Every mother wants the best for her child, and the decisions she makes about the child’s growth and development have a lifelong impact. Deciding when to introduce solid foods and when to stop breastfeeding can have significant implications for the wellbeing of both mother and child. The three biggest child health problems confronting the world today are allergy, HIV and malnutrition. While nutritional guidelines are available, it is important to realise that level of income is a fundamental factor that can influence nutritional choices and child mortality.

The University of Pretoria’s Department of Paediatrics and Child Health is taking part in a collaborative research project evaluating infant feeding guidelines – particularly in the context of resource-constrained settings, infant feeding and allergies. The aim of this research is to strategise feeding guidelines to optimise overall maternal and child health.

Recent studies conducted in high-income countries showed that introducing foods other than breast milk, and particularly allergenic foods, to infant diets before the age of six months could significantly reduce the child’s risk of developing food allergies in later childhood. (Allergenic foods include cow’s milk protein, egg, peanuts, fish, sesame seeds, and wheat.) To address the challenges faced by people living in resource-constrained settings, the Department’s research emphasises that infant feeding guidelines should be mindful of the socio-economic realities in different settings, and that exclusive breastfeeding (EBF) remains the best nutritional option for infants, especially those younger than six months. Among the many benefits of EBF is the fact that it significantly reduces the risk of illnesses, such as lower respiratory tract infections and gastroenteritis. It also reduces the risk of mother-to-child HIV transmissions compared to partial breastfeeding (breastfeeding supplemented by other fluids and solids).

There is no research available that reflects the middle- to long-term impacts of early allergen introduction on maternal and child health outcomes. While the introduction of allergenic foods might reduce the risk of developing food allergies in high-income settings, substantial studies have shown that early introduction to solid foods can increase islet autoimmunity (and the progression to Type 1 diabetes), obesity, adult-onset celiac disease (an autoimmune disorder that results in intolerance to gluten), eczema, anaemia and diarrheal disease. EBF, however, has long-term benefits to both infant and mother, which is evident immediately after birth and all the way into adulthood. The long-term benefits of EBF include protection against the development of non-communicable diseases, such as diabetes and heart disease. There is even a possible causal link between predominant breastfeeding, and intelligence and income at 30 years of age.

The Department’s research notes that guidelines that promote the early introduction of allergenic foods to infants cannot be standardised, especially in resource-limited settings. Paediatricians and other health care professionals working in infant health care need to assume an individualised approach to feeding practices and special needs. While it is acknowledged that infants from atopic families (families that suffer from allergies) are more prone to allergies in adult life, the benefits of EBF outweigh any arguments against it. The Department advises that when infant feeding guidelines are developed, concerted efforts should be made to combine feeding guidelines for allergy prevention and for child mortality prevention in a unified protocol. Furthermore, in countries where child mortality is high (typically those that are resource-constrained), EBF should be recommended at a primary health care level and earlier introduction of solids should not be advocated.

This research highlights the importance of adopting a holistic approach to making decision for the optimum wellbeing of infants. No one feeding pattern should be prioritised and decisions should not be based solely on one area of concern, such as allergy. Despite other studies, the Department of Paediatrics and Child Health believes the general benefits of EBF for maternal and child health cannot be ignored.

This research forms part of a collaborative study between the universities of Cape Town, the Western Cape, the Witwatersrand, KwaZulu-Natal, Stellenbosch and Pretoria, as well as the South African Medical Research Council.

The University of Pretoria’s Department of Paediatrics and Child Health is taking part in a collaborative research project evaluating infant feeding guidelines.

Picture credits:

Unicef Ethiopia

USAID