Childhood undernutrition remains a major health problem in resource-poor settings. Approximately one-third of children less than five years of age in developing countries are stunted (low height-for-age), and large proportions are also deficient in one or more micronutrients. Recent data shows that just over half of 6-9 month olds are breastfed and given complementary foods and only 39 per cent of 20-23 month olds are provided with continued breastfeeding.
It is well recognized that the period from birth to two years of age is the “critical window” for the promotion of optimal growth, health, and development. Insufficient quantities and inadequate quality of complementary foods, poor child-feeding practices and high rates of infections have a detrimental impact on health and growth in these important years. Even with optimum breastfeeding children will become stunted if they do not receive sufficient quantities of quality complementary foods after six months of age (Lancet 2008). An estimated six per cent or six hundred thousand under-five deaths can be prevented by ensuring optimal complementary feeding.
Improved feeding of children under two years of age is particularly important because they experience rapid growth and development, are vulnerable to illness and there is evidence that feeding practices are poor in most developing countries. Continued breastfeeding beyond six months should be accompanied by consumption of nutritionally adequate, safe and appropriate complementary foods that help meet nutritional requirements when breastmilk is no longer sufficient. From 6-12 months, breastfeeding – if implemented optimally – should continue to provide half or more of the child’s nutritional needs, and from 12-24 months, at least one-third of their nutritional needs. In addition to nutrition, breastfeeding continues to provide protection to the child against many illnesses and provides closeness and contact that helps psychological development. Appropriate complementary foods can be readily consumed and digested by the young child from six months onwards and provides nutrients - energy, protein, fat and vitamins and minerals - to help meet the growing child's needs in addition to breastmilk.
Low-quality complementary foods combined with inappropriate feeding practices put under-twos in developing countries at high risk for undernutrition and its associated outcomes. Too often, solid, semi-solid and soft foods are introduced too soon or too late. The frequency and amount of food offered may be less than required for normal child growth, or their consistency or nutrient density may by inappropriate in relation to the child's needs. Too much of a poor complementary food could displace the more nutritive breastmilk in the child's diet.