Overview of 2011 consultation input on the draft Nutrition for Healthy Term Infants - Recommendations from Birth to Six Months

Stakeholders were invited to review and provide comments on the draft statement: Nutrition for Healthy Term Infants - Recommendations from Birth to Six Month between January 6 and April 15, 2011. All input received from the consultation was considered in preparing the revised draft the statement

The following table highlights some of the main comments received on the first consultation draft and the related changes reflected in the revised draft statement.

Overview of 2011 consultation input on the draft Nutrition for Healthy Term Infants - Recommendations from Birth to Six Months
What was heard Resulting changes to the draft
Clarify breastfeeding should continue beyond six months Added introductory statement: "Breastfeeding - exclusively for about the first six months, and sustained for up to two years or longer, with appropriate complementary feeding - is important for the nutrition, immunologic protection, growth, and development of infants and toddlers."
Avoid equating breastfeeding with formula feeding / Section on formula too long
  • Highlighted the 'importance' of breastfeeding rather than the 'benefits' of breastfeeding
  • Separated the guidance on infant formulas and breastfeeding
  • Omitted principle on the use of formula.
  • Added text on unique components of breastmilk
  • Condensed and simplified content on the composition of infant formulas and removed detail that provided no implication for practice.
Confusion about who needs supplemental vitamin D and for how long.
  • Clarified wording of principle and recommendation to avoid misinterpretation.
  • Added explanation that "Exclusively formula-fed infants do not require a vitamin D supplement because the formula contains adequate vitamin D."
  • Clarified the current recommendation for the duration of vitamin D supplementation for breastfed infants is to one year of age.
  • Added the following statement: "There are no known health benefits associated with intakes above 10 µg (400 IU) (IOM, 2011)."
  • Clarified position on maternal supplementation.
Reaction to the timing of introduction of solids
  • Changed guidance to 'at about six months of age' and referenced observing the infant's signs of readiness for solid foods.
  • Modified the recommendation to focus on the importance of iron-rich first foods.
  • Omitted advice concerning "If solids are introduced earlier than six months..."
Wording suggestions for the section on the protection, support and promotion of breastfeeding
  • Replaced seven recommendations with one overarching recommendation to implement the policies and practices of the WHO/UNICEF Baby-Friendly Initiative.
Discuss donor milk options for mothers unable to breastfeed
  • Added guidance on use of donor milk based on the WHO Global Strategy for Infant and Young Child Feeding
  • Referenced CPS statement on Human Milk Banking.
Evidence presented for six month exclusive duration or for any breastfeeding is inconsistent and unclear.
  • Clarified rationale and health outcomes specific to six months exclusive duration.
  • Delineated references for 'any' breastfeeding from those for the six month exclusive duration. Highlighted the strongest evidence related to outcomes for the infant.
Guidance on iron supplementation for breastfed infants before 6 months is unclear, incomplete or not appropriate in the section Removed guidance on iron supplementation from the first section and developed an In Practice note, which reflects the current lack of evidence about iron deficiency and the need for supplementation before six months, but identifies sub-groups known to be at greater risk.
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