Adherence to Introduction of Iron-Rich Solid Foods Recommendations for Infants: An Analysis of Canadian Community Health Survey Data Using Cycles 2015-2018.

Background: Globally, guidelines on the introduction of solid foods to a breastfed infant's diet emphasize the importance of iron-rich foods.

Objectives: The objective of this study was to report on adherence to Nutrition for Healthy Term Infants (NHTI) guidance on introduction of iron-rich solid foods first in infants living in Canada and to explore factors associated with adherence using disaggregated data.

Methods: Nationally representative cross-sectional data from the Canadian Community Health Survey annual cycles 2015-2018 from biological mothers delivering an infant in the past 5 y were used (N = 7253). Age at introduction of solid food and the type of first food were weighted and then categorized by breastfeeding history. Foods were categorized as typically iron-rich or not. Correlates of adherence were explored using logistic regression.

Results: Most (65.8%; 95% CI: 63.7, 67.8) mothers introduced iron-rich solids first to their infant's diet between 5 and 6.99 mo of age. The most common first iron-rich solid was infant cereal (66.1%; 95% CI: 64.3, 67.9). Mothers from rural areas had a higher odds of introducing an iron-rich food first. Lower odds were observed among those from the Western provinces and immigrants. Among those who exclusively breastfed for ≥5 mo (n = 3390), 62.3% (95% CI: 59.5, 65.1) introduced an iron-rich solid food first, of these 19.7% (95% CI: 16.9, 22.6) did so late (≥7 mo). Higher odds of late introduction of iron-rich foods in this subgroup were associated with mothers who were single, never married, were of lower education, immigrated >5 y ago, and were of Black or South Asian race.

Conclusions: Most infants in Canada are introduced to an iron-rich solid food first at about 6 mo of age, indicating partial adherence to the NHTI guidelines. More efforts are needed to reinforce the importance of introducing iron-rich solid foods first in the diet of the breastfed infant at about 6 mo of age.