I. INTRODUCTION AND COMMENTARY

This workshop was convened jointly by The International Paediatric Association and the Committee on Nutrition of the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition in Casablanca, Morocco, August 26-28, 1999. Its aim was to explore the research issues and questions that would need to be addressed to improve the understanding and practice of complementary feeding.

Each contributor was asked to review briefly a specific topic, and to identify the research which, in his or her opinion, was needed to optimize complementary feeding in infancy. Current guidelines and practices were reviewed, but it was appreciated that because the evidence base is limited, current guidelines are to some extent arbitrary. There is a need to be constantly aware of this and to share this uncertainty with caregivers and policymakers, lest undue credence is placed in the current guidelines. Guidelines will adapt as more evidence becomes available and they will become less dependent on accepted practices.

Probably the biggest debate centers on the best time to introduce complementary feeds, and on the nature of these feeds. Most, if not all, guidelines recommend exclusive breastfeeding until at least 4 months. Even so, many mothers, including those in populations that epitomize ideal breastfeeding by maintaining it into the second year of life, give infants solids as early as 2 months. Of particular concern in the timing, and the amount, of exposure to complementary foods are issues relating to immune function, the acquisition of immunotolerance, and functional imprinting of intestinal function, its microflora, and of systemic metabolism. The main debate over timing is if it should be about 6 months, or at 4 to 6 months.

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