Infant and Young Child Feeding in Egypt

Complementary feeding (CF), as defined by the World Health Organization (WHO) in 2002, is ‘‘the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants’’ so that ‘‘other foods and liquids are needed, along with breast milk’’ (1).

Adequate nutrition during infancy and early childhood is fundamental to the development of each child’s full human potential. It is well recognized that the period from birth to two years of age is a “critical window” for the promotion of optimal growth, health and behavioral development.

Longitudinal studies have consistently shown that this is the peak age for growth faltering, deficiencies of certain micronutrients, and common childhood illnesses such as diarrhea. After a child reaches 2 years of age, it is very difficult to reverse stunting that has occurred earlier (1).

In contrast to the large literature on breast and formula feeding, less attention has been paid to the CF period, especially to the type of foods given, or whether this period of significant dietary change influences later health, development, or behavior.

The more limited scientific evidence base is reflected in considerable variation in CF recommendations and practices between and within countries. (2).

Child growth, development and wellbeing are determined by the feeding practices and nutritional status of the child. Infant feeding practices in most of Egyptian surveys showed that the majority of infants are breastfed. Exclusive breast-feeding is common but not universal in early infancy. median duration of breastfeeding was 17 months Surveys showed that breast-feeding continued for the majority of children beyond the first year of life. The percentage of children aged 6-9 months who received both breast milk and solid food is higher in urban areas. In rural areas, mothers are more likely to initiate and continue breast-feeding than mothers in urban areas (3,4).

Less than one-quarter of children aged 6-23 months were being fed according to minimum Infant and Young Child Feeding standards for diet diversity and meal frequency. One in five Egyptian children under age 5 was stunted, 8 percent were wasted (thin for their height), and 6 percent were underweight (thin for their age). Fifteen percent of children were overweight (heavy for their age). Slightly more than one-quarter of children age 6-59 months were anemic (5)

Regarding micronutrient deficiencies, anaemia is considered the most prevalent. The groups most affected are preschool children and their mothers. The World Health Organization have estimated that 29.9% of preschool aged children in Egypt suffer from anemia (WHO 2014). Studies suggest the problem may be more widespread; a 2012 study of 300 infants at Ain Shams University Children’s Hospital identified an anaemia prevalence of 66%, of which 43% was iron deficiency anaemia.  (6).

Similarly, vitamin A deficiency is also a challenge in Egypt with recent data from the WHO indicating that 11.9% of preschool children are vitamin A deficient. Vitamin D status is also a concern, with a recent study indicating that 60% and 32.6% of Egyptian neonates were vitamin D deficient and insufficient respectively  (8) this was associated with low maternal vitamin D status and a consequence of low fish consumption and limited skin exposure. Cross-sectional studies suggest that poor vitamin D status of Egyptian infants persists into childhood and adolescence (7,8)

These health problems in Egyptian infants are multifactorial and may be due to lack of nutritional guidelines especially for introduction of complementary feeding, socioeconomic factors, cultural barriers and peer pressures.

There are currently no detailed guidelines for complementary feeding in Egypt. Consequently, current practice deviates greatly from international guidelines

  The purpose of guideline  is to review current recommendations and practice; summarize evidence for nutritional aspects and short-and long-term health effects of the timing and composition of CF; provide advice to health care providers for proper CF considering different aspects of CF with respect to developmental readiness, nutritional adequacy, and health effects; content, with respect to nutritional requirements and health effects; method of feeding; and specific dietary practices.