WHO has new children’s dietary guide – 12/12/2023 – Equilíbrio

The World Health Organization (WHO) has produced a new guide for complementary feeding for infants and children aged 6 to 23 months, providing the main guidelines on the subject.

The document presents recommendations to guide families from breastfeeding, through food introduction to the consumption of different foods, such as cow’s milk and other allergens.

One of the main points that generated great repercussion among pediatricians and nutritionists is in relation to the early introduction of food (before six months for some specific situations) and, when breastfeeding is not possible, formulas should only be used until 12 months of age. life.

The Einstein Agency sought out experts in the area to discuss the topic and help guide those responsible for children in offering a healthy diet.

Infant food
Acting correctly during food introduction, when breast milk or infant formula are no longer adequate to meet the child’s nutritional needs, can influence the little one’s entire life.

“The introduction of food is a sensitive point for many families, as there is great concern about doing what is best for the baby associated with guidance from different professionals and advice from family and friends, which becomes even more intense with social networks that allow that these hunches arrive all the time from everywhere”, says pediatrician Sabrine Teixeira Ferraz Grunewald, associate professor at the Maternal and Child Department at the Federal University of Juiz de Fora, in Minas Gerais.

The first years of a child’s life is a fundamental period for them to learn to accept healthy foods and drinks and to establish long-term eating patterns.

“This period coincides with the peak risk phase of growth failure and the appearance of nutritional deficiencies”, explains Vanessa Ramis Figueira, senior nutritionist at the Maternal and Child Department at Hospital Israelita Albert Einstein.

The specialist recalls that the consequences of inappropriate nutrition during this period may be related to inadequate growth, malnutrition, excess weight and micronutrient deficiencies, which can lead to impaired motor, cognitive and socio-emotional development and an increased risk of infectious diseases.

“Another important point is that the prevalence of overweight and obesity has increased significantly in recent years, which requires a new view on the topic”, highlights the nutritionist.

The WHO document, released in October this year, aims to replace the two previous guidelines related to the topic, one from 2003 and the other from 2005.

Both were focused on malnutrition and did not include the high-income population, which was included in this new guide also aimed at countries of all social classes. The document considers the needs of babies who are or are not breastfed, excluding premature children, those with low birth weight, those recovering from serious illnesses or those with neurological disabilities.

See the items that are part of the new guide and the considerations of the experts interviewed by Agência Einstein regarding them:

1 – Breastfeeding should continue for up to two years or more

This is not a new recommendation, as the main health institutions have argued for a long time that the ideal is for breastfeeding to be maintained after the introduction of food until at least 24 months of age. In this item, the document draws attention to the fact that this recommendation must be followed. Breastfeeding mothers need protection, an enabling environment and assistance, such as daycare centers and breastfeeding support rooms in the workplace, flexible breastfeeding hours, access to information, guidance and counseling services for queries.

If it is necessary to use another milk instead of breast milk from 12 to 23 months, the authors consider that there is not enough evidence to recommend skimmed cow’s milk instead of whole milk or vegetable milk instead of animal milk. Those with added sugars are not appropriate in any situation.

2 – In the case of children aged 6 to 11 months who are not breastfed, both infant formula and cow’s milk can be used to feed them. From one year of age onwards, infant formulas or dairy compounds are no longer recommended.

This is one of the big differences between the new guide and those previously released. “Studies that compared the consumption of cow’s milk with that of infant formula in this age group found no differences in outcomes related to growth, development and childhood illnesses”, says pediatrician Grunewald.

“This is one of the examples that the current guidelines sought to be more flexible and should consider individual characteristics of families, in addition to cultural and economic aspects involved in this decision, after all, the cost of formulas can be excessive for many of them.”

However, this decision needs to be considered. “There are positions from the Brazilian Society of Pediatrics and other medical societies showing that the introduction of fresh cow’s milk before the end of the first year of life can trigger important problems, such as a greater risk of anemia, intestinal bleeding and food allergies”, he says. pediatrician and nutritionist Mauro Fisberg, member of the advisory body in pediatrics and applied sciences in pediatrics at the Federal University of São Paulo (Unifesp) and coordinator of the Center of Excellence in Nutrition and Eating Difficulties at the Pensi Institute, linked to the Sabará Children’s Hospital.

“Breast milk is the most recommended food for supplying calcium, vitamins and minerals, and, if it is impossible to continue breastfeeding, the use of age-appropriate infant formulas is recommended. There are certainly economic arguments linked to its price that may prevent the use of this type of product, in addition to the risk of inadequate dilution and distribution to other family members. Therefore, the Brazilian Society of Pediatrics believes that there should be some type of subsidy for the low-income population to so that she can have access to the appropriate product”, says Fisberg, who is a full member of the Department of Nutrology at the Society of Pediatrics of São Paulo.

3 – The introduction of complementary foods should start from six months of age

Despite this recommendation, the guideline recognizes that some children may benefit from incorporating food in advance, taking into account the following potential risks: increased morbidity from gastrointestinal diseases in locations where food and water hygiene is not adequate, low nutritional quality of complementary foods compared to breast milk in countries with low income, inadequate development and risk of obesity.

She also considers the concern about the late introduction —after 6 months of age— of complementary foods due to the inadequacy of breast milk in essential nutrients, especially iron, and the risk of this affecting the acceptance of new flavors and textures. Furthermore, evidence suggests that delaying the introduction of some foods, such as tree nuts and peanuts, may promote food allergies rather than prevent them.

“This recommendation is one of the differences of the new document, as Brazilian and international guidelines highlight the introduction of complementary feeding at six months of age, an age at which most babies already have adequate neuropsychomotor development to be safely fed”, says the pediatrician.

“However, most studies that compared different times for food introduction did not find statistically significant differences in relation to items such as weight gain, anemia, respiratory or allergic diseases. Therefore, professionals must also take into account cultural and family preferences when assessing when foods should start to be part of the child’s diet”, he adds.

“For many years, the Brazilian Society of Pediatrics has adopted the WHO concept that indicates that breastfeeding should be exclusive at least until the sixth month, which can be considered guidance that aims to protect mothers and children from all social levels, guaranteeing the unbeatable advantages of breast milk”, says Fisberg.

The pediatrician and nutritionist explains that, from a clinical point of view, he considers the concept of the American Academy of Pediatrics and the European Society of Pediatrics, Gastroenterology, Hepatology and Nutrition (ESPGHAN), which recommends starting complementary feeding after the sixth month of life .

In some cases, upon assessment by the pediatrician, it can be started between the fourth and sixth months, according to the specialist, but never before 16 weeks nor after 26 weeks of life. He highlights that this decision requires the analysis of growth curves, maternal nutritional status, among several other aspects of the mother and baby, reinforcing the concept that breastfeeding should be exclusive for as long as possible.

4 – Children aged 6 to 23 months should have a diverse diet

Previous guidelines established a caloric average to be achieved during this period. The current one focuses on a diversified diet in which vegetables, fruits and foods of animal origin, including meat, fish or eggs, should be consumed daily. Legumes, nuts and seeds should be on the menu frequently, especially when meat, fish or eggs and vegetables are limited on the menu. Consumption of starchy items should be minimized as they do not provide high-quality protein or nutrients such as iron, zinc and vitamin B12.

5 – Foods rich in sugar, salt, trans fats, sweeteners and sugary drinks should be avoided and the consumption of natural fruit juice should be limited

The guideline considers it very important to provide counseling to those responsible regarding the short and long-term harm caused by consuming these foods.

“The document highlights that studies that evaluated the intake of juices did not reveal evidence of a negative impact on health outcomes, however, as concentrates are rich in natural sugar, it is still recommended to avoid them, especially before the first year of life” , says Grunewald.

“Therefore, contrary to what some social media pages have incorrectly reported in recent days, the WHO has not approved the consumption of fruit juice.”

It is worth noting that the Food Guide for Brazilian Children under 2 years of age, published in 2019 by the Ministry of Health, also does not recommend offering sugar and preparations that contain this ingredient until 24 months of age.

6 – The use of nutritional supplements and fortified foods may be recommended for children aged 6 to 23 months

These items may come into play in some situations where the needs for some nutrients are not being met through normal nutrition. However, it is essential that this only happens following a medical recommendation that must be made taking into account each person’s needs and the situation in the region where they live.

7 – Responsive eating should be encouraged

“Previous guidelines established a number of daily meals depending on consumption and nutritional goals, the current one highlights the importance of children aged 6 to 23 months being encouraged to eat responsively, that is, encouraged to eat autonomously, respecting their preferences, development, physiological needs and appetite and encouraging self-regulation in eating”, explains Figueira, nutritionist at Einstein.