BMA Board of ScienceBox 7: The UK Infant feeding survey 2005 findings on complementary feeding• In 2005, mothers were introducing solid foods later than in the 2000 survey (51% by fourmonths compared with 85% by four months respectively).• Very few women (2%) followed DH guidance to delay weaning onto solid foods until sixmonths.• Babies given solid foods between four <strong>and</strong> six months were much more likely to be fedcommercially-prepared foods (85%) than home-prepared foods (51%).• Most mothers (92%) avoided the use of salt completely in the diets of their babies.• The proportion of mothers avoiding the use of salt increased between 2000 <strong>and</strong> 2005 (33%to 51%), rises were also seen in the proportion avoiding nuts (30% to 48%) <strong>and</strong> honey(6% to 13%); a greater awareness of food allergies was a key reason for this change. 131The IFS showed that in 2005, although there was a decline in prevalence of very early introduction ofsolid foods since 2000, most infants had been introduced to solid foods before the recommendedage of six months. 131 The main reasons given for the introduction of solid foods before three monthswere that the baby was not satisfied with milk alone, or the mother’s experience with a previousbaby. <strong>Early</strong> introduction of solid foods was more common in younger mothers, <strong>and</strong> among mothersof lower socio-economic status <strong>and</strong> lower educational attainment (see Figure 9).Figure 9: Age by which solids had been introduced according to mother’s socio-economicclassification: Infant Feeding Survey 2005Managerial &professionalIntermediateRoutine &manual1008060%40200Birth 1 2 3 4 5 6 7MonthsSource: Bolling K, Grant C, Hamlyn B et al (2007) Infant feeding survey 2005. London: The Information Centre.<strong>Early</strong> life nutrition <strong>and</strong> lifelong health 31
BMA Board of ScienceAmong working mothers, delaying return to work until at least six months was associated withlater introduction of solid foods. 131The nature of the weaning diet varied by mother’s socio-economic status. When compared withother women, mothers in managerial/professional occupations were more likely to feed theirinfants cooked vegetables <strong>and</strong> fruit, rice <strong>and</strong> pasta, <strong>and</strong> meat <strong>and</strong> fish, <strong>and</strong> less likely to provideregular servings of sweets, biscuits <strong>and</strong> savoury snacks. 131There are two large cohort studies of UK infants in which variations in complementary feeding <strong>and</strong>weaning practice <strong>and</strong> dietary intakes have been assessed: ALSPAC <strong>and</strong> the Southampton Women’sSurvey (SWS). The ALSPAC study collected dietary data using three-day diet diaries for over 1,000infants born in 1991-92. 135, 136 At eight months, 34 per cent of the infants had not eaten any fruit<strong>and</strong> 25 per cent had not eaten vegetables in the three-day study period, while 26 per cent of theinfants had eaten chocolate. At 18 months, 16 per cent of the children had not eaten fruit <strong>and</strong> 8per cent had not eaten vegetables in the three-day period but 63 per cent of the children hadeaten chocolate <strong>and</strong> 66 per cent had eaten savoury snacks. Although intakes of most nutrientswere above the reference nutrient intakes (considered adequate for 97% of children), vitamin Dintakes were low at both ages, <strong>and</strong> iron intakes were low at 18 months.The ALSPAC study also showed that at 18 months, the most common container for drinks was atrainer cup. Eighty-six per cent of children had at least one drink from a trainer cup over a 24-hourperiod, 64 per cent of children were given at least one drink in a bottle, <strong>and</strong> 10 per cent solelyused a bottle. Use of a bottle was more common among children who had not been breastfed,who had older siblings, <strong>and</strong> who had mothers who smoked. 137 Children being fed milk in a bottleconsumed greater volumes when compared with children given milk in a cup; this was particularlymarked for the children only fed by bottle. A wide variety of drinks were given at this age,including low calorie squashes (48%), tea <strong>and</strong> coffee (17%), <strong>and</strong> fizzy drinks (7%). Maternaleducation was the most important factor associated with the types of drinks consumed at this age– more highly educated mothers gave their children fruit juices more often, whereas women withlow levels of educational attainment were more likely to give their children tea, coffee <strong>and</strong> softdrinks. Seventeen per cent of children whose mothers had Certificate of Secondary Education(CSE) qualifications or less were given fizzy drinks over a 24-hour period.More recently the dietary patterns of 1,434 infants born to women in the SWS between 1999-2003were reported. 138 The most important pattern of diet identified at both six months <strong>and</strong> 12 monthsof age was consistent with current infant feeding guidance, <strong>and</strong> was characterised by highconsumption of vegetables, fruit, meat <strong>and</strong> fish, <strong>and</strong> other home-prepared foods. This dietarypattern was labelled the ‘infant guidelines’ pattern. Infants who had high scores for this patternof feeding were also more likely to have been breastfed. A number of factors, including a rangeof maternal <strong>and</strong> family characteristics were considered as influences on the infants’ pattern scores.At both ages the key determinant of the nature of the infant diet was the quality of the mother’sdiet. Infants whose mothers had high prudent diet scores <strong>and</strong> ‘healthier’ dietary patterns,characterised by high intakes of fruits <strong>and</strong> vegetables, <strong>and</strong> wholemeal bread, 139 were more likely tohave a comparable diet, <strong>and</strong> were fed in accordance with infant feeding guidelines. Conversely,mothers who had low prudent diet scores <strong>and</strong> whose diets were characterised by high intakes ofwhite bread <strong>and</strong> chips, added sugar <strong>and</strong> full-fat dairy products, were less likely to provide a diet fortheir infant that conformed with infant feeding guidance (see Figure 10). The influence ofmother’s dietary pattern on her infant’s diet was independent of a range of other factors, includingher educational attainment <strong>and</strong> smoking status.32<strong>Early</strong> life nutrition <strong>and</strong> lifelong health
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