Dear all:

First, in International Nutrition we defined "supplementary" as extra food provided to a 
family, or vulnerable family members in addition to the diet they had access to on their 
own.  "Complementary" was defined as the foods given to an infant in addition to breast 
milk.

I want to make it abundantly clear that all of the studies I have ever seen on providing 
malnourished mothers with "supplementary foods' in developing countries never showed 
an improvement in their milk supply or their infant's growth.  Some of the earlier studies 
on infants compared "supplementary" food provided to infants compared to locally 
prepared and often contaminated "complementary" foods.  In fact, my dissertation results 
(completed in the early 1990s) from data collected in the 1970s showed that 
uncontaminated food provided at feeding centers to 3-6 month old infants resulted in 
greater height at two years of age. Here's the hitch --- NONE of the infants in this part of 
Guatmala were exclusively breastfed after 3 months.   I cannot overemphasize the fact 
that the COMPARISON group was not exclusively breastfed --- the comparison group was 
receiving complementary foods that were most likely far more contaminated than that 
offered at the feeding center.  So, this did not show anything other than children have 
higher length at a later age if they are fed clean food between three to six months than if 
they are fed contaminated food between three and six months of age.  From any logical 
standpoint, the CLEANEST and most NUTRIENT dense food is breast milk.  Had these 
infants in the 1970s been offered breastmilk alone, I am dead certain their growth would 
have been far more healthy than those who received the "Supplementary" food.

While I was working on my dissertation the 4-6 month range was still up for grabs. 
Because I knew that my research might be misinterpreted by some as justification that it 
is just fine to offer complementary foods between three and six months I never published 
my results. Shortly after I finished my doctoral dissertation much of the research 
supporting six months was conducted, much of it by researchers at UC. Davis.  I was 
quite happy to see that UC Davis and others were able to really do the appropriate 
research to show that six months is the appropriate "approximate" age for starting solids.  

In fact, much of the research does show that too early of an introduction of solids even in 
developed countries can actually CAUSE growth faltering.  Why is this?  Because most of 
the foods we introduce to young infants are very low in nutrient density.  Think about 
cereal - it is not very dense in nutrients.  If you have a small stomach and fill up on 
cereal you can't drink enough of the far more nutrious breast milk.   This is ESPECIALLY 
true in developing countries where access to latrines, water, and a means of making the 
water potable is difficult.  So, even in developing countries, infants usually do much 
better without disrupting their gut with some other substance.  In short, if an infant is 
faltering in growth, stuffing them full of cereal is not a solution and is likely to make the 
situation worse.

Now, here's my real mom story.  My son absolutely loved to toddle around the Museum 
of Natural History.  The instant he saw the oldest ground in gum that had become part of 
the floor, he would drop down and speed crawl (he was faster crawling than running) to 
the gum and try to plaster his mouth to it if I didn't notice in time.  He had an amazing 
ability to find old gum.

Best, Susan Burger

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