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>Date: Mon, 6 Apr 1998 10:01:34 +0100
>Subject: Further precision
>To: DETTWYLER Kathy <[log in to unmask]>
>Content-Description: cc:Mail note part
>
>     Kathy,
>
>     Calling into question, then redefining, WHO's current infant-feeding
>     recommendation began in a big way after the Forty-seventh World Health
>     Assembly in May 1994 and the adoption of resolution WHA47.5. The
>     following paragraphs should help you through the thicket on this one.
>
>     Jim
>
>     ***
>
>     May I suggest that you read World Health Assembly resolution WHA45.34
>     (1992), which dealt with WHO's entire infant-feeding recommendation,
>     and compare it with resolution WHA47.5 (1994), which focused on
>     complementary feeding. You will see that the relevant wording in
>     resolution WHA47.5 -- "fostering appropriate complementary feeding
>     practices from the age of about six months, emphasizing continued
>     breast-feeding and frequent feeding with ... local foods" -- is
>     virtually identical to the wording in resolution WHA45.34 --
>     "Reaffirming that during the first four to six months of life no food
>     or liquid other than breast milk, not even water, is required to meet
>     the normal infant's nutritional requirements, and that from the age of
>     about six months infants should begin to receive ... locally available
>     foods ... in addition to breast milk."
>
>     I would also like to draw your attention to the boxed text on pages 3
>     and 4 of the offprint from WHO's Weekly Epidemiological Record (No.
>     17, April 1995), which is a concise statement of WHO's current
>     infant-feeding recommendation:
>
>     "The World Health Organization recommends that infants should be fed
>     exclusively on breast milk from birth to 4 to 6 months of age; that
>     is, they should be given no others liquids or solids than breast milk,
>     not even water, during this period.  Given the worldwide variation in
>     growth velocity, an age range is an essential element of this feeding
>     recommendation.
>
>     "After this initial 4-to-6-month period of exclusive breast-feeding,
>     children should continue to be breast-fed for up to 2 years of age or
>     beyond, while receiving nutritionally adequate and safe complementary
>     foods.  Starting complementary feeding too early or too late are both
>     undesirable.  Ideally, the decision when precisely to begin will be
>     made by a mother, in consultation with her health worker, based on her
>     infant's specific growth and development needs.
>
>     "WHO's current infant-feeding recommendation was based initially on
>     the technical review and discussion undertaken in 1979 in connection
>     with a joint WHO/UNICEF meeting on infant and young child feeding.
>     The meeting's statement and recommendations were subsequently endorsed
>     in their entirety by the World Health Assembly.  Important additional
>     scientific evidence including, most recently (1993), from the WHO
>     Expert Committee on the use and interpretation of anthropometry,
>     underscores the reliability of the 1979 review."
>
>     Consistent with this recommendation, three essential principles govern
>     complementary feeding:
>
>     * It is undesirable for complementary feeding to start either too
>     early or too late.
>
>     * Ideally, the decision when *precisely* to begin complementary
>     feeding should be made by a mother, in consultation with her health
>     worker, based on her infant's specific growth and development needs.
>
>     * Breast-feeding should continue.
>
>
>