e-Library of Evidence for Nutrition Actions (eLENA)


An online library of evidence-informed guidelines for nutrition interventions and single point of reference for the latest nutrition guidelines, recommendations and related information.

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Complementary feeding

Intervention | Last updated: 20 January 2025


Complementary feeding is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk. The transition from exclusive breastfeeding to family foods – referred to as complementary feeding – typically covers the period from 6–23 months of age, even though breastfeeding may continue to two years of age and beyond. This is a critical period of growth during which nutrient deficiencies and illnesses contribute globally to higher rates of undernutrition among children under five years of age.

A number of successful strategies have been developed to improve complementary feeding practices in low- and middle-income countries, where practical difficulties can limit adherence to complementary feeding guidelines.

WHO Recommendations


Continued breastfeeding

  • Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health.
  • Breastfeeding should continue up to 2 years or beyond (strong, very low-certainty evidence)

Milks for children fed milks other than breast milk 

  1. Milks 6–11 months: for infants 6–11 months of age who are fed milks other than breast milk, either milk formula or animal milk can be fed (conditional, low-certainty evidence).
  2. Milks 12–23 months: for young children 12–23 months of age who are fed milks other than breast milk, animal milk should be fed. Follow-up formulas are not recommended (conditional, low-certainty evidence) 

Age of introduction of complementary foods

  • Infants should be introduced to complementary foods at 6 months (180 days) while continuing to breastfeed (strong, low-certainty evidence).

Dietary diversity 

  • Infants and young children 6–23 months of age should consume a diverse diet: 
    1. Animal-source foods, including meat, fish, or eggs, should be consumed daily (strong, low-certainty evidence). 
    2. Fruits and vegetables should be consumed daily (strong, low-certainty evidence), and 
    3. Pulses, nuts and seeds should be consumed frequently, particularly when meat, fish, or eggs and vegetables are limited in the diet (conditional, very low-certainty evidence).

Unhealthy foods and beverages

  • Foods high in sugar, salt and trans fats should not be consumed (strong, low-certainty evidence). 
  • Sugar-sweetened beverages should not be consumed (strong, low-certainty evidence). 
  • Non-sugar sweeteners should not be consumed (strong, very low-certainty evidence). d. Consumption of 100% fruit juice should be limited (conditional, low-certainty evidence).

Nutrient supplements and fortified-food products 

  • In some contexts where nutrient requirements cannot be met with unfortified foods alone, children 6–23 months of age may benefit from nutrient supplements or fortified food products. 
    1. Multiple micronutrient powders (MNPs) can provide additional amounts of selected vitamins and minerals without displacing other foods in the diet (context-specific, moderate-certainty evidence).
    2. For populations already consuming commercial cereal grain-based complementary foods and blended flours, fortification of these cereals can improve micronutrient intake, although consumption should not be encouraged (context-specific, moderate-certainty evidence).
    3. Small-quantity lipid-based nutrient supplements (SQ-LNS) may be useful in food insecure populations facing significant nutritional deficiencies (context-specific, high-certainty evidence).

Responsive feeding

  • Children 6–23 months of age should be responsively fed, defined as “feeding practices that encourage the child to eat autonomously and in response to physiological and developmental needs, which may encourage self-regulation in eating and support cognitive, emotional and social development” (strong, low-certainty evidence).


Evidence


Related Cochrane reviews


Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under

Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Cochrane Database of Systematic Reviews. 2018; Issue 5. Art. No.: CD011768.


Effectiveness of provision of animal‐source foods for supporting optimal growth and development in children 6 to 59 months of age

Eaton JC, Rothpletz‐Puglia P, Dreker MR, Iannotti L, Lutter C, Kaganda J, Rayco‐Solon P. Cochrane Database of Systematic Reviews. 2019; Issue 2. Art. No.: CD012818.


Other related systematic reviews


Impact of education and provision of complementary feeding on growth and morbidity in children less than 2 years of age in developing countries: a systematic review

Lassi ZS, Das JK, Zahid G, Imdad A, Bhutta ZA. BMC Public Health. 2013; 13 Suppl3:S13.


Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries

Dewey KG, Adu-Afarwuah S. Maternal & Child Nutrition. 2008; 4:24–85.


Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries

Imdad A, Yakoob MY, Bhutta ZA. BMC Public Health. 2011; 13;11 Suppl 3:S25.