4. Conclusions

In conclusion we have shown that:

(a) Energy intake of breast-fed infants is far below current recommended levels throughout the first year of life, even in a population of well-nourished, high socioeconomic status families and with complementary feeding after 4-6 months. We have shown previously that these low intakes are due more to infant self-regulation of intake than to constraints on maternal breast-milk production (DEWEY and LNERDAL, 1986). Furthermore, infants provided with solid foods tend to reduce their intake of breast milk initially, rather than increasing energy intake, indicating that they do not consume all of the energy made available to them (STUFF and NICHOLS, 1989; NOMMSEN et al., 1989).

(b) Growth velocity of breast-fed infants is also considerably lower than current reference data, even as late as 9-12 months of age when other foods provide the majority of the child’s energy intake. However, differences in achieved growth by 12 months of age are apparent only for weight, not for length, indicating that, on the average, these infants are leaner but not shorter than the NCHS median.

(c) Morbidity, time sleeping, and activity are unrelated to low energy intake or slow growth velocity in our cohort of breast-fed infants. In other words, infants with low intakes and slow growth were just as healthy and active as infants with higher intakes and more rapid growth. Thus, the deviation of breast-fed infants from current recommendations for energy intake and growth can be considered a normal pattern with no apparent deleterious consequences in our population. Further research is necessary to establish guidelines for identifying truly inadequate intakes and growth faltering among breast-fed infants in different environments.