDewey.ChessaLutterwastheresponsibletechnicalofficerandprovidedcommentsandtechnicaloversight.JoseMartinesandBernadetteDaelmansprovidedextensivecomments.Anearlierdraftwasreviewedandcommentedonbythepar-ticipantsattheWHOGlobalConsultationonComplementaryFeeding,December10-13,2001.TABLESTable1:Minimumnumberofmealsrequiredtoattainthelevelofenergyneededfromcomplementaryfoodswithmeanenergydensityof0.6,0.8,or1.0kcal/gforchildrenindevelopingcountrieswithloworaveragelevelsofbreastmilkenergyintake(BME),byageandgroup.Table2:Minimumdietaryenergydensity(kcal/g)requiredtoattainthelevelofenergyneededfromcomplementaryfoodsin2-5meals/dbychildrenindevelopingcountrieswithloworaveragelevelofbreastmilkintake(BME)Table3:Percentageofenergyfromcomplementaryfoodsthatshouldbeprovidedasfattopreparedietswith30%or45%oftotalenergyasfat,forchildrenindevelopingcountries,byagegroupandlevelofbreastmilkenergyintakeTable4:PotentialassessmentneedsandactionsGuidingPrinciplesforComplementaryFeedingoftheBreastfeedChild7FoodandNutrition3333333436INTRODUCTIONAdequatenutritionduringinfancyandearlychildhoodisfundamentaltothedevelopmentofeachchild’sfullhumanpotential.Itiswellrecognizedthattheperiodfrombirthtotwoyearsofageisa“criticalwindow”forthepromotionofoptimalgrowth,healthandbehavioraldevelop-ment.Longitudinalstudieshaveconsistentlyshownthatthisisthepeakageforgrowthfalter-ing,deficienciesofcertainmicronutrients,andcommonchildhoodillnessessuchasdiarrhea.Afterachildreaches2yearsofage,itisverydifficulttoreversestuntingthathasoccurredearli-er(Martorelletal.,1994).Theimmediateconsequencesofpoornutritionduringtheseforma-tiveyearsincludesignificantmorbidityandmortalityanddelayedmentalandmotordevelop-ment.Inthelong-term,earlynutritionaldeficitsarelinkedtoimpairmentsinintellectualper-formance,workcapacity,reproductiveoutcomesandoverallhealthduringadolescenceandadulthood.Thus,thecycleofmalnutritioncontinues,asthemalnourishedgirlchildfacesgreateroddsofgivingbirthtoamalnourished,lowbirthweightinfantwhenshegrowsup.Poorbreastfeedingandcomplementaryfeedingpractices,coupledwithhighratesofinfectiousdis-eases,aretheprincipalproximatecausesofmalnutritionduringthefirsttwoyearsoflife.Forthisreason,itisessentialtoensurethatcaregiversareprovidedwithappropriateguidanceregardingoptimalfeedingofinfantsandyoungchildren.Complementaryfeedingisdefinedastheprocessstartingwhenbreastmilkaloneisnolongersufficienttomeetthenutritionalrequirementsofinfants,andthereforeotherfoodsandliquidsareneeded,alongwithbreastmilk.Thetargetagerangeforcomplementaryfeedingisgener-allytakentobe6to24monthsofage,eventhoughbreastfeedingmaycontinuebeyondtwoyears.Areviewoffeedingguidelinespromotedbyvariousnationalandinternationalorganiza-tionshasshownthatthereareinconsistenciesinthespecificrecommendationsforfeedinginfantsandyoungchildren(Dewey,inpress).Someofthefeedingguidelinesarebasedmoreontraditionandspeculationthanonscientificevidence,orarefarmoreprescriptivethanisnec-essaryregardingissuessuchastheorderoffoodsintroducedandtheamountsofspecificfoodstobegiven.Toavoidconfusion,asetofunified,scientificallybasedguidelinesisneeded,whichcanbeadaptedtolocalfeedingpracticesandconditions.8FoodandNutritionThetargetagerangeforcomple-mentaryfeedingisgenerallytakentobe6to24monthsofage,eventhoughbreastfeedingmaycontinuebeyondtwoyears.Theguidelinesdescribedhereinweredevelopedfromdiscussionsatseveraltechnicalconsul-tationsanddocumentsoncomplementaryfeeding(WHO/UNICEF,1998;WHO/UNICEFTechnicalConsultationonInfantandYoungChildFeeding,2000;WHOGlobalConsultationonComplementaryFeeding,2001;AcademyforEducationalDevelopment,1997;DeweyandBrown,2002).Thetargetgroupfortheseguidelinesisbreastfedchildrenduringthefirsttwoyearsoflife.Thisdocumentdoesnotcoverspecificfeedingrecommendationsfornon-breast-fedchildren,althoughmanyoftheguidelinesarealsoappropriateforsuchchildren(exceptfortherecommendationsregardingmealfrequencyandnutrientcontentofcomplementaryfoods).Appropriatedietsforchildrenwhoarenotbreastfed(suchasthoseofHIV-positivemotherswhochoosenottobreastfeed),oftenreferredtoas“replacementfeeding”,arethesubjectofotherdocuments(WHO/UNICEFHIVandInfantFeedingCounseling:AtrainingCourse,2000).Itshouldalsobenotedthattheguidelineshereinapplytonormal,terminfants(thisincludeslowbirthweightinfantsbornat37weeksgestation).Infantsorchildrenrecoveringfromacutemal-nutritionorseriousillnessesmayneedspecializedfeeding,whichiscoveredbyclinicalmanu-als(forexample,theWHOmanual“ManagementoftheChildwi