- C. Bührer
- O. Genzel-Boroviczény
- F. Jochum
- T. Kauth
- M. Kersting
- B. Koletzko
- W. Mihatsch
- H. Przyrembel
- T. Reindeer
- P. Room
- Nutrition Commission of the German Society for Paediatrics and Adolescent Medicine
Summary of the
The Nutrition Commission of the German Society for Paediatrics and Adolescent Medicine has updated its recommendations on the nutrition of healthy infants and compiled them as expert recommendations in an overview. A total of 35 core statements are formulated on 5 main topics (breastfeeding, breast milk substitutes, supplementary food, family food, overarching aspects) and commented on with hints for practical application.
We recommend breastfeeding without supplementary feeding during the first 4 to 6 months of life, and continued breastfeeding alongside complementary food. Postnatal breastfeeding support is particularly important, including the renunciation of routine supplementary feeding. Infants who are not breastfed should receive infant formula, also in addition to supplementary food. If the risk of atopy is increased, hydrolysis food (HA) is recommended until supplementary feeding is introduced. The use of follow-on formulae is possible after the introduction of supplementary food. Bottle feed must be prepared fresh and fed immediately. Supplementary food should not be introduced before the beginning of the 5th month of life and not later than the beginning of the 7th month of life. It is recommended to introduce small amounts of gluten and a variation of the food at the same time. A vegetable-potatomeat or fish porridge (readily bioavailable iron, omega-3 fatty acids), followed by a (cow) milk-cereal porridge and a cereal-fruit porridge, either homemade or as an industrially produced product, is suitable as the first complementary meal. Balanced family food can be introduced from around the age of 10 months. A lactovegetarian diet is possible, a vegan diet without supplementation is not recommended for infants. The supplementation of 2 mg vitamin K orally (on the 1st day of life, between the 3rd and 10th day of life and between the 4th and 6th week of life) and of vitamin D (400-500 IU/d) from the 2nd week combined with fluoride (0.25 mg) as a tablet is recommended.
Nutrition of healthy infants
The Nutrition Committee of the German Pediatric Society has updated its recommendations for the nutrition of healthy infants. Five main topics (breastfeeding, breast milk substitutes, complementary feeding, family diet and general aspects) are addressed in the form of 35 key statements along with detailed comments on their practical application.
Exclusive breastfeeding is recommended as the most suitable for almost all infants during the first 4–6 months, followed by partial breastfeeding along with complementary feeding; breastfeeding needs specific support particularly postnatal and routine supplementary feeding should be avoided. Non-breast-fed infants should receive infant formula, which should also accompany complementary feeding. In cases of increased risk for atopy, a formula based on hydrolyzed protein (HA) should be given until the start of complementary feeding. Follow-on formula may be given together with complementary feeding. Bottle feeds should be freshly prepared and given without delay. Complementary feeding should be introduced between the beginning of the fifth and the seventh month and at this time small amounts of gluten should also be introduced. Variation of complementary feeds is recommended. A vegetable-potato-meat or fish puree (highly bioavailable iron, omega-3 fatty acids) is well-suited to start complementary feeding, followed by (whole) cow’s milk cereal meal and a cereal–fruit meal, either homemade or as a commercial product. At the age of approximately 10 months infants can participate in a healthy family diet. A lactovegetarian type diet is possible; however a vegan diet if not supplemented cannot be acceptable for infants. Supplementation of 2 mg vitamin K orally 3 times (on day 1, between days 3 and 10, and between weeks 4–6 after birth) and of vitamin D (400–500 IU/day) starting from the 2nd week of life combined with fluoride (0.25 mg/day) in tablet form is recommended for all healthy infants.
Compliance with ethical guidelines
Conflict of interest. C. Bührer received funding from Milupa, Nutricia, Nestlé and Humana for symposia, lecture fees and travel expenses. F. Jochum conducted research, organised symposia and gave lectures funded by various manufacturers of infant food and parenteral nutrition products. M. Kersting carried out research projects and gave lectures funded by various companies in the food industry. The grants went to the Research Institute for Child Nutrition. B. Koletzko is a member of the National Breastfeeding Commission and admits to being biased in favour of breastfeeding. The Ludwig Maximilian University of Munich and its member B. Koletzko received financial support for scientific and educational projects by infant food manufacturers (Abbott, Danone, Fonterra, Hipp, Mead Johnson, Nestlé), mainly as part of and in the framework of publicly funded research projects funded by the European Commission, the Federal Ministry of Education and Research and the German Research Foundation. W. Mihatsch has provided scientific advice to the following companies or institutions, conducted studies with them, organised symposia or received lecture fees or travel expenses from them: AlzChem, Ardeypharm, Baxter, Danone, DMS, FHI, HIPP, Humana, Mead Johnson, Nestle, Milupa, Numico and Pfizer. T. Reinehr received lecture fees from the companies Nestle and Hipp. O. Genzel-Boroviczény, T. Kauth, H. Przyrembel and P. Zimmer state that there is no conflict of interest. This contribution does not include studies on humans or animals.