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Re: ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence? (Cattaneo et al. 2011).

Dear Editor, The Committee on Nutrition of the European Society for Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN CoN) is a standing committee of ESPGHAN aimed at promoting medical and scientific knowledge in the field of paediatric nutrition since its inception in 1968. The primary purposes of ESPGHAN CoN are the promotion of knowledge of paediatric nutrition in health and disease, stimulation of nutritional research and dissemination of such knowledge. As a leading scientific body, ESPGHAN CoN contributes to the standards of health care in Europe to promote healthy nutrition for children in Europe and worldwide. As a scientific body, we are always open to debate but were rather surprised and disappointed that your journal elected to give stage to a personal attack (Cattaneo et al. 2011) on authors of the recommendations made by ESPGHAN CoN more than 3 years ago (ESPGHAN Committee on Nutrition 2008). The aim of that paper (ESPGHAN Committee on Nutrition 2008) was to provide evidence-based guidance on the introduction of solid foods.We concluded with recommendations not to postpone the introduction of solid foods later than the beginning of the seventh month of life, and not to introduce solids before the beginning of the fifth month of life. Very similar recommendations were made at the same time by the American Academy of Pediatrics (Greer et al. 2008) and more recently by the European Food Safety Authority [EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) 2009], indicating that there is consistent scientific agreement on the available evidence. All these reviews have concluded that at this time there is no compelling evidence to demonstrate important advantages of exclusive breastfeeding for 6 months over and above advantages of breastfeeding for 6 months along with appropriate and safe complementary feeds, a point that does not apply to populations under poor hygienic conditions. Personal and emotional attacks are not convincing arguments with which to challenge a thorough scientific evaluation. We should like to point out that recommendations on the timely introduction of solids are unrelated to the recommendation to breast feed for the first 6 months of life and thereafter, and also unrelated to discussions on the potential use of infant formulae. Furthermore, in both our paper on complementary feeding (ESPGHAN Committee on Nutrition 2008) and on breastfeeding (ESPGHAN Committee on Nutrition 2009), we state that exclusive breastfeeding for about 6 months is a desirable goal. Indeed, ESPGHAN strongly promotes the protection, promotion and support of breastfeeding for 6 months andthereafter as long as mutually desired by both mother and child (ESPGHAN Committee on Nutrition 2009).