Understanding how complementary feeding method longitudinally affects developmental outcomes in young children

The complementary feeding period, i.e., when infants are introduced to foods and liquids different from milk, has important implications for the child’s long-term physical, cognitive, and socio-emotional well-being. This proposal primarily aims to assess whether children exposed to different complementary feeding approaches have different cognitive, motor, language and self-regulation outcomes by two years of age. An additional aim is to evaluate children’s BMI outcomes.

In the last 10-15 years, there has been a rise in complementary feeding approaches alternative to “traditional complementary feeding” (that entails caregivers offering infants specially-prepared pureed foods on a spoon). These approaches have been labelled “on-demand complementary feeding” in Italy and “baby-led weaning” in UK and other Anglophone countries. Both of these approaches are based on the infant signalling an interest in food (rather than on parents offering food to the infant), setting the pace and intake of the meal, and often eating independently.

Notwithstanding “on-demand complementary feeding” and “baby-led weaning” are gaining popularity among new parents, the scientific studies on the outcomes of these approaches are relatively scarce, confined almost exclusively to the United Kingdom and New Zealand, and entirely focussing on children’s health outcomes and eating behaviour. However, alternative complementary feeding approaches may also influence cognitive, motor and language development and self-regulation ability, due to the early experience of choosing, manipulating, and chewing food within a positive family context (compared to the experience of being passively fed pureed food on a spoon often in the absence of other family members, except for the feeding caregiver, which is typical of the traditional complementary feeding approach). Crucially, research on how the complementary feeding approach impacts on developmental outcomes is still lacking.

To fill this gap, our research team will conduct a cohort study spanning from 4 to 24 months of age in 150 Italian children. It will be assessed whether the experience of independent infant feeding within the family social context, typical of “on-demand complementary feeding”, will lead to superior cognitive, language, and self-regulation outcomes, compared to “traditional complementary feeding”. To this purpose, children will be assessed for complementary feeding practices (“on-demand” vs. “traditional”), gross and fine motor development, oral-motor development, language development, self-regulation, weight and height, eating behaviour, and temperament. Background and demographic information, along with data on mother’s mental health and responsiveness during the meal, will be also collected.

The research team comprises two Research Units, including ethologists, developmental psychologists and one neuropsychiatrist. Moreover, the research team will be advised by a biostatistician and by the Associazione Culturale Pediatri, a no-profit association involving 1,400 Italian paediatricians, with a prevalence of family paediatricians, aimed at developing paediatric culture and promoting child health.

This research will provide an evidence-based approach to complementary feeding that will significantly contribute to the rich international debate on this topic. In addition, it will also have an impact in other directions, such as dissemination of information concerning healthy food habits and sustainability in food choice, designing guidelines and interventions for the empowerment of new parents, promoting the education of professionals, public understanding of science, and training of young researchers.