Dietary and Complementary Feeding Practices of US Infants, 6 to 12 Months: A Narrative Review of the Federal Nutrition Monitoring Data

Complementary foods and beverages (CFBs) are key components of an infant’s diet in the second 6 months of life. This article summarizes nutrition and feeding practices examined by the 2020 Dietary Guidelines Advisory Committees during the CFB life stage. Breastfeeding initiation is high (84%), but exclusive breastfeeding at 6 months (26%) is below the Healthy People 2030 goal (42%). Most infants (51%) are introduced to CFBs sometime before 6 months. The primary mode of feeding (ie, human milk fed [HMF]; infant formula or mixed formula and human milk fed [FMF]) at the initiation of CFBs is associated with the timing of introduction and types of CFBs reported. FMF infants (42%) are more likely to be introduced to CFBs before 4 months compared with HMF infants (19%). Different dietary patterns, such as higher prevalence of consumption and mean amounts, were observed, including fruit, grains, dairy, proteins, and solid fats. Compared with HMF infants of the same age, FMF infants consume more total energy (845 vs 631 kcal) and protein (22 vs 12 g) from all sources, and more energy (345 vs 204 kcal) and protein (11 vs 6 g) from CFBs alone. HMF infants have a higher prevalence of risk of inadequate intakes of iron (77% vs 7%), zinc (54% vs <3%), and protein (27% vs <3%). FMF infants are more likely to have an early introduction (<12 months) to fruit juice (45% vs 20%) and cow’s milk (36% vs 24%). Registered dietitian nutritionists and nutritional professionals should consider tailoring their advice to caregivers on dietary and complementary feeding practices, taking into account the primary mode of milk feeding during this life stage to support infants’ nutrient adequacy. National studies that address the limitations of this analysis, including small sample sizes and imputed breast milk volume, could refine findings from this analysis.     

Association of infant feeding practices in the general population with infant growth and stool characteristics

This was a prospective cohort study of 976 infants from birth to 12 months of age. Infants were fed breast milk, goat infant formula, cow infant formula, or a combination of formula and breast milk during the first 4 months of age. Data on type of milk feeding and infant growth (weight and height) were collected at birth and at 4, 8, and 12 months during routine clinical assessment. The number and consistency of bowel motions per day were recorded based on observational data supplied by the mothers. Infants fed breast milk or goat or cow infant formula during the first 4 months displayed similar growth outcomes. More of the infants fed cow infant formula had fewer and more well-formed bowel motions compared with breast-fed infants. The stool characteristics of infants fed goat formula resembled those of infants fed breast milk.     

不同喂养方式对婴儿体格和智能发育的影响研究

目的 探讨不同喂养方式对婴儿体格和智能发育的影响。方法 根据生后前6个月的喂养方式将2010年至2013年在从化市妇幼保健院儿童保健门诊按规定程序体检且资料齐全的284例婴儿,分为母乳喂养组和混合喂养组。回顾性研究其在1、3、6、9、12个月的身长、体重、头围等体格发育和6、12个月智能发育情况。结果 母乳喂养组婴儿在6个月前的身长、体重均高于混合喂养组（两组1、3、6个月身长比较t值分别为4．25、2．20、3．80,体重比较t值分别为2．76、2．54、3．54,均P＜0．05）,两组在6个月后身长、体重无显著性差异（两组9、12个月身长比较t值分别为0．58、1．40,体重比较t值分别为0．61、1．83,均P＞0．05）;两组儿童的头围、发育商在1岁内均无显著性差异（t值为0．04～1．68,均P＞0．05）。结论 婴儿配方奶在很大程度上接近了母乳,但母乳仍然具有营养丰富、经济卫生、携带方便等不可替代的优势,是6个月内婴儿最好的天然食品。     

Lactational exposure to polychlorinated biphenyls,dichlorodiphenyltrichloroethane, and dichlorodiphenyldichloroethylene and infant growth: an analysis of the Pregnancy,Infection, and Nutrition Babies Study

Pan IJ, Daniels JL, Herring AH, Rogan WJ, Siega‐Riz AM, Goldman BD, Sjödin A. Lactational exposure to polychlorinated biphenyls, dichlorodiphenyltrichloroethane, and dichlorodiphenyldichloroethylene and infant growth: an analysis of the Pregnancy, Infection, and Nutrition Babies Study. Paediatric and Perinatal Epidemiology 2010; 24: 262–271. Polychlorinated biphenyls (PCB), 2,2‐bis(p‐chlorophenyl)‐1,1,1‐trichloroethane (p,p’‐DDT) and 2,2‐bis(p‐chlorophenyl)‐1,1‐dichloroethylene (p,p’‐DDE), the most stable metabolite of p,p’‐DDT, are persistent organic pollutants and environmental endocrine disruptors. Infant exposure to these chemicals through breast feeding may influence children's growth, but this potential adverse effect could be complicated by the coexisting benefits of breast feeding. This study examined the associations between lactational exposure to these chemicals and infant growth in the first 12 months by using data from the Pregnancy, Infection and Nutrition Babies Study in central North Carolina, United States, 2004–06. The study population was restricted to the infants who were breast fed for 6 months or longer. PCBs, p,p’‐DDT and p,p’‐DDE were measured in breast milk at 3 months postpartum. Lactational exposure up to 12 months of age was estimated as the product of chemical concentrations and the duration of breast feeding. The infant's weight and length were recorded from the medical record for each routine paediatric well‐child visit in the first 12 months. Women–child pairs who breast fed for 6 months or longer and returned the growth card (n = 210) were included in the study. Linear mixed effects models were used to assess the associations between chemical concentrations in breast milk and longitudinal infant weight and length measurements in the first 6 months. Multivariable linear regression models were used to assess the relationships between lactational exposure to chemicals until 12 months of age and the z‐scores of infant weight, length and weight‐for‐length at 12 months. Overall, no association was observed. Breast feeding for 6 months or longer, with lactational exposure to PCBs, p,p’‐DDT and p,p’‐DDE at the low background level concentrations studied here, resulted in no measurable influence on infant growth in the first 12 months.     

A novel infant formula milk with added long-chain polyunsaturated fatty acids from single-cell sources: a study of growth, satisfaction and health

OBJECTIVE: To evaluate the growth, feeding and health of babies fed a novel infant formula milk with added long chain polyunsaturated fatty acids (LCPs) produced from single-cell sources, at concentrations similar to those found in mature breast milk. DESIGN: Randomized double-blind control trial. SUBJECTS: One-hundred and forty healthy, full-term infants of birth weight 2.5-4.5 kg born at the Maternity Department, East Glamorgan General Hospital, Wales, whose mothers had already decided to bottle feed. INTERVENTIONS: Subjects were randomized to two groups; one (control group) to receive a standard formula milk and the other to receive the trial milk with added LCPs. Milks were supplied in a double-blind fashion and given for the first 12 weeks of life. Anthropometric measurements were made at recruitment, 3 months, 6 months and 1 y. Feeding diaries were completed at 6 weeks and 3 months, and a parental record was kept of any ill health suffered by the subjects during the first year of life. RESULTS: Of 140 infants recruited, 31 did not complete the protocol. Small but statistically significant differences were found only in the subscapular skinfold thickness at 6 weeks and 3 months, that in the trial group being slightly higher, but unlikely to be of any clinical importance. No differences were found in the feeding patterns of the infants in the two groups. Stool patterns were similar, as were the frequencies of illness and allergy. CONCLUSIONS: This study supports the view that LCPs from single-cell sources do not have detrimental effects on the growth, feeding and general health of infants.     

Contribution of complementary foods to the total daily water needs of urban Guatemalan infants

Background: Estimates of adequate intake (AI) for water only became available in 2005. The daily water AI for 6–12‐month‐old infants of both sexes is 800 mL. The present study aimed to estimate the water intake of urban infants receiving both breast milk and complementary feeding (CF) and to compare them with the reference AI. Methods: Sixty‐four infants, 42 boys and 22 girls, aged 6–12 months on enrolment, from a low‐income district of Guatemala City, were recruited to the study. Quantitative 24‐h recalls and breastfeeding histories were collected in three serial interviews. The quantity of water was estimated from recipes and food composition moisture values for the CF items reported. The amount of breast milk needed to complement foods and beverages in meeting the individual energy needs was calculated, and breast milk’s water contribution was derived accordingly. The total quantity of water in beverages, including human milk, liquids in recipes and moisture of foods, was tabulated as the infants’ daily intake. Results: Some 56.3% of the water needs for boys and 41.1% for girls were satisfied by just water obtained from plain water, other complementary beverages and moisture of foods within CF, exclusive of breast milk. Adding the estimated breast milk intake, the median water intake for the infant sample was essentially equal to the 800 mL of the AI. Conclusions: The infants in this low‐income community are approximating the recommended AI for daily water through the currently selected pattern of lactation and CF.     

How Feasible Is Baby-Led Weaning as an Approach to Infant Feeding? A Review of the Evidence

Baby-Led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. The BLW infant also shares family food and mealtimes and is offered milk (ideally breast milk) on demand until they self-wean. Anecdotal evidence suggests that many parents are choosing this method instead of conventional spoon-feeding of purées. Observational studies suggest that BLW may encourage improved eating patterns and lead to a healthier body weight, although it is not yet clear whether these associations are causal. This review evaluates the literature with respect to the prerequisites for BLW, which we have defined as beginning complementary foods at six months (for safety reasons), and exclusive breastfeeding to six months (to align with WHO infant feeding guidelines); the gross and oral motor skills required for successful and safe self-feeding of whole foods from six months; and the practicalities of family meals and continued breastfeeding on demand. Baby-Led Weaning will not suit all infants and families, but it is probably achievable for most. However, ultimately, the feasibility of BLW as an approach to infant feeding can only be determined in a randomized controlled trial. Given the popularity of BLW amongst parents, such a study is urgently needed.     

Growth pattern of exclusively breast-fed infants during the first six months of life in Ile-Ife,Osun State,Nigeria

Several studies to determine the growth pattern of exclusively breast fed infants have provided varying conclusions as to the sufficiency of breast milk alone to support adequate growth for the first six months of life. Disagreement exists concerning the optimal timing of introduction of complementary foods to exclusively breast fed infants. This prospective study thus examined the adequacy of breast milk alone to support normal growth during the first six months of life in our environment. The overall objective was to propose a scientifically sound national recommendation on the appropriate timing for the introduction of complementary feeding in Nigeria. Three hundred and fifty-two mother/infant pairs were serially recruited into the study; all babies were aged 14 days or less and weighed 2.5 kg and above. Three hundred and forty-five (98%) were successfully followed up till the infants were six months old. By six months, 264 (76.5%) were exclusively breast-fed, while 81 (23.5%) had commenced complementary feeding. Growth curves of exclusively breast-fed infants showed increasing weight from birth to six months. Although the 50th percentile birth weight for both boys and girls were the same (3.2 kg), boys gained weight faster than the girls from the age of one month to six months and were heavier at six months. Additionally, the 50th percentile curves of these infants (both genders) for the first six months were above the 50th percentile curve of the World Health Organisation and National Centre for Health Statistics (WHO/NCHS) reference currently used on our national "road to health" (growth monitoring) cards. It was concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the children studied and that our national recommendation that infants be introduced to complementary feeding at six months is appropriate.     

广东省4个月婴儿生长状况与喂养模式调查

在广东省的城乡对７７７名４个月的婴儿进行了生长状况与喂养模式的现况调查，与ＷＨＯ推荐的ＮＣＨＳ体格生长标准比较，城市婴儿４个月时其身长与体重的发育良好，而农村婴儿的身长和体重则低于参考标准，也低于同龄的城市婴儿。６４％城市婴儿和９９％的农村婴儿在４个月时仍喂哺母乳，７７％的城市婴儿和５９％的农村婴儿４个月前已经添加了辅助食品，辅助食品的种类有明显的城乡差别，农村辅食质量次于城市。母乳喂养有利于城乡４个月婴儿的体重生长，４个月前添加辅食影响农村婴儿体重生长。应继续在广东城乡提倡母乳喂养，不提倡过早添加辅食，应提高农村婴儿的断奶过渡食品的质量。     

Preliminary data from demographic and health surveys on infant feeding in 20 developing countries

This study describes infant feeding practices in developing countries, specifically complementary liquids and foods in the first year of life. Data were compiled from Demographic and Health Surveys conducted from 1999 to 2003. We analyzed data from those countries with available data, including results for child-level 24-h and 7-d food and fluid intakes. We used datasets from 20 countries with information on >35,000 infants categorized by age: 0-6 and 6-12 mo. For analysis, we grouped data for fluids other than breast milk as water, other milk (e.g., tinned, powdered, animal), infant formula, and other liquids (e.g., fruit juice, herbal tea, sugar water). All specific solid foods were grouped as any solid foods. We present data on breast-feeding and maternal-reported fluid and solid intake by infants in a 24-h period, for individual countries, and in a pooled analysis. Pooled data show that 96.6% of 0- to 6- and 87.9% of 6- to 12-mo-old infants were currently breast-fed. Reported feeding of other fluids was lower among 0- to 6-mo-olds than 6- to 12-mo-olds: water (45.9 vs. 87.4%), other milk products (11.9 vs. 29.6%), infant formula (9.0 vs. 15.1%), and other liquids (15.1 vs. 41.0%). Pooled analysis showed that 21.9% of mothers reported feeding 0- to 6-mo-old infants some type of solid food, and 80.1% of mothers reported feeding solids to 6- to 12-mo-olds. These survey data show that other milks, other liquids, and solid foods are each much more commonly fed throughout infancy than commercial infant formulas in the countries studied.     

Systematic review concerning the age of introduction of complementary foods to the healthy full-term infant

OBJECTIVES: To evaluate existing data from published studies investigating outcomes (growth, nutritional status and morbidity) in relation to the age of introduction of complementary foods to the healthy full-term infant. To assess the methodological quality of current scientific evidence on which infant feeding recommendations are based. SEARCH STRATEGY: A database was created following a search of electronic databases MEDLINE and BIDS, a handsearch of relevant journals and consultation with international experts in infant feeding practices. The search was conducted during a 6-month period and encompassed the years 1982-1998. INCLUSION CRITERIA: Randomised/non-randomised controlled trials and cohort studies investigating the relationship to the health of full-term infants of the introduction of complementary foods to childhood health. DATA COLLECTION AND ANALYSIS: Assessment of studies for inclusion and their compliance with methodological criteria was undertaken independently by two reviewers and discrepancies were resolved by discussion. RESULTS: From over 400 published papers identified, 33 met specific inclusion criteria. Significant differences in baseline characteristics of subjects in included studies meant that data were not amenable to meta-analysis. The consensus of the authors was that, of the 33 included publications, 13 contained data supporting the current WHO recommendations which attempt to accommodate all infants, including those whose nutritional requirements are not met by exclusive breast-feeding for 6 months. An equal number contained data that would support a recommendation for delaying the introduction of complementary foods until 6 months of age within the study population. The remaining seven were unable to provide evidence to support a change from the current WHO infant feeding recommendations which state that 'infants should be fed exclusively on breast milk from birth to 4-6 months of age'. None of the studies met all the methodological criteria. CONCLUSIONS: This review has shown that there is a lack of clear evidence to either support or refute a change to the current recommendations for the age of introduction of complementary foods to the breast milk or formula fed infant. Whilst exclusive breast feeding for the first 6 months of life can support growth and development in some infants, sub-groups have been identified within certain populations who may require complementary feeding prior to this age.     

Breast feeding and weaning practices of urban housewives in Srinagar

Researchers interviewed 125 mothers in Srinagar, India about breast feeding and weaning practices. Overall the mothers were generally illiterate (52%), housewives (67.2%), Muslim (76%), and from a nuclear family (56%). 39% were in the low income group. Most of the children (48%) ranged for 6-12 months old. 96% of the children had been breast fed. Some of the reasons for breast feeding included nutritional quality, economical, pleased the mother, and made the infant feel secure. 65.8% breast fed their infants on demand. 65.7% weaned their infants between 7-9 months yet 52% believed breast feeding should continue to 18 months. 96% breast fed their infants while ill with diarrhea. 57% believed colostrum to be unhygienic and did not feed it to their infants. 72% decided to breast feed before becoming pregnant while 36% decided to bottle feed before pregnancy. 89% of illiterate mothers breast fed while only 45% of literate mothers did. Further, only 11.8% of the mothers whose family income was 1500 rupees/month breast fed whereas 47% in the lower and 41.2% in the middle income groups did. At 7-9 months, 69.8% of illiterate and 69.5% of literate mothers had already introduced semi solid foods. 78.3% of literate mothers gave semi solid foods to their infants 2 times/day, but only 11.6% of the illiterate mothers did so. Moreover 81.4% of illiterate mothers only fed their infants semi solid foods once a day. Literate mothers were more likely than literate mothers to feed their infants solid foods (75% vs. 46.2%), introduce them at an earlier age (22.2% vs 10%, 7-9 months), and feed them more often (55.5% vs 16.6%; twice a day). In conclusion, the higher the educational status the more likely mothers were likely to breast feed.     

Associations between Infant Feeding Practice Prior to Six Months and Body Mass Index at Six Years of Age

Rapid growth during infancy is associated with increased risk of overweight and obesity and differences in weight gain are at least partly explained by means of infant feeding. The aim was to assess the associations between infant feeding practice in early infancy and body mass index (BMI) at 6 years of age. Icelandic infants (n = 154) were prospectively followed from birth to 12 months and again at age 6 years. Birth weight and length were gathered from maternity wards, and healthcare centers provided the measurements made during infancy up to 18 months of age. Information on breastfeeding practices was documented 0–12 months and a 24-h dietary record was collected at 5 months. Changes in infant weight gain were calculated from birth to 18 months. Linear regression analyses were performed to examine associations between infant feeding practice at 5 months and body mass index (BMI) at 6 years. Infants who were formula-fed at 5 months of age grew faster, particularly between 2 and 6 months, compared to exclusively breastfed infants. At age 6 years, BMI was on average 1.1 kg/m² (95% CI 0.2, 2.0) higher among infants who were formula fed and also receiving solid foods at 5 months of age compared to those exclusively breastfed. In a high-income country such as Iceland, early introduction of solid foods seems to further increase the risk of high childhood BMI among formula fed infants compared with exclusively breastfed infants, although further studies with greater power are needed.     

Mothers who Formula Feed: Their Practices,Support Needs and Factors Influencing their Infant Feeding Decision

The majority of mothers in Ireland provide formula milk to their infants during the initial weeks postpartum; however, data are lacking on their formula feeding practices and support needs. This prospective Dublin-based observational study, which included 450 eligible mother–term infant pairs recruited and followed up to six months postpartum, aimed to advance our understanding of maternal formula feeding practices, their reasons for deciding to formula feed, sources of feeding information and perceived support needs; insights into infant formula milk consumption patterns in relation to current feeding guidelines are also provided. In summary, the vast majority of infants at six weeks were provided with formula milk (n =368; 81.8%). Positive maternal perceptions of formula feeding were among the most frequently reported reasons underlying mothers' decisions to formula feed (e.g. convenience, 17.3%). Potential public health concerns over the large formula milk volumes consumed by infants (mean 205 ml/kg/day) relative to infant feeding guidelines (150 ml/kg/day) were raised from this study. Some mothers continue to add solid foods to infant bottle feeds at six weeks (3.8%) and six months (6%), a non-recommended feeding practice posing a choking risk for infants. Crucially, this study highlights the need to provide greater support and information to mothers who decide to formula feed postpartum, including practical information on sterilisation and formula reconstitution. While breastfeeding promotion and research continues to be a public health priority in Ireland, addressing the support and information needs of mothers who formula feed, an under-represented and understudied population in the literature, also needs to be considered to ensure optimal health and safety for their infants.     

甘肃省贫困地区婴幼儿喂养与喂养困难状况分析

目的 通过了解甘肃省贫困地区婴幼儿喂养与喂养困难的状况,探索解决贫困地区婴幼儿喂养问题的有效途径。方法 采取整群抽样的方法,通过问卷,调查 6~36个月龄婴幼儿的喂养方式、喂养行为及喂养困难。结果 1)喂养人喂养方式与喂养行为方面突出的问题是:50.6%将纯牛奶或纯羊奶作为母乳的替代物;56.5%在 6~12月完全断母乳;51.2%和15.8% 分别到7~8月和>9月开始添加辅食;72.9%对新添加的食物让婴儿尝试的次数<5次。2)不合理喂养与喂养困难间差异有统计学意义(P<0.05)的因素有:完全断母乳时间<6月;给婴儿吃剩饭;对不好的饮食习惯不矫正。结论 西部贫困地区婴幼儿喂养的问题在起步阶段就出现一些不正确的喂养观念与行为,因此,通过健康教育及早的向抚养人宣传科学喂养的理念及方法是丞待解决的问题。     

Delayed onset of weanling diarrhoea associated with high breast milk intake

In a West African community where breast feeding was practised universally for 18 to 24 months infants with the higher breast milk intakes were given supplementary foods later than others. Although 66% of infants had diarrhoea before the introduction of these foods, it was generally mild and only 12% suffered diarrhoea-induced weight loss in this pre-weaning period. By the end of infancy, all children had had diarrhoea and 89% had suffered weight loss in one or more attacks. As the bulk of diarrhoeal morbidity occurred after weaning had started, children with the higher breast milk intakes tended to be older before losing weight with diarrhoea. By one year, children with a higher than average breast milk intake and with no diarrhoea-induced weight loss in the first half of infancy weighed an average of 1 kg more than those with low breast milk intakes and early weight loss with diarrhoea. Interventions which improve or maintain maternal lactation performance should not only increase the nutrient intake of an infant, but also delay the almost inevitable weight loss of weanling diarrhoea.     

不同喂养方式对早产儿生长发育的影响

目的:探讨早产儿住院期间开奶时间及出院后喂养方式对其生长发育的影响。方法:选择张掖市人民医院102例早产儿,其中7天内禁食者45例,生后72 h经母乳喂养或早期微量喂养者67例,出院后纯母乳喂养者64例,早产配方奶喂养3月者13例,生后即足月配方奶喂养25例。所有早产儿出院后3月、1岁、3岁分别测量体重、身高、头围3项生长指标,按7日内开始喂养、7日后开始喂养和母乳喂养、早产配方奶喂养、足月配方奶喂养分类进行统计分析,观察不同开始喂养时间和不同喂养方式对早产儿体格发育的影响。结果:住院期间7日内开始喂养的早产儿出院后3月时的体重、身高和头围明显高于住院期间7日后开始喂养的早产儿(P<0.05);出院后采用早产儿配方奶、母乳喂养和足月配方奶喂养的早产儿,其3月及1岁时的体重、身高和头围依次降低,3组差异有统计学意义(P<0.01),q检验进一步显示,早产儿配方奶、母乳喂养和足月配方奶喂养者体重、身高、头围比较有统计学差异(P<0.01),3组3岁时体格生长指标比较无统计学差异(P>0.05)。结论:对住院的早产儿,开始喂养时间早,可以促进3月内的婴儿的体格生长,出院后的用早产儿配方奶能促进1岁内的体格生长,优于母乳喂养,而母乳喂养优于足月配方奶喂养,出院后首选早产儿配方奶或母乳喂养。     

Infant feeding and growth of Chinese infants: birth to 2 years

Summary. A cohort of 174 healthy full-term Chinese infants was followed up regularly for 2 years for their weight, length, head circumference, triceps and subscapular skinfold thickness, and their feeding practice. The majority of babies (92% at 2 months) were bottle fed with full strength infant formula. The energy intake over the first year of life was comparable with that of healthy Caucasian infants. The mean protein intake during the weaning period exceeded fourfold that of the WHO recommendation. At 2 years, infants were -0.6 standard deviation score (SDS) lighter and -0.4 SDS shorter than the National Centre for Health Statistics (NCHS) reference.     

Infant feeding patterns on Mauritius Island, 1991

The 1991 Mauritius Contraceptive Prevalence Survey (CPS) included a special module on infant feeding patterns in Mauritius. Since 1985, when a similar CPS was conducted, the incidence of breast-feeding has fallen from 86% to 72%. The duration of any breast-feeding among those breast-fed remained constant at 13.6 months. The module allowed for an assessment of the World Health Organization (WHO) breast-feeding indicators on exclusive breast-feeding, timely complementary feeding and continued breast-feeding. Only 16% of infants 0–3 months old are exclusively breast-fed; only 29% of infants 6–9 months old receive breast milk and complementary foods and only 27% of children 12–15 months are still breast-fed. These patterns of limited breast-feeding and early supplementation may signal future declines in breast-feeding for other African and Asian countries. Published by Elsevier Science Ltd     

New guidelines on infant feeding in the first 12 months of life

Paediatric dietitian Judy More discusses several recent directives and guidelines on infant feeding in the first year of life. These include recommendations that babies should be fed exclusively on breast milk for their first six months and that soy formulae should normally be avoided for babies under six months old. There is also specific new advice on restricting salt intake for infants.