COMPLEMENTARY FEEDI NG PRACTI CES TO CHI LDREN DURI NG
THEI R FI RST YEAR OF LI FE
Cr ist ina Mar ia Gar cia de Lim a Par ada1 Mar ia Ant oniet a de Bar r os Leit e Car v alhaes1 Milena Tem er Jam as2
Par ada CMGL, Car v alh aes MABL, Jam as MT. Com plem en t ar y f eedin g pr act ices t o ch ildr en du r in g t h eir f ir st y ear of life. Rev Lat ino- am Enfer m agem 2007 m ar ço- abr il; 15( 2) : 282- 9.
This st udy aim ed t o inv est igat e com plem ent ar y feeding pr act ices dur ing childr en’s fir st y ear of life in Bot ucat u, SP, Br azil. Pr act ices w er e descr ibed accor ding t o t he age r ange and t he br east feeding ( BF) pr act ice. Dat a w er e collect ed d u r in g a m u lt i- v accin at ion cam p aig n t h r ou g h t h e in t er v iew of 1 , 2 3 8 in d iv id u als w h o accom panied children younger t han one year old being vaccinat ed. Differences associat ed wit h t he BF sit uat ion w er e ident ified by t he chi- squar e t est and Fisher ’s ex act t est . The ear ly int r oduct ion of com plem ent ar y food was observed, which led t o t he low frequency of exclusive breast feeding ( 36.9% < 4 m ont hs) . Children younger t han 4 m ont hs old consum ed t ea ( 30. 7% ) ; childr en bet w een 4 and 6 m ont hs old consum ed fr uit s ( 54. 1% ) , soups ( 3 9 . 9 % ) and hom e- m ade food ( 1 9 . 2 % ) . Juice w as offer ed only t o 1 5 . 2 % of childr en y ounger t han 4 m ont hs old who were com plet ed weaned, 60% of t he children was offered wat er. Dat a show t hat t he consist ence of t h e f ood con su m ed w as in ap p r op r iat e: ch ild r en b et w een 6 an d 8 m on t h s old w er e of f er ed t h e f am ily ’s r egular food ( 48. 8% ) and childr en older t han 8 m ont hs ( 71. 6% ) w er e offer ed soup. Ther efor e, int er v ent ions focused on com plem ent ar y feeding ar e j ust ified on t he cit y .
DESCRI PTORS: br east feeding; Milk , hum an; supplem ent ar y feeding
PRÁCTI CAS DE ALI MENTACI ÓN COMPLEMENTARI A EN NI ÑOS
DENTRO DEL PRI MER AÑO DE VI DA
El obj et iv o f u e est u diar las pr áct icas de alim en t ación com plem en t ar ia en el pr im er añ o de v ida de n iñ os en la r eg ión d e Bot u cat u , SP, las cu ales f u er on d escr it as seg ú n el g r u p o et ár eo y las p r áct icas d e lact ancia m at erna ( LM) . Fueron ent revist ados 1238 acom pañant es de niños m enores de 1 año vacunados en la Cam paña de Vacunación Múlt iple. Diferencias asociadas con la sit uación de LM fueron ident ificadas a t ravés del t est Chi- cuadr ado y el t est ex act o de Fisher . La int r oducción de alim ent os conplem ent ar ios fue pr ecoz, lo que pr oduj o una baj a fr ecuencia en la lact ancia m at er na ex clusiv a ( 3 6 , 9 % en < 4 m eses) . Niños m enor es de 4 años consum ier on m at es ( 30, 7% ) , ent r e 4 y 6 m eses consum ier on fr ut as ( 54, 1% ) , sopas ( 39, 9% ) y com ida ( 1 9 , 2 % ) . Los j u g os f u er on of r ecid os ap en as en 1 5 , 2 % d e los n iñ os m en or es d e 4 m eses q u ien es y a n o lact aban, y , agua en 60, 0% de los casos. Los dat os m uest r an pr ev alencia en el consum o de pr epar aciones inadecuadas con relación a su consist encia: ofert a de com ida por part e de la fam ilia en niños ent re 6 y 8 m eses ( 48,8% ) y ofert a de sopa a niños m ayores de 8 m eses ( 71,6% ) . Se sugiere que el m unicipio realice int ervenciones en focan do la alim en t ación su plem en t ar ia.
DESCRI PTORES: lact ancia m at er na; leche hum ana; alim ent ación com plem ent ar ia
PRÁTI CAS DE ALI MENTAÇÃO COMPLEMENTAR EM CRI ANÇAS
NO PRI MEI RO ANO DE VI DA
Obj et ivou- se est udar prát icas de alim ent ação com plem ent ar no prim eiro ano de vida em Bot ucat u, SP, descr ev en do- as segu n do f aix a et ár ia e pr esen ça do aleit am en t o m at er n o ( AM) . For am en t r ev ist ados 1 . 2 3 8 acom p an h an t es d as cr i an ças m en or es d e 1 an o v aci n ad as em Cam p an h a d e Mu l t i v aci n ação. Di f er en ças associadas à sit uação do AM foram ident ificadas pelo t est e qui- quadrado e t est e exat o de Fisher. A int rodução d e alim en t os com p lem en t ar es f oi p r ecoce, lev an d o à b aix a f r eq ü ên cia d e aleit am en t o m at er n o ex clu siv o ( 36,9% em < 4 m eses) . Crianças m enores de 4 m eses consum iram chás ( 30,7% ) , crianças ent re 4 e 6 m eses consum ir am fr ut as ( 54, 1% ) , sopas ( 39, 9% ) e com ida ( 19, 2% ) . Sucos for am ofer ecidos a apenas 15, 2% das crianças m enores de 4 m eses com desm am e com plet o, água a 60% . Os dados apont am consum o de preparações inadequadas pela consist ência: ofert a de com ida da fam ília a crianças ent re 6 e 8 m eses ( 48,8% ) e ofert a de sopa a cr ianças acim a de 8 m eses ( 71, 6% ) . Just ificam - se no m unicípio int er v enções focadas na alim ent ação com p lem en t ar .
DESCRI TORES: aleit am ent o m at er no; leit e hum ano; suplem ent ação alim ent ar
1
PhD, Assist ant Professor, e- m ail: cparada@fm b.unesp.br, carvalha@fm b.unesp.br; 2 Undergraduat e Nursing St udent , e- m ail: m ikkinha2004@yahoo.com .br. Universit y Est adual Paulist a “ Júlio de Mesquit a Filho” Medical School
I NTRODUCTI ON
I
n t he light of cur r ent scient ific k now ledge, t here is a consensus about hum an m ilk as being t heo n l y f o o d p r o d u ct t h a t i s ca p a b l e o f a d e q u a t e l y
at t ending t o all phy siological peculiar it ies of infant s’
m et abolism during t he first six m ont hs of t heir lives( 1).
Desp it e ad v an ces in b r east f eed in g r at es in
t he last decade, t he br east feeding sit uat ion in Br azil
r em ains far below WHO ( Wor ld Healt h Or ganizat ion)
r ecom m en dat ion s: ex clu siv e br east f eedin g u n t il t h e
s i x t h m o n t h o f l i f e a n d b r e a s t f e e d i n g w i t h
com plem ent ary foods unt il t he age of t wo or m ore( 2).
I n Bot ucat u/ SP, t he cit y where t his st udy was carried
out , a progressive increase in exclusive breast feeding
has been observed am ong children younger t han 120
days, wit h prevalence levels of 19.1% in 1995, 22.6%
in 1999 and 36.9% in 2004( 3).
Com plem ent ary feeding is defined as feeding
d u r in g t h e p er iod in w h ich , b esid es m ot h er ’s m ilk ,
ot h er f oods or f lu ids ar e of f er ed t o t h e ch ild( 4 ). As
t here is no specific t erm t o designat e t he int roduct ion
of food product s t o children who are not breast fed, in
t h is st u dy, t h e t er m com plem en t ar y f eedin g w ill be
u se d i n d e p e n d e n t l y o f t h e ch i l d ’ s b r e a st f e e d i n g
sit u at ion .
Th e W H O r e c o m m e n d s t h e o f f e r i n g o f
com p lem en t ar y f ood s f r om t h e ag e of six m on t h s
onwar ds( 1). How ever, t he cur r ent t endency, endor sed
by t he Brazilian Healt h Minist ry, is t o recom m end t he
in t r od u ct ion of com p lem en t ar y f ood s at t h e ag e of
six m ont hs( 5).
I n o r d e r t o g u a r a n t e e sa t i sf a ct i o n o f t h e
child’s nut r it ional needs, com plem ent ar y foods m ust
b e: t im ely ( in t r od u ct ion w h en en er g y an d n u t r ien t
n e e d s e x ce e d w h a t e x cl u si v e b r e a st f e e d i n g ca n
offer) ; adequat e ( providing sufficient energy, prot eins
and m icr onut r ient s t o sat isfy t he nut r it ional needs of
a growing child) ; innocuous ( hygienic preparat ion and
st or ag e, of f er ed w it h clean h an d s an d u sin g clean
u t en sils) , of f er ed w it h a t ech n iq u e, f r eq u en cy an d
consist ency t hat ar e adequat e for t he age, at t ending
t o t he child’s feelings of hunger and sat iet y( 5).
At first, the food products offered to children m ust
be prepared especially for t hem , in t he form of pulps,
vegetable m ush, cereals or fruits. These are the so-called
transition foods. From the age of eight m onths onwards,
the sam e foods prepared for the fam ily can be offered,
provided that they are m ashed, m inced, chopped or cut
in sm all pieces. The use of cups is recom m ended to offer
wat er or ot her fluids, while sem i- solid and solid foods
should be given with a plate and spoon(4).
I n view of t he im por t ance of com plem ent ar y
feeding for t he child’s gr ow t h and dev elopm ent , t his
r e se a r ch w a s p r o p o se d w i t h t h e a i m o f st u d y i n g
com plem ent ar y feeding pr act ices in t he fir st y ear of
life in Bot ucat u- SP, descr ibing t heir use accor ding t o
age r ange and ident ifying differ ences associat ed w it h
t he pr esence of br east feeding.
METHOD
St udy Ty pe and Dat a Collect ion
We car r ied out a cr oss- sect ional st udy. Dat a
were obt ained during t he 1st phase of t he 2004 Nat ional
Mu lt ivaccin at ion Cam paign in Bot u cat u - SP, a cit y of
ab ou t 1 1 0 , 0 0 0 in h ab it an t s, locat ed in t h e Cen t r
al-Sout h of t he st at e. We int erview ed 1238 com panions
of children of less t han one year old – 90.6% of t he
est im at ed n u m ber of ch ildr en f or t h is age r an ge – ,
and obt ained inform at ion about t he consum pt ion ( yes,
n o ) o f f o o d p r o d u ct s d u r i n g t h e d a y b e f o r e t h e
r esear ch. We ask ed about t he consum pt ion of w at er,
t eas, j u ices, f r u it s, ( liqu id or pow der ) m ilk , bean s,
m eat , por r idge, soup, m ush and solid food.
We st udied childr en of less t han six m ont hs
t o a s s e s s t h e t i m e l y i n t r o d u c t i o n o r n o t o f
co m p l e m e n t a r y f o o d s, ch i l d r e n a t t h e a g e o f si x
m on t h s b ecau se com p lem en t ar y f ood s sh ou ld st ar t
in t his age r ange, and childr en bet w een six and t en
m ont hs t o follow t he indicat or s r ecom m ended by t he
WHO( 6 ). Th e ag e r an g e b et w een ei g h t an d t w el v e
m ont hs was st udied because, at t his age, it is indicat ed
t hat children st art t o receive t he sam e food prepared
for t heir r elat iv es( 4- 5).
Et h ical pr ocedu r es
Th is st u d y w as assessed an d ap p r ov ed b y
Sc h o o l a n d c o m p l i e s w i t h r e c o m m e n d a t i o n s f o r
r esear ch inv olv ing hum an beings.
Dat a an aly sis
Quest ionnair es w er e check ed and coded and
a dat abase was creat ed in Epi I nfo 6.0 soft ware, using
r e so u r ce s t h a t o n l y p e r m i t t e d t h e e n t r y o f d a t a
est ablished in t he coding. File consist ency was checked
b y v e r i f y i n g a sso ci a t e d q u e st i o n s i n p a r t o f t h e
quest ionnair es and cor r ect ing t he ident ified er r or s.
I n o r d e r t o a sse ss t h e r e l a t i o n b e t w e e n com plem en t ar y food con su m pt ion an d t h e pr esen ce
or not of breast feeding, t he chi- square t est was used
w it h a 5 % sig n if ican ce lev el. Wh en t h e n u m b er of
ch ildr en in a specif ic cat egor y w as low er t h an f iv e,
Fisher’s Exact Test was perform ed, wit h t he sam e 5%
sign if ican ce lev el.
RESULTS
Table 1 pr esent s t he consum pt ion fr equency
of com plem ent ar y foods accor ding t o t he child’s age r an ge.
Table 1 – Consum pt ion fr equency of com plem ent ar y
foods in children of less t han one year old. Bot ucat u,
2 0 0 4
d o o F e g A m 4 -| 0 ) 0 1 4 = n
( (4n=|-169m8) 6(n=|-874m) (6n|=-31091m) (8n=|-1423m7) º
N % Nº % Nº % Nº % Nº % e g d i r r o P s e
Y 30 7,3 69 34,8 45 53,6 209 53,5 211 48,3
o
N 380 92,7 129 65,2 39 46,4 182 46,5 226 51,7
p u o S s e
Y 10 2,4 79 39,9 58 69,0 295 75,4 313 71,6
o
N 398 97,1 117 59,1 25 29,8 96 24,6 121 27,7
d e m r o f n I t o
N 2 0,5 2 1,0 1 1,2 - - 3 0,7
d o o F d il o S s e
Y 2 0,5 38 19,2 41 48,8 234 59,8 327 74,8
o
N 399 97,3 155 78,3 42 50,0 157 40,2 110 25,2
d e m r o f n I t o
N 9 2,2 5 2,5 1 1,2 - -
-e c i u J s e
Y 23 5,6 76 38,4 52 61,9 264 67,5 300 68,6
o
N 387 94,4 122 61,6 32 38,1 127 32,5 137 31,4
t i u r F s e
Y 17 4,1 107 54,1 62 73,8 289 73,9 324 74,2
o
N 390 95,2 88 44,4 20 23,8 94 24,1 105 24,0
d e m r o f n I t o
N 3 0,7 3 1,5 2 2,4 8 2,0 8 1,8
a e T
s e
Y 126 30,7 52 26,3 23 27,4 103 26,3 86 19,7
o
N 270 65,9 141 71,2 59 70,2 281 71,9 341 78,0
d e m r o f n I t o
N 14 3,4 5 2,5 2 2,4 7 1,8 10 2,3
s r e h t O s e
Y 13 3,2 41 20,7 42 50,0 235 60,1 290 66,4
o
N 390 95,1 143 72,2 37 44,0 138 35,3 132 30,2
d e m r o f n I t o
N 7 1,7 14 7,1 5 6,0 18 4,6 15 3,4
Table 1 shows t hat 126 children of less t han
f ou r m on t h s old ( 3 0 . 7 % ) r eceiv ed t ea, w h ile ot h er
f ood p r od u ct s w er e less con su m ed . Mor eov er, t h e
pr opor t ion of ch ildr en con su m in g t h e dif f er en t f ood
p r od u ct s w e ex am in ed in cr eases as ag e ad v an ces,
ex cep t f or t ea, f or w h ich con su m p t ion p r ev alen ce
d e cr e a se s t o 1 9 . 7 % i n ch i l d r e n o l d e r t h a n e i g h t
m ont hs, and por r idge and soup, w hich ar e a bit less
co n su m ed i n t h e a g e r a n g e f r o m ei g h t t o t w el v e
m ont hs in com par ison w it h childr en bet w een six and
t en m ont hs.
Table 2 pr esen t s t h e pr opor t ion of ch ildr en
w h o con su m ed m eat in sou p or solid f ood an d bean s
in solid f ood am on g t h ose r eceiv in g salt y f ood, per
ag e r an g e. Ch i l d r en o f l ess t h an f o u r m o n t h s o l d
w e r e e x c l u d e d , a s f e w o f t h e m r e c e i v e d t h e s e
p r o d u ct s.
Table 2 – I nt r oduct ion of com plem ent ar y foods w it h
m eat or beans in children bet ween 4 m ont hs and one
y ear old. Bot ucat u, 2004
d o o F e g A m 6 -| 4 ) 8 9 1 = n
( 6(n|=-784m) 6(n|=-31901m) 8(n|=-1423m7) º
N % Nº % Nº % Nº %
t a e M / p u o S s e
Y 52 65,8 46 79,3 248 84,1 284 90,7
o
N 27 34,2 12 20,7 45 15,2 24 7,7
d e m r o f n i t o
N - - - - 2 0,7 5 1,6
l a t o
T 79 100,0 58 100,0 295 100,0 313 100,0
t a e M / d o o f d il o S s e
Y 19 50,0 25 61,0 161 68,8 251 76,8
o
N 19 50,0 16 39,0 70 29,9 74 22,6
d e m r o f n i t o
N - - - - 3 1,3 2 0,6
l a t o
T 38 100,0 41 100,0 234 100,0 327 100,0
t a e M / d o o f d il o S s e
Y 33 86,8 35 85,4 209 89,3 303 92,7
o
N 5 13,2 6 14,6 24 10,3 24 7,3
d e m r o f n i t o
N - - - - 1 0,4 -
-l a t o
T 38 100,0 41 100,0 234 100,0 327 100,0
Th e of f er in g of com p lem en t ar y f ood s w it h
m eat an d b ean s al so i n cr eased as ag e ad v an ced ,
ex cept f or a sligh t decr ease in t h e of f er in g of f ood
wit h beans am ong six- m ont h- olds in com parison wit h
childr en bet w een four and six m ont hs old.
Tables 3 t o 5 show t he relat ion bet w een t he
pr esen ce of br east f eedin g an d com plem en t ar y f ood
Ta b l e 3 – Re l a t i o n b e t w e e n b r e a s t f e e d i n g a n d
com p lem en t ar y f ood s in ch ild r en u p t o six m on t h s
old. Bot ucat u, 2004
e g A g n i d e e f t s a e r
B 0 -|4m(n=410) 4-|6m(n=198) 6-|7m(n=84) s
e
Y No Yes No Yes No d
o o
F Nº % Nº % Nº % Nº % Nº % Nº % e g d i r r o P s e
Y 16 4,7 14 21,2 36 26,1 33 55 24 54,5 21 52,5
o
N 32895,3 52 78,810273,9 27 45 20 45,5 19 47,5
α2=22,40p=0,0000α2=15,40p=0,0000 α2=0,04 p=0,8510
p u o S s e
Y 8 2,3 2 3 53 38,7 26 44,1 31 70,5 27 69,3
o
N 33497,7 64 97 84 61,3 33 55,9 13 29,5 12 30,7
8 7 6 6 , 0 = r e h s i
F α2=0,50 p=0,481 α2=0,01 p=0,9034
d o o F d il o S s e
Y 0 0 2 3 25 18,5 13 22,4 16 36,4 25 64,1
o
N 336 100 63 97 11081,5 45 77,6 28 63,6 14 35,9
9 5 2 0 , 0 = r e h s i
F α2=0,39 p=0,5326 α2=6,36 p=0,0116
e c i u J s e
Y 13 3,8 10 15,2 47 34,1 29 48,3 26 59,1 26 65
o
N 33196,2 56 84,8 91 65,9 31 51,7 18 40,9 14 35
α2=11,37p=0,0007 α2=3,60 p=0,0576 α2=0,31 p=0,5775
ti u r F s e
Y 12 3,5 5 7,6 70 51,1 37 63,8 32 74,4 30 76,9
o
N 32996,5 61 92,4 67 48,9 21 36,2 11 25,6 9 23,1
α2=2,27 p=0,1315 α2=2,65 p=0,1013 α2=0,07 p=0,7919
a e T
s e
Y 96 28,9 30 46,8 30 21,9 22 36,7 9 21,4 14 35
o
N 236 71,1 34 53,210778,1 38 63,3 33 78,6 26 65
α2=7,98 p=0,0047 α2=4,68 p=0,0304 α2=1,87 p=0,1714
r e t a W s e
Y 57 16,6 40 60,6 78 56,5 54 90 40 90,9 37 92,5
o
N 28683,4 26 39,4 60 43,5 6 10 4 9,1 3 7,5
α2=59,20p=0,0000α2=21,09p=0,0000 α2=0,07 p=0,7921
s r e h t O s e
Y 11 3,2 2 3,2 25 19,4 16 29,1 20 48,8 22 57,9
o
N 32996,8 61 96,810480,6 39 70,9 21 51,2 16 42,1 0 0 0 0 , 1 = r e h s i
F α2=2,10 p=0,1473 α2=0,66 p=0,4172
The consum pt ion frequency of any exam ined
food or liquid was proport ionally higher am ong children
of less t han six m ont hs old w ho w er e not br east fed.
I n t he age range under four m ont hs old, not receiving
br east m ilk w as associat ed w it h a h igh er fr equ en cy
o f p o r r i d g e co n su m p t i o n ( p = 0 . 0 0 0 0 ) , h o m e- m ad e
food ( Fisher = 0.0259) , fr uit j uice ( p= 0.0007) , t eas
( p= 0.0047) and wat er ( p= 0.0000) . We also found an
associat ion in t h e age r an ge of f ou r t o six m on t h s
bet ween not being breast fed and great er consum pt ion
of som e com plem ent ar y foods, such as por r idge ( p=
0.0000) , fruit j uice ( p= 0.0576) , t eas ( p= 0.0304) and
w at er ( p= 0.0000) . Am ong six - m ont h- olds, not being
b r e a s t f e d w a s o n l y a s s o c i a t e d w i t h a h i g h e r
co n su m p t i o n f r e q u e n cy o f h o m e - m a d e f o o d ( p =
0 . 0 1 1 6 ) .
Ta b l e 4 p e r m i t s co m p a r i n g d i f f e r e n ce s i n
com plem ent ary food and liquid consum pt ion according
t o breast feeding in t wo age ranges: six t o t en m ont hs
and eight t o t w elve m ont hs.
Ta b l e 4 – Re l a t i o n b e t w e e n b r e a s t f e e d i n g a n d
com plem ent ary foods in children bet w een six m ont hs
and one y ear old. Bot ucat u, 2004
g n i d e e f t s a e r B e g A ) 1 9 3 = n ( m 0 1 -|
6 8|-12m(n=437) s
e
Y No Yes No
d o o
F Nº % Nº % Nº % Nº %
e g d i r r o P s e
Y 100 52,1 109 54,8 89 48,4 122 48,2
o
N 92 47,9 90 45,2 95 51,6 131 51,8
α2=0,28 p=0,5938 α2=0,00 p=0,9755
p u o S s e
Y 150 78,1 145 72,9 142 77,6 171 68,1
o
N 42 21,9 54 27,1 41 22,4 80 31,9
α2=1,46 p=0,2269 α2=4,72 p=0,0293
d o o F d il o S s e
Y 103 53,7 131 65,8 136 73,9 191 75,5
o
N 89 46,3 68 34,2 48 26,1 62 24,5
α2=6,04 p=0,0140 α2=0,14 p=0,7069
e c i u J s e
Y 126 65,6 138 69,4 134 72,8 166 65,6
o
N 66 34,4 61 30,6 50 27,2 87 34,4
α2=0,62 p=0,4320 α2=2,58 p=0,1085
t i u r F s e
Y 144 76,6 145 74,3 141 77,9 183 73,8
o
N 44 23,4 50 25,7 40 22,1 65 26,2
α2=0,26 p=0,6110 α2=0,96 p=0,3281
a e T
s e
Y 42 22,6 61 30,8 30 16,8 56 22,5
o
N 144 77,4 137 69,2 148 83,2 193 77,5
α2=3,31 p=0,0689 α2=2,05 p=0,1522
r e t a W s e
Y 182 94,8 188 94,5 179 97,3 243 96
o
N 10 5,2 11 5,5 5 2,7 10 4
α2=0,02 p=0,8886 α2=0,49 p=0,4837
s r e h t O s e
Y 106 58,6 129 67,2 120 68,6 170 68,8
o
N 75 41,4 63 32,8 55 31,4 77 31,2
α2=2,97 p=0,0846 α2=0,00 p=0,9556
We o b s e r v e d s o m e d i f f e r e n c e s i n
com p lem en t ar y f ood con su m p t ion accor d in g t o t h e
presence of breast feeding. I n t he age range bet ween
six and t en m ont hs, t he absence of breast feeding was
a s s o c i a t e d w i t h a h i g h e r f r e q u e n c y o f c h i l d r e n
r eceiv in g h om e- m ad e f ood ( p = 0 . 0 1 4 0 ) . Br east f ed
children bet ween eight and t welve m ont hs old, on t he
o t h er h an d , r ecei v ed si g n i f i can t l y m o r e so u p ( p =
0 . 0 2 9 3 ) .
Table 5 show s t he presence of m eat in soup
pr epar at ions and m eat or beans in hom em ade food
accor din g t o br east feedin g in ch ildr en bet w een fou r
Ta b l e 5 – Re l a t i o n b e t w e e n b r e a s t f e e d i n g a n d
in t r od u ct ion of com p lem en t ar y f ood s w it h m eat or
beans in children bet ween four m ont hs and one year
old. Bot ucat u, 2004
d o o
F Soupwtihmeat Adutlmfoeoadtwhti Adutlbfeoaondswhti
g n i d e e f t s a e r B / e g
A Yes No Yes No Yes No
º
N % Nº % Nº % Nº % Nº % Nº % m
6 -| 4
g n i d e e f t s a e r B
s e
Y 32 61,5 21 77,8 11 57,9 14 73,7 22 66,7 3 60
o
N 20 38,5 6 22,2 8 42,1 5 26,3 11 33,3 2 40
α2=2,12 p=0,1451 α2=1,05 p=0,3049 Fisher=1,0000
m 7 -| 6
g n i d e e f t s a e r B
s e
Y 23 50 8 66,7 8 32 8 50 11 31,4 5 83,3
o
N 23 50 4 33,3 17 68 8 50 24 68,6 1 16,7
α2=1,06 p=0,3026 α2=1,33 p=0,2490 Fisher=0,0260
m 0 1 -| 6
g n i d e e f t s a e r B
s e
Y 12148,8 27 60 67 41,6 33 47,1 91 43,5 11 45,8
o
N 12751,2 18 40 94 58,4 37 52,911856,5 13 54,2
α2=1,91 p=0,1664 α2=0,61 p=0,4358 α2=0,05 p=0,8302
m 2 1 -| 8
g n i d e e f t s a e r B
s e
Y 12945,4 11 45,8103 41 31 41,912741,9 8 33,3
o
N 15554,6 13 54,2148 59 43 58,117658,1 16 66,7
α2=0,00 p=0,9690 α2=0,02 p=0,8954 α2=0,68 p=0,4111
Table 5 evidences an associat ion bet ween not
bein g br east f ed an d gr eat er con su m pt ion of h om
e-m ade food w it h beans for childr en at t he age of six
m ont hs old only ( Fisher = 0.0260) .
Finally, we also exam ined t he way liquids were
offered t o children of less t han one year old, whet her
feeding bot t les were used, in relat ion t o breast feeding.
We found an associat ion bet ween not being breast fed
an d u sin g r u b b er t eat s on f eed in g b ot t les t o of f er
liq u id s acr oss all ag e r an g es ( d at a n ot in clu d ed in
any Table) .
DI SCUSSI ON
Fir st , w e w ill consider som e aspect s r elat ed
t o t h e v a l i d i t y o f t h i s s t u d y. Se l e c t i n g c h i l d r e n
par t icipat ing in a Mult ivaccinat ion Cam paign r evealed
t o be a good choice, because it allowed us t o assess
t he feeding of 90.6% of childr en under one y ear old
i n t h e c i t y , g u a r a n t e e i n g h i g h p o p u l a t i o n a l
r e p r e se n t a t i v e n e ss. Ho w e v e r, a s t h i s i s a cr o
ss-sect ion al st u dy, it is lim it ed by t h e im possibilit y of
ident ifying at what age t he consum pt ion of each food
pr oduct st ar t ed.
The result s obt ained in t his research evidence
t he unt im ely and early int roduct ion of com plem ent ary
foods in child feeding in t he cit y under st udy, leading
t o t he int errupt ion of exclusive breast feeding as early
as t h e f ir st m on t h s of lif e. Th e sam e sit u at ion h as
been observed in ot her nat ional st udies( 7- 10), indicat ing
t hat t his is not a local problem .
A com par ison bet w een childr en of less t han
four m ont hs old in t his st udy and children of t he sam e
age from a cit y in t he Nort heast of Brazil( 9) shows t hat
t h e s i t u a t i o n i s a b i t b e t t e r i n Bo t u c a t u : l o w e r
p r ev alen ce lev els of j u ice ( 8 . 4 % an d 5 . 6 % ) , sou p
( 5 . 3 % an d 2 . 4 % ) an d h om e- m ade f ood ( 2 . 1 % an d
0.5% ) , despit e sim ilar t ea consum pt ion levels ( 31.8%
and 30. 7% ) .
Com plem ent ing breast m ilk wit h non- nut rit ive
liquids like t eas during t he first six m ont hs of life is a
long- est ablished cult ur al pr act ice in our m eans, but
i n a d e q u a t e a n d u n n e c e s s a r y f r o m a b i o l o g i c a l
perspect ive, despit e long and dry days. Moreover, t his
h a b i t k n o w i n g l y l e a d s t o d e c r e a s e d t o t a l m i l k
con su m p t ion an d can cu lm in at e in ear ly w ean in g ,
besides raising m orbidit y and m ort alit y risks( 5). I n t his
st udy, we found t hat t ea was present in feeding habit s
d u r i n g t h e f i r s t y e a r o f l i f e , w i t h t h e h i g h e s t
consum pt ion frequencies in children of less t han four
m o n t h s o l d , w h e r e a l m o st o n e t h i r d o f ch i l d r e n
consum ed it on t he day befor e dat a collect ion.
I n anot her st udy car r ied out in Bot ucat u in
2 0 0 4 , i t w as ev i d en ced t h at t h e m ai n m ot i v e t h e
m ot her s alleged for t he ear ly int r oduct ion of t eas in
t heir children’s feeding was considering t hat t he child
needed t hese fluids, t hat is, t hat t hey were necessary
t o sat isf y t h e ch ild ’s n eed s( 1 1 ), su g g est in g lack of
knowledge about t he possible harm ful effect s for healt h
of t hese foods in t his st age of life.
As expect ed, t he proport ion of children in t his
st udy who consum ed sem i- solid, solid and liquid foods
increased wit h age. The sam e occurred in São
Carlos-SP and Feir a de Sant ana- BA, w her e foods like fr uit s,
m u sh a n d h o m e- m a d e f o o d p r esen t ed co n st a n t l y
incr easing consum pt ion pr ev alence r at es( 8- 9).
Aft er com plet ing six m ont hs, t he presence of
com plem ent ar y foods is desir able but , unt il t he age
of eight m ont hs, t hese should be prepared especially
for t he child and offered as porridge, veget able m ush,
c e r e a l s o r f r u i t s( 5 ). A s o p p o s e d t o t h e s e
r eco m m en d at i o n s, w e f o u n d i n t h i s r esear ch t h at
48.8% of childr en at t he age of six m ont hs ( 6| - 7m )
w er e alr ead y r eceiv in g t h e sam e h om e- m ad e f ood
prepared for t he ent ire fam ily, t hat is, an inadequat e
consist ency t hat could im pair t he accept ance of t he
Only 19 childr en ( 3.0% ) aged six m ont hs or
o l d e r w e r e r e ce i v i n g n o so l i d o r se m i - so l i d f o o d
w h at soev er ( h om e- m ade food, fr u it or salt y m u sh ) .
Hence, t he problem in t he cit y under st udy is relat ed
t o t h e e a r l y a n d n o t l a t e i n t r o d u c t i o n o f
com p lem en t ar y f ood s.
The offering of m eat in soup increased when
com paring t he age groups bet ween six and t en m ont hs
a n d b e t w e e n e i g h t a n d t w e l v e m o n t h s, r e a ch i n g
considerable part s of t he children: 84.1% and 90.7% ,
r espect iv ely. The sam e occur r ed w it h t he offer ing of
m eat in h om e- m ad e f ood : 6 8 . 8 % an d 7 6 . 8 % an d
beans in food: 89. 3% and 92. 7% . I ndependent ly of
t he age range, we perceived a favorable sit uat ion for
adequat e ir on int ak e.
Th e i n t r o d u ct i o n o f co m p l em en t a r y f o o d s
sh ou ld also b e d iscu ssed accor d in g t o t h e t y p e of
f e e d i n g t h a t i s p r a c t i c e d , i n v i e w o f v a r y i n g
r ecom m en d at ion s.
For ch ild r en of less t h an f ou r m on t h s an d
bet w een f ou r an d six m on t h s, com plem en t ar y f ood
consum pt ion has always been higher in non- breast fed
ch i l d r e n , w h i ch i s u n d e r st a n d a b l e , a s t h e e a r l i e r
int roduct ion of com plem ent ary foods is recom m ended
w hen br east feeding is absent : w at er bet w een m eals
as from birt h; fruit j uice bet ween t wo and four m ont hs
for children receiving full- fat m ilk; fruit and salt y m ush
from t he fourt h t o t he eight h m ont h of life( 12).
I n general, t he cit y displayed an unfavorable
sit u at ion for ch ildr en of less t h an fou r m on t h s: t h e
prevalence of breast feeding was only 36.9%( 3); am ong
n o n - b r e a s t f e d c h i l d r e n , o n t h e o t h e r h a n d , t h e
pr esence of com plem ent ar y foods w as less fr equent
t h an r ecom m en d ed lev els. I n t h is last g r ou p , on ly
60.6% r eceived wat er. Am ong non- br east fed childr en
b et w een 2 | - 4 m on t h s, on ly 1 2 . 1 % r eceiv ed f r u it
j u i ce, w h i ch i s r ecom m en d ed t o su p p l y v i t am i n C
needs in childr en r eceiv ing non- enr iched cow ’s m ilk .
Th e h ig h con su m p t ion lev el of t eas am on g
non- breast fed children ( 46.8% ) seem s t o indicat e t hat
t h eir m ot h er s r eplace w at er ( r ecom m en ded) by t ea
( advised against ) . I n t he m ot hers’ represent at ion, t ea
plays an im port ant role t o relieve t he child’s cram ps( 11).
The com plem ent ar y feeding sit uat ion am ong
non- br east fed childr en fr om four m ont hs onw ar ds is
slight ly bet t er: in t he age range bet ween 4 | - 6 m ont hs,
48. 3% r eceiv ed j uice, 63. 8% fr uit m ush and 44. 1%
sou p .
For breast fed children bet ween 6 | - 7 m ont hs,
9 0 . 9 % r eceiv ed solid or sem i- solid foods, indicat ing
a high lev el of t im ely com plem ent ar y feeding in t his
age range. However, as t his is a cross- sect ional st udy,
w e c a n n o t a f f i r m w h e n t h e s e p r o d u c t s w e r e
in t r od u ced .
As t o offer in g t h e sam e foods pr epar ed for
t h e fam ily t o t h e ch ild, t h e sam e r ecom m en dat ion s
a r e g i v e n i n d e p e n d e n t l y o f t h e d u r a t i o n o f
breast feeding, t hat is, t o int roduce t his food from t he
eight h m ont h of life onwards. However, bet ween 6 | - 7
m on t h s, 3 6 . 4 % of t h e b r east f ed ch ild r en r eceiv ed
h om e- m ad e f ood , ag ain st 6 4 . 1 % of n on - b r east f ed
children, evidencing t he early t ransit ion from a doughy
t o a solid con sist en cy, m ain ly am on g n on - br east fed
children. These dat a also indicat e t he early int errupt ion
of special food preparat ion for all of t he child’s m eals,
which m ay be a risk, as t he Brazilian adult populat ion’s
v eget able consum pt ion is low( 13).
I t w a s o b s e r v e d i n t h i s s t u d y t h a t
approxim at ely t hree quart ers of t he children bet ween
8 | - 1 2 m on t h s ( 7 3 . 9 % of br east f ed an d 7 5 . 5 % of
non- breast fed children) had received hom e- m ade food
on t h e d ay b ef or e d at a collect ion . Th is p r act ice is
considered adequat e for t his age range. However, soup
co n su m p t i o n w a s a l so h i g h : 6 8 . 1 % a m o n g n o n
-breast fed and 77.6% am ong -breast fed children, which
s h o u l d b e d i s c o u r a g e d , d u e t o t h e i n a d e q u a t e
consist ency of t his food for t his age range, as children’s
reduced gast ric capacit y m akes it difficult for t hem t o
s u p p l y t h e i r e n e r g y n e e d s t h r o u g h d i l u t e d
com plem en t ar y f oods( 4 ).
Con t in u ed br east f eedin g r at es at eigh t , t en
an d t w elv e m on t h s cor r espon ded t o 5 1 . 0 % , 4 3 . 1 %
an d 3 7 . 8 % , r espect iv ely. Alt h ou gh t h ese lev els ar e
f ar f r om ideal, t h ey in dicat e a r eason able sit u at ion
for cont inued br east feeding, especially in t he eight h
m o n t h o f l i f e . Th u s , t h e e a r l y i n t r o d u c t i o n o f
c o m p l e m e n t a r y f o o d s , a c c o m p a n i e d b y t h e
int er r upt ion of ex clusiv e br east feeding, is r at ified as
t he cit y ’s m ain pr oblem .
Th e u s e o f a r t i f i c i a l t e a t s t o o f f e r
com plem ent ar y feeding, such as feeding bot t les, w as
s i g n i f i c a n t l y a n d n e g a t i v e l y a s s o c i a t e d w i t h
breast feeding in all age ranges. This also occurred in
o t h er st u d i es( 7 - 1 0 ), h i g h l i g h t i n g t h e i m p o r t a n ce o f
in f or m in g an d ad v isin g ag ain st t h ese in m at er n it y
hospit als and k inder gar t ens, as w ell as st r at egies t o
address t he m ot hers, evidence t he harm ful effect s of
using t hem and t he viabilit y of offering com plem ent ary
FI NAL CONSI DERATI ONS
Com plem ent ar y foods w er e int r oduced at an
early st age in children of less t han one year old. Alm ost one t hird of children under four m ont hs old used
non-n u t r i t i v e f l u i d s l i k e t eas, l ead i non-n g t o l ow ex cl u si v e br east f eedin g pr ev alen ce lev els. I n t h is age r an ge,
n on - br east fed ch ildr en w er e in a bet t er sit u at ion in t er m s of com p lem en t ar y f eed in g : t ea con su m p t ion
was also frequent , children needing fruit j uice did not
r eceiv e it and t he pr ev alence of w at er consum pt ion, w h i c h s h o u l d b e o f f e r e d t o a l l c h i l d r e n , w a s
approxim at ely 60% . This produced low levels of t im ely com plem ent ar y food int r oduct ion in t he fir st m ont hs
of life, independent ly of t he br east feeding sit uat ion. As t o com plem en t ar y f eedin g con su m ed by
children bet w een six and t w elve m ont hs old, t he low p r ev alen ce lev el of ch ild r en w h o h ad n ot r eceiv ed
so l i d o r sem i - so l i d f o o d s o n t h e d a y b ef o r e d a t a c o l l e c t i o n a g a i n r a t i f i e s t h e e a r l y a n d n o t l a t e
in t r odu ct ion of food pr odu ct s as t h e cit y ’s pr oblem . I n t h is ag e r an g e, in d icat or s w er e f av or ab le: h ig h
prevalence of children receiving soups wit h m eat and
hom e- m ade food wit h m eat and beans, which are good sour ces of ir on, a cr it ical nut r ient in t his age r ange.
How ev er, som e pr oblem s w er e det ect ed in t er m s of food consist ency, such as t he ear ly offer ing of solid
foods and t he m aint enance of soup for childr en w ho should be r eceiv ing solid food.
He n ce , p r o f e ssi o n a l s a n d h e a l t h se r v i ce s
act iv e in br east f eedin g pr om ot ion an d su ppor t n ow h av e t o w or k t o ch an ge t h is u n f av or able pict u r e in
t er m s of com plem ent ar y food consum pt ion. Ther e is a n u r g e n t n e e d t o f o c u s f o o d c o u n s e l i n g f o r
b r ea st f eed i n g i n f a n t s o n co m p l em en t a r y f eed i n g , b e s i d e s t h e a l r e a d y q u i t e d i s s e m i n a t e d a c t i o n s
im plem en t ed in ou r m ean s t o pr om ot e an d su ppor t
b r east f eed in g .
A s u c c e s s f u l e x p e r i e n c e w a s r e c e n t l y
developed in t he Sout h of Brazil, where undergraduat e n u t r it ion st u den t s w er e t r ain ed an d paid t en h om e
v isit s t o a gr ou p of br east f eedin g in f an t s an d t h eir m ot hers, during t he first life year, giving advice based
on gu idelin es by t h e Br azilian Healt h Min ist r y( 5 ). I n com p ar ison w it h a g r ou p t h at d id n ot r eceiv e t h e
int ervent ion, lower levels of fluid int roduct ion like wat er and t ea were found am ong t he st udied children in t he
f ir st y ear of lif e, as w ell as a 6 0 % in cr ease in t h e
chance of receiving exclusive breast feeding for at least four m ont hs, and a 40 % lower consum pt ion of sweet s
( candies, soft dr ink s, snack s and chocolat e) , am ong ot her obser v ed benefit s( 14) .
An ot h er Br azilian st u d y, car r ied ou t in t h e Nor t heast , also ident ified a v er y fav or able r esponse
t o a hom e int ervent ion aim ed at support ing exclusive br east feeding and av oiding t he ear ly int r oduct ion of
com plem en t ar y feedin g( 1 5 ).
Mak ing possible act ions as efficient as t hose
descr ibed abov e in public basic healt h car e ser v ices
is a challenge healt h professionals have t o face wit hout d e l a y. Ev i d e n c e s h o w s t h e c h i l d ’s h o m e a s t h e
pr efer ent ial space for t heir dev elopm ent .
Finally, it should be appoint ed t hat t his st udy
d i d n o t a i m t o g e t t o k n o w w h y t h e d e t e c t e d com plem ent ar y feeding pr oblem s occur. I t is k now n
t hat child car e pr act ices, including feeding pr act ices, ar e influenced by cult ur al, em ot ional, socioeconom ic
and healt h service problem s. Hence, new st udies are
r ecom m en ded, bot h epidem iological an d qu alit at iv e r e se a r ch , t o o b t a i n d e e p e r k n o w l e d g e a b o u t t h e
con dit ion in g fact or s of m at er n al beh av ior r elat ed t o infant feeding now aday s.
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