Child Nutrition Advisory Group

Paediatric Nutrition

Paediatric NUTRITION

Guideline Summaries
British Dietetic Association (BDA) Policy Statement on Complementary Feeding: Introduction of Solid Food to an Infants Diet

Updated in April 2020, the British Dietetic Association (BDA) policy statement on complementary feeding provides advice on the introduction of solid food to both healthy and preterm infants for healthcare professionals. Link

Summary of recommendations:

Recommendations of different authorities:
World Health Organization (WHO)¹

• WHO recommends continuing breastfeeding until two years of age or beyond.

Remarks:
1. WHO. The optimal duration of exclusive breastfeeding: report on an expert consultation. 2001.

Reference:
The British Dietetic Association. Position Statement: Complementary Feeding. April 2020.
The Chinese Society of Parenteral and Enteral Nutrition (CSPEN) Guidelines for Nutrition Support in Neonates

The guidelines by CSPEN proposed the recommendations on nutrient intakes in neonates basing on a review of scientific reports and expert consensus. Link

Recommended intakes for enteral nutrition:

Recommendations for feeding mode:

Summary of recommendations on the selection of breastfeeding and enteral formula:
For breastfeeding:

Formulas that are suitable for enteral feeding:

Reference:
Working Group of Pediatrics Chinese Society of Parenteral And Enteral Nutrition, Working Group of Neonatology Chinese Society of Pediatrics, Working Group of Neonatal Surgery Chinese Society of Pediatric Surgery. CSPEN guidelines for nutrition support in neonates. Asia Pac J Clin Nutr 2013;22(4):655-663. doi: 10.6133/apjcn.2013.22.4.21.
European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Position Paper on Vitamin D in the Healthy Pediatric Nutrition

The ESPGHAN Committee on Nutrition published a position paper on vitamin D to provide updated figures on the prevalence of vitamin D deficiency, its health benefits, and recommendations for the prevention of deficiency in the healthy European paediatric population. Link

Summary of position paper:

Reference:
Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R, Turck D, van Goudoever J; ESPGHAN Committee on Nutrition. Vitamin D in the Healthy Paediatric Population: A Position Paper by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2013;56(6):692-701. doi: 10.1097/MPG.0b013e31828f3c05.
American Academy of Pediatrics (AAP) Clinical Report on Calcium and Vitamin D Requirements of Enterally Fed Preterm Infants

This American Academy of Pediatrics (AAP) published clinical report for healthcare professionals provides guidance on the evaluation and management of vitamin D and calcium requirements of preterm infants. Link

Summary of guidance:

Reference:
Abrams SA; the COMMITTEE ON NUTRITION. Calcium and Vitamin D Requirements ofEnterally Fed Preterm Infants. Pediatrics 2013;131(5):e1676-e1683. doi: 10.1542/peds.2013-0420.
American Academy of Allergy, Asthma & Immunology (AAAAI) Recommendations on Primary Prevention of Allergic Disease through Nutrition Interventions

The Adverse Reactions to Food Committee of AAAAI developed a set of nutritional recommendations for primary care physicians and specialists, on the primary prevention of allergic disease through nutritional interventions based on current available literatures and expert opinion. Link

Summary of recommendations:

Remarks:
1. Infants with at least 1 first-degree relative (parent or sibling) with a documented allergic condition.
2. Cow’s milk , egg, soy, wheat, peanut, tree nuts, fish, shellfish, etc.
3. Rice or oat cereal, vegetables, fruits, etc.

Reference:
Fleischer DM, Spergel JM, Assa’ad AH, Pongracic JA. Primary Prevention of Allergic Disease Through Nutritional Interventions. J Allergy Clin Immunol: In Practice 2013;1:29-36
European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) GI Committee Practical Guidelines: Diagnostic Approach and Management of Cow's-Milk Protein Allergy in Infants and Children

This medical position paper provides insight into how cow's milk protein (CMP) is the leading cause of food allergy in infants and young children younger than 3 years. The position paper also contains correct diagnosis and management to affected infants, based on published evidence-based guidelines. Link

Summary of recommendations:
Diagnosis:

• Thorough medical history and physical examination

• Suspected cow’s milk protein allergy (CMPA) can be followed by CMP elimination

• Improvement of clinical symptoms from CMP elimination from diet should be confirmed by a standardized oral challenge test performed under medical supervision

Management of confirmed CMPA:

Reference:
The British Dietetic Association. Complementary feeding: introduction of solid food to an infant’s diet. April 2013.
American Academy of Pediatrics (AAP) Recommendations for Maternal Dietary Restriction, Breastfeeding, and Timing of Introduction of Complementary Foods and Hydrolyzed Formulas on the Development of Atopic Diseases

It has been recognized that early childhood events, including diet, are likely to be important in the development of both childhood and adult diseases. This clinical report reviews the nutritional options during pregnancy, lactation, and the first years of life that may affect the development of atopic disease in early life. Link

Summary of recommendations:

Reference:
Greer FR, Sicherer SH, Burks AW. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics 2008;121(1):183-191.
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Key Nutrition Papers
Learning to eat: birth to age 2 y

Reference: Birch LL, Doub AE. Am J Clin Nutr 2014;99(3):723S-728S. Link to PubMed
Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines

Reference: Koletzko B, et al. (eds) World Rev Nutr Diet. Basel, Karger, 2014, vol 110, pp I-XII (DOI:10.1159/000360233). Link to article
Toward an operative diagnosis of fussy/picky eating: a latent profile approach in a population-based cohort

Reference: Tharner A, et al. Int J Behav Nutr Phys Act 2014;11:14. Link to PubMed
Vitamin D deficiency is associated with diagnosis and severity of childhood atopic dermatitis

Reference: Wang SS, et al. Pediatr Allergy Immunol 2014;25(1):30-35. Link to PubMed
Dietary exposures and allergy prevention in high-risk infants: A joint statement with the Canadian Society of Allergy and Clinical Immunology

Reference: Chan ES, et al. Paediatr Child Health 2013;18(10):545-554. Link to PubMed
Long-term effects of LCPUFA supplementation on cognitive outcomes

Reference: Colombo J, et al. Am J Clin Nutr 2013;98(2):403-412. Link to PubMed
Omega-3 long-chain polyunsaturated fatty acids on cognitive performance and behavior in children

Reference: Montgomery P, et al. PLoS One 2013;8(6):e66697. Link to PubMed
Critical windows for nutritional interventions against stunting

Reference: Prentice AM, et al. Am J Clin Nutr 2013;97(5):911-918. Link to PubMed
Choline metabolites status and neurodevelopmental outcomes in children

Reference: Strain JJ, et al. Br J Nutr 2013;110(2):330-336. Link to PubMed
Developmental status of infants fed breast milk, cow's milk formula, or soy formula

Reference: Andres A, et al. Pediatrics 2012;129(6):1134-1140. Link to PubMed
World Allergy Organization (WAO) position paper on probiotics and allergy

Reference: Fiocchi A, et al. World Allergy Organ J 2012;5(11):148-167. Link to PubMed
Long-chain polyunsaturated fatty acid supplementation in infancy reduces heart rate and positively affects distribution of attention

Reference: Colombo J, et al. Pediatr Res 2011;70(4):406-410. Link to PubMed
Early nutrition and immunity – progress and perspectives

Reference: Calder PC, et al. Br J Nutr 2006;96(4):774-790. Link to PubMed
n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases

Reference: Calder PC. Am J Clin Nutr 2006;83(6 Suppl):1505S-1519S. Link to PubMed
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Paediatric Nutrition

Paediatric NUTRITION

Guideline Summaries

British Dietetic Association (BDA) Policy Statement on Complementary Feeding: Introduction of Solid Food to an Infants Diet

The Chinese Society of Parenteral and Enteral Nutrition (CSPEN) Guidelines for Nutrition Support in Neonates

European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Position Paper on Vitamin D in the Healthy Pediatric Nutrition

American Academy of Pediatrics (AAP) Clinical Report on Calcium and Vitamin D Requirements of Enterally Fed Preterm Infants

American Academy of Allergy, Asthma & Immunology (AAAAI) Recommendations on Primary Prevention of Allergic Disease through Nutrition Interventions

European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) GI Committee Practical Guidelines: Diagnostic Approach and Management of Cow's-Milk Protein Allergy in Infants and Children

American Academy of Pediatrics (AAP) Recommendations for Maternal Dietary Restriction, Breastfeeding, and Timing of Introduction of Complementary Foods and Hydrolyzed Formulas on the Development of Atopic Diseases

Key Nutrition Papers

Learning to eat: birth to age 2 y

Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines

Toward an operative diagnosis of fussy/picky eating: a latent profile approach in a population-based cohort

Vitamin D deficiency is associated with diagnosis and severity of childhood atopic dermatitis

Dietary exposures and allergy prevention in high-risk infants: A joint statement with the Canadian Society of Allergy and Clinical Immunology

Long-term effects of LCPUFA supplementation on cognitive outcomes

Omega-3 long-chain polyunsaturated fatty acids on cognitive performance and behavior in children

Critical windows for nutritional interventions against stunting

Choline metabolites status and neurodevelopmental outcomes in children

Developmental status of infants fed breast milk, cow's milk formula, or soy formula

World Allergy Organization (WAO) position paper on probiotics and allergy

Long-chain polyunsaturated fatty acid supplementation in infancy reduces heart rate and positively affects distribution of attention

Early nutrition and immunity – progress and perspectives

n-3 polyunsaturated fatty acids, inflammation, and inflammatory diseases