Complementary Feeding in Italy: From Tradition to Innovation
Abstract
:1. Introduction
2. Materials and Methods
- “Sweet milk flour”: a popular method used in the past decades, with sweet milk flour as the base for making the first weaning food, nowadays it has been almost completely abandoned.
- “Traditional spoon-feeding”: a widely used method involving feeding babies homemade liquid or semi-liquid foods, or commercial BFs. The basic plate in this case is made of vegetable broth with semolina or rice flour, freeze-dried meat or fresh meat, olive oil and parmesan cheese.
- “Traditional spoon-feeding with adult food tastings”: while following a traditional CF style, parents often decide to let their children have a tasting of other foods, especially when sharing the meal. In this case, parents mash and mince the food they are eating and feed it to their child, mixing the traditional approach with some aspects typical of other methods of CF (such as BLW or self-weaning).
- “Self-weaning”: an on-demand approach pioneered by the Italian pediatrician Lucio Piermarini [9], similar to the baby-led weaning (BLW) method described by Rapley [10] considering that the food offered to the infant is partly the same that the parents eat; the main difference is that in the self-weaning approach the food is minced, mashed and spoon-fed instead of being hand-held by the infant.
3. Results
3.1. Questionnaire to Pediatricians
3.1.1. Type of CF
3.1.2. Age of CF Introduction
3.1.3. Written Information
3.1.4. BFs
3.2. Questionnaire to Families
3.2.1. Breastfeeding
3.2.2. Timing of Complementary Foods Introduction
3.2.3. Type of CF
3.2.4. BFs
3.2.5. Pediatrician Indications
4. Discussion
4.1. Breastfeeding
4.2. Complementary Feeding
4.3. Role of PCPs
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Monteiro, C.A.; Cannon, G.; Lawrence, M.; da Costa Louzada, M.L.; Pereira Machado, P. Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System; FAO: Rome, Italy, 2019. [Google Scholar]
- Fewtrell, M.; Bronsky, J.; Campoy, C.; Domellöf, M.; Embleton, N.; Mis, N.F.; Hojsak, I.; Hulst, J.M.; Indrio, F.; Lapillonne, A.; et al. Complementary Feeding: A position paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) committee on nutrition. J. Pediatr. Gastroenterol. Nutr. 2017, 64, 119–132. [Google Scholar] [CrossRef]
- Warren, J. An update on complementary feeding. Nurs. Child. Young People 2018, 30, 38–47. [Google Scholar] [CrossRef]
- Langley-Evans, S.C. Nutrition in early life and the programming of adult disease: A review. J. Hum. Nutr. Diet. 2014, 28, 1–14. [Google Scholar] [CrossRef]
- WHO. Global Strategy for Infant and Young Child Feeding; World Health Organization: Geneva, Switzerland, 2003. [Google Scholar]
- EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA); Castenmiller, J.; De Henauw, S.; Hirsch-Ernst, K.; Kearney, J.; Knutsen, H.K.; Maciuk, A.; Mangelsdorf, I.; McArdle, H.J.; Naska, A.; et al. Appropriate age range for introduction of complementary feeding into an infant’s diet. EFSA J. 2019, 17, e05780. [Google Scholar]
- Caroli, M.; Mele, R.; Tomaselli, M.; Cammisa, M.; Longo, F.; Attolini, E. Complementary feeding patterns in Europe with a special focus on Italy. Nutr. Metab. Cardiovasc. Dis. 2012, 22, 813–818. [Google Scholar] [CrossRef]
- Giovannini, M.; Riva, E.; Banderali, G.; Scaglioni, S.; Veehof, S.H.E.; Sala, M.; Radaelli, G.; Agostoni, C. Feeding practices of infants through the first year of life in Italy. Acta Paediatr. 2004, 93, 492–497. [Google Scholar] [CrossRef] [PubMed]
- Piermarini, L. Io mi Svezzo da solo! Dialoghi sullo Svezzamento; Bonomi Editore: Pavia, Italy, 2009. [Google Scholar]
- Rapley, G.; Murkett, T. Baby-Led Weaning: Helping Your Baby to Love Good Food; Random House: New York, NY, USA, 2008. [Google Scholar]
- Annuario Statistico del Servizio Sanitario Nazionale. Anno 2018. Available online: https://www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=2980 (accessed on 19 December 2020).
- Gidrewicz, D.A.; Fenton, T.R. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr. 2014, 14, 216. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Congiu, M.; Reali, A.; Deidda, F.; Dessì, A.; Bardanzellu, F.; Fanos, V. Breast Milk for Preterm Multiples: More Proteins, Less Lactose. Twin Res. Hum. Genet. 2019, 22, 265–271. [Google Scholar] [CrossRef]
- Breastfeeding: A Mother’s Gift, for Every Child. Available online: https://data.unicef.org/resources/breastfeeding-a-mothers-gift-for-every-child/ (accessed on 2 May 2018).
- ISTAT. Gravidanza, Parto e Allattamento al Seno. Available online: https://www.istat.it/it/files//2014/12/gravidanza.pdf (accessed on 9 December 2014).
- Huh, S.Y.; Rifas-Shiman, S.L.; Taveras, E.M.; Oken, E.; Gillman, M.W. Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics 2011, 127, e544–e551. [Google Scholar] [CrossRef] [PubMed]
- Ferreira, H.L.O.C.; Oliveira, M.F.D.; Bernardo, E.B.R.; Almeida, P.C.D.; Aquino, P.D.S.; Pinheiro, A.K.B. Fatoresassociados à adesãoaoaleitamentomaternoexclusivo. Ciencia Saude Coletiva 2018, 23, 683–690. [Google Scholar] [CrossRef]
- Alvisi, P.; Brusa, S.; Alboresi, S.; Amarri, S.; Bottau, P.; Cavagni, G.; Corradini, B.; Landi, L.; Loroni, L.; Marani, M.; et al. Recommendations on complementary feeding for healthy, full-term infants. Ital. J. Pediatr. 2015, 41, 36. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Brown, A.; Lee, M. An exploration of experiences of mothers following a baby-led weaning style: Developmental readiness for complementary foods. Matern. Child Nutr. 2011, 9, 233–243. [Google Scholar] [CrossRef] [Green Version]
- D’Auria, E.; Borsani, B.; Pendezza, E.; Bosetti, A.; Paradiso, L.; Zuccotti, G.V.; Verduci, E. Complementary feeding: Pitfalls for health outcomes. Int. J. Environ. Res. Public Health 2020, 17, 7931. [Google Scholar] [CrossRef]
- Muraro, A.; Halken, S.; Arshad, S.H.; Beyer, K.; Dubois, A.E.J.; Du Toit, G.; Eigenmann, P.; Grimshaw, K.; Hoest, A.; Lack, G.; et al. EAACI Food Allergy and Anaphylaxis Guidelines. Primary prevention of food allergy. Allergy Eur. J. Allergy Clin. Immunol. 2014, 69, 590–601. [Google Scholar] [CrossRef]
- Prescott, S.L.; Smith, P.; Tang, M.; Palmer, D.J.; Sinn, J.; Huntley, S.J.; Cormack, B.; Heine, R.G.; Gibson, R.A.; Makrides, M. The importance of early complementary feeding in the development of oral tolerance: Concerns and controversies. Pediatr. Allergy Immunol. 2008, 19, 375–380. [Google Scholar] [CrossRef] [PubMed]
- Mermiri, D.-Z.T.; Lappa, T.; Papadopoulou, L.A. Review suggests that the immunoregulatory and anti-inflammatory properties of allergneic foods can provoke oral tolerance if introduced early to infants’ diets. Acta Paediatr. 2017, 106, 721–726. [Google Scholar] [CrossRef] [PubMed]
- Ferraro, V.; Zanconato, S.; Carraro, S. Timing of Food Introduction and the Risk of Food Allergy. Nutrients 2019, 11, 1131. [Google Scholar] [CrossRef] [Green Version]
- Beauchamp, G.K.; Moran, M. Dietary experience and sweet taste preference in human infants. Appetite 1982, 3, 139–152. [Google Scholar] [CrossRef]
- Keller, K.L.; Steinmann, L.; Nurse, R.J.; Tepper, B.J. Genetic taste sensitivity to 6-n-propylthiouracil influences food preference and reported intake in preschool children. Appetite 2002, 38, 3–12. [Google Scholar] [CrossRef]
- Mennella, J.A.; Jagnow, C.P.; Beauchamp, G.K. Prenatal and Postnatal Flavor Learning by Human Infants. Pediatrics 2001, 107, e88. [Google Scholar] [CrossRef] [Green Version]
- Robino, A.; Paviotti, G.; Cont, G. Genetica del gusto e svezzamento. Medico e Bambino 2020, 39, 20–22. [Google Scholar]
- Maier-Nöth, A.; Schaal, B.; Leathwood, P.; Issanchou, S. The lasting influences of early food-related variety experience: A longitudinal study of vegetable acceptance from 5 months to 6 years in two populations. PLoS ONE 2016, 11, e0151356. [Google Scholar] [CrossRef] [Green Version]
- Cameron, S.L.; Heath, A.-L.M.; Taylor, R.W. How feasible is baby-led weaning as an approach to infant feeding? A review of the evidence. Nutrients 2012, 4, 1575–1609. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Remy, E.; Issanchou, S.; Chabanet, C.; Nicklaus, S. Repeated exposure of infants at complementary feeding to a vegetable puŕee increases acceptance as effectively as flavor-flavor learning and more effectively than flavor-nutrient learning. J. Nutr. 2013, 143, 1194–1200. [Google Scholar] [CrossRef] [Green Version]
- Brown, A. No difference in self-reported frequency of choking between infants introduced to solid foods using a baby-led weaning or traditional spoon-feeding approach. J. Hum. Nutr. Diet. 2017, 31, 496–504. [Google Scholar] [CrossRef] [PubMed]
- Morison, B.J.; Taylor, R.W.; Haszard, J.J.; Schramm, C.J.; Erickson, L.W.; Fangupo, L.J.; Fleming, E.A.; Luciano, A.; Heath, A.-L.M. How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6–8 months. BMJ Open 2016, 6, e010665. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Daniels, L.; Heath, A.-L.M.; Williams, S.M.; Cameron, S.L.; Fleming, E.A.; Taylor, B.; Wheeler, B.J.; Gibson, R.S.; Taylor, R.W. Baby-Led Introduction to SolidS (BLISS) study: A randomised controlled trial of a baby-led approach to complementary feeding. BMC Pediatr. 2015, 15, 179. [Google Scholar] [CrossRef] [Green Version]
- Daniels, L.; Taylor, R.W.; Williams, S.M.; Gibson, R.S.; Fleming, E.A.; Wheeler, B.; Taylor, B.J.; Haszard, J.J.; Heath, A.-L.M. Impact of a modified version of baby-led weaning on iron intake and status: A randomised controlled trial. BMJ Open 2018, 8, e019036. [Google Scholar] [CrossRef]
- Daniels, L.; Taylor, R.W.; Williams, S.M.; Gibson, R.S.; Samman, S.; Wheeler, B.J.; Taylor, B.J.; Fleming, E.A.; Hartley, N.K.; Heath, A.-L.M. Modified Version of Baby-Led Weaning Does Not Result in Lower Zinc Intake or Status in Infants: A Randomized Controlled Trial. J. Acad. Nutr. Diet. 2018, 118, 1006–1016.e1. [Google Scholar] [CrossRef]
- Erickson, L.W.; Taylor, R.W.; Haszard, J.J.; Fleming, E.A.; Daniels, L.; Morison, B.J.; Leong, C.; Fangupo, L.J.; Wheeler, B.J.; Taylor, B.; et al. Impact of a modified version of baby-led weaning on infant food and nutrient intakes: The BLISS randomized controlled trial. Nutrients 2018, 10, 740. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Carstairs, S.; Craig, L.C.A.; Marais, D.; Bora, O.E.; Kiezebrink, K. A comparison of preprepared commercial infant feeding meals with home-cooked recipes. Arch. Dis. Child. 2016, 101, 1037–1042. [Google Scholar] [CrossRef]
- Mesch, C.M.; Stimming, M.; Foterek, K.; Hilbig, A.; Alexy, U.; Kersting, M.; Libuda, L. Food variety in commercial and homemade complementary meals for infants in Germany. Market survey and dietary practice. Appetite 2014, 76, 113–119. [Google Scholar] [CrossRef]
- Noble, S.; Emmett, P. Differences in weaning practice, food and nutrient intake between breast- and formula-fed 4-month-old infants in England. J. Hum. Nutr. Diet. 2006, 19, 303–313. [Google Scholar] [CrossRef]
- Boudet-Berquier, J.; Salanave, B.; De Launay, C.; Castetbon, K. Introduction of complementary foods with respect to French guidelines: Description and associated socio-economic factors in a nationwide birth cohort (Epifane survey). Matern. Child Nutr. 2016, 13, e12339. [Google Scholar] [CrossRef]
- Blissett, J. Relationships between parenting style, feeding style and feeding practices and fruit and vegetable consumption in early childhood. Appetite 2011, 57, 826–831. [Google Scholar] [CrossRef]
- Komninou, S.; Halford, J.; Harrold, J. Differences in parental feeding styles and practices and toddler eating behaviour across complementary feeding methods: Managing expectations through consideration of effect size. Appetite 2019, 137, 198–206. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hodges, E.A.; Wasser, H.M.; Colgan, B.K.; Bentley, M.E. Development of Feeding Cues During Infancy and Toddlerhood. MCN Am. J. Matern. Nurs. 2016, 41, 244–251. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Brambilla, P.; Giussani, M.; Picca, M.; Bottaro, G.; Buzzetti, R.; Milani, G.P.; Agostoni, C.; Becherucci, P. Do the opinions of pediatricians influence their recommendations on complementary feeding? Preliminary results. Eur. J. Pediatr. 2019, 179, 627–634. [Google Scholar] [CrossRef]
- Martínez Rubio, A.; Cantarero Vallejo, D.; Espín Jaime, B. ¿Cómo orientan los pediatras de Atención Primaria la alimentación complementaria? Pediatría Atención Primaria 2018, 20, 35–44. [Google Scholar]
What style of CF do you usually suggest? | |||
Sweet milk flour | Traditional spoon-feeding | Self-weaning | Traditional with adult food tastings |
What age do you suggest to begin CF at? | |||
4 months (91–120 days) | 5 months (121–150 days) | 6 months (151–180 days) | 7 months (181–210 days) |
Do you provide families with written information about CF? | |||
yes | no | ||
Do you endorse the use of commercial BFs for CF? | |||
yes | no |
Since Birth, Your Infant Has Been Fed with… | ||||||
Breast and Formula Milk | Only Formula Milk | Breast Milk until 3 Months | Breast Milk until 6 Months | |||
When did you offer your infant complementary foods? (Months of age) | ||||||
3 | 4 | 5 | 6 | 7 | 8 | >8 |
What style of CF did you use? | ||||||
Sweet milk flour | Traditional spoon-feeding | Self-weaning | Traditional with adult food tastings | |||
Did you feed your infant commercial BFs? | ||||||
yes | no | sometimes | ||||
Did you follow your family care pediatrician’s indications? | ||||||
yes | no | partly |
Questionnaire Items | Italy | North | Center | South | p Value |
---|---|---|---|---|---|
n = 665 | n = 207 | n = 302 | n = 156 | ||
Style of CF * n (%) | |||||
Traditional spoon-feeding | 397 (60%) | 99 (48%) | 185 (62%) | 113 (73%) | <0.01 |
Self-weaning | 82 (12%) | 33 (16%) | 34 (11%) | 15 (10%) | 0.14 |
Traditional with adult food tastings | 186 (28%) | 75 (36%) | 82 (27%) | 27 (17%) | <0.01 |
Age (months) n (%) | |||||
4 | 50 (7.5%) | 7 (3%) | 21 (7%) | 22 (14%) | <0.01 |
5 | 308 (46%) | 107 (52%) | 122 (41%) | 79 (51%) | 0.02 |
6 | 297 (45%) | 91 (44%) | 155 (51%) | 51 (33%) | <0.0001 |
7 | 10 (1.5%) | 2 (1%) | 4 (1%) | 4 (2%) | 0.41 |
Written information n (%) | |||||
yes | 604 (91%) | 185 (89%) | 283 (94%) | 136 (87%) | 0.049 |
no | 61 (9%) | 22 (11%) | 19 (6%) | 20 (13%) | 0.049 |
Advise of BFs n (%) | |||||
yes | 422 (63%) | 125 (60%) | 171 (57%) | 126 (81%) | <0.01 |
no | 243 (37%) | 82 (40%) | 131 (43%) | 30 (19%) | <0.001 |
Questionnaire Items | Italy | North | Center | South | p Value |
---|---|---|---|---|---|
n = 2023 | n = 584 | n = 1230 | n = 209 | ||
Type of milk * n (%) | |||||
Mixed | 248 (16%) | 45 (16%) | 175 (15%) | 28 (21.5%) | 0.144 |
Only artificial | 455 (29%) | 46 (17%) | 373 (32%) | 36 (27.7%) | 0.011 |
Maternal until 3 months | 126 (8%) | 26 (10%) | 86 (7%) | 14 (10.8%) | 0.242 |
Maternal until 6 months | 741 (47%) | 156 (57%) | 533 (46%) | 52 (40%) | |
Style of CF n (%) | |||||
Sweet milk flour | 73 (4%) | 27 (5%) | 33 (3%) | 13 (6.2%) | 0.01 |
Traditional spoon-feeding | 1555 (77%) | 359 (61%) | 1031 (84%) | 165 (78.9%) | <0.001 |
Self-weaning | 190 (9%) | 79 (14%) | 91 (7%) | 20 (9.6%) | <0.001 |
Traditional with adult food tastings | 205 (10%) | 119 (20%) | 75 (6%) | 11 (5.3%) | <0.001 |
Age (months) n (%) | |||||
3 | 23 (1%) | 4 (0.7%) | 16 (1%) | 3 (1.4%) | 0.467 |
4 | 248 (12%) | 40 (6.8%) | 179 (15%) | 29 (13.9%) | <0.001 |
5 | 740 (37%) | 230 (39.7%) | 428 (35%) | 80 (38.3%) | 0.041 |
6 | 817 (40%) | 249 (44%) | 482 (39%) | 79 (37.8%) | 0.122 |
7 | 103 (5%) | 28 (4.8%) | 65 (5%) | 10 (4.8%) | 0.886 |
8 | 32 (2%) | 10 (1.7%) | 19 (2%) | 3 (1.4%) | 0.950 |
>8 | 60 (3%) | 14 (2.3%) | 41 (3%) | 5 (2.4%) | 0.479 |
Use of BFs n (%) | |||||
yes | 667 (33%) | 253 (43%) | 353 (29%) | 61 (29%) | <0.001 |
no | 382 (19%) | 118 (20%) | 244 (20%) | 20 (10%) | 0.01 |
sometimes | 974 (48%) | 213 (37%) | 633 (51%) | 128 (61%) | 0.001 |
Adherence to indications n (%) | |||||
yes | 1688 (83%) | 445 (76%) | 1063 (87%) | 180 (86%) | <0.001 |
no | 74 (4%) | 19 (3%) | 54 (4%) | 1 (1%) | 0.017 |
partly | 261 (13%) | 120 (21%) | 113 (9%) | 28 (13%) | <0.001 |
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Alvisi, P.; Congiu, M.; Ficara, M.; De Gregorio, P.; Ghio, R.; Spisni, E.; Di Saverio, P.; Labriola, F.; Lacorte, D.; Lionetti, P. Complementary Feeding in Italy: From Tradition to Innovation. Children 2021, 8, 638. https://doi.org/10.3390/children8080638
Alvisi P, Congiu M, Ficara M, De Gregorio P, Ghio R, Spisni E, Di Saverio P, Labriola F, Lacorte D, Lionetti P. Complementary Feeding in Italy: From Tradition to Innovation. Children. 2021; 8(8):638. https://doi.org/10.3390/children8080638
Chicago/Turabian StyleAlvisi, Patrizia, Marco Congiu, Monica Ficara, Patrizia De Gregorio, Roberto Ghio, Enzo Spisni, Pietro Di Saverio, Flavio Labriola, Doriana Lacorte, and Paolo Lionetti. 2021. "Complementary Feeding in Italy: From Tradition to Innovation" Children 8, no. 8: 638. https://doi.org/10.3390/children8080638