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International Child Health Unit, Department of Paediatrics, University of Uppsala, Uppsala, Sweden
Barbara A. Underwood
National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
The "Guideline on Protein-Rich Mixtures for Use as Weaning Foods," PAG guideline no. 8, issued in 1971 by the Protein Advisory Group of the United Nations System (PAG guidelines referred to in this paper are on file at the World Health Organization and the Food and Agriculture Organization), has served as a basic reference on the subject. In recent years it has been supplemented by reports from the Codex Alimentarius Commission's Committee on Foods for Special Dietary Uses- whose documents provide guidelines for standards on the development and use of foods for infants and young children, including supplementary foods, in generic terms , but do not elaborate on the preparation and use of these foods specifically in developing countries.
The suggested new guidelines presented here build primarily on the technical information in the Codex committee's 1985 "Guidelines for Development of Supplementary Foods for Older Infants and Young Children'' , by providing practical suggestions to be considered when tailoring the development and use of supplementary foods to less than optimal conditions. These conditions usually require extra considerations to maximize the likelihood that the supplementary food will be affordable and that its preparation will lead to a nutritious, safe product. Even the most hygienic and nutritious supplementary foods can be rendered unsafe by exposure to contaminated environments or through handling by persons with poor personal sanitary practices.
PURPOSE, SCOPE, AND FOCUS
The purpose of these guidelines is to advise persons in developing countries on the preparation and feeding of low-cost, affordable processed foods that are suitable as supplements to breast milk or breast-milk substitutes when either becomes insufficient to satisfy the nutritional requirements of older infants and young children. (Throughout this article the term "breast milk" applies also to breast-milk substitutes if breast milk is not available.) Processed supplementary foods are intended primarily for use during normal infants' weaning period and also for the progressive adaptation of infants and young children to ordinary foods. They may be used as part of the total diet or as the only food under unusual circumstances, including emergency conditions.
The scope of these guidelines includes several considerations. Four to six months is the age range selected for introducing cereal-based supplementary foods. It is also recognized that (a) breast milk is adequate to meet the nutritional needs of younger infants under most circumstances, (b) younger infants require a milk product as the major food, and (c) formulated foods that contain a high proportion of milk generally are too expensive for most less privileged population groups [3-6].
The focus is the appropriate use of low-cost, affordable formulated supplementary foods. The emphasis, therefore, is on supplementary foods formulated from vegetable sources. When used as a complement to breast milk, they can provide the dietary increment in energy and nutrients that is needed to meet increasing physiological requirements to support normal growth and development.
An increased demand for low-cost supplementary foods in countries with developing economies is predictable. Current trends in such countries show a dramatic migration of low-income families to urban areas. This is associated with an increased economic necessity for the mothers to participate in work outside the home. Child-minders, often older siblings, are needed to provide food to infants and young children during periods when mothers are unavailable to breast-feed and/or provide supplementary foods. These circumstances necessitate that nutritionally adequate, hygienic foods be available that can be simply and safely prepare