The WHO recommends that complementary feeding, including animal milk, should begin at six months of age. However, Australia's national guidelines, along with those of New Zealand, the United States, and Europe, recommend that animal milk only be introduced after 12 months.
This has led to a joint publication of a paper by 11 paediatric groups, which criticised the WHO’s position on this issue.
Trade body Infant Nutrition Council (INC) has similarly expressed concerns about these WHO's recommendations.
“The WHO did not conduct proper consultation both with governments, industry and other stakeholders before publishing these guidelines. As a result, it creates confusion, and that can be potentially dangerous,” said CEO of the INC Jonathan Chew.
Complementary feeding to commence at six months or 12 months of age?
The INC asserts that solid foods and animal milk should only be introduced at 12 months of age. This is because animal milk is a poor source of iron compared to infant formula, which, according to Australia’s guidelines, has iron supplemented in its composition to ensure that it is appropriate for the needs of infants, said Chew.
According to the WHO, infants can get their iron needs met from consuming other solids. However, the eating patterns of most infants can make it difficult for them to start having a well balanced diet.
“It’s a two steps forward, one step back kind of situation. When infants first start consuming complementary foods at six months, they can be picky about the foods they eat. They could eat certain foods on some days, while other days they won’t. This can make it challenging for parents to get their children to start eating a well balanced diet.
“That’s why the National Health and Medical Research Centre, which is responsible for infant feeding guidelines in Australia, says that until kids are 12 months of age, they're better off continuing to consume breast milk or infant formula,” explained Chew.
However, public health groups – like academics and activists – support WHO’s recommendation.
“This is creating confusion, especially for parents, caregivers and healthcare professionals. It is a problem when the WHO doesn't properly consult in the development of its own guidance and doesn't specify that a country’s national context is important,” added Chew.
For example, WHO guidance classifies breast milk substitutes as any milk-based product for children up to 36 months. In Australia, however, the Food Standards Code clearly distinguishes between infant formula – for 0–12 months of age – and products for toddlers – for 12 months old and beyond.
Infant formula is designed to closely emulate breast milk, as it is considered a substitute for it. But formula milk products for toddlers are regulated differently and aim to supplement specific dietary needs, such as providing iron or zinc or reducing protein levels, as toddlers cannot absorb protein like adults do.
This distinction is recognised by the Australian government and reflected in the Food Standards Code.
“Infant formula is intended to mimic breast milk, while products for toddlers have a different composition and are not substitutes for breast milk. Yet, the WHO’s broad definition, covering up to 36 months, leads to criticism of infant formula companies even though there are valid nutritional reasons for differentiating these products,” said Chew.
Infant formula products highly regulated in Australia – INC
Many activists and academics argue that not adhering strictly to WHO guidance creates risks for infants using formula products, but Chew said this is inaccurate because WHO guidelines overlook how products are regulated under local laws.
“Australia's National Food Code and regulations are specifically designed to safeguard infants' health under local conditions, and the industry complies with these. None of the media criticisms focus on breaching local standards – they focus on WHO recommendations, which aren’t always relevant at the local level.
“The idea that private companies are solely profit-driven and can’t be trusted is disconnected from how decisions around research and development are actually made,” said Chew.
Infant formula companies invest heavily in making their products as close as possible to breast milk, which remains the gold standard for infant nutrition.
Given the complexities of developing infant formula that aligns with both local regulations and evolving nutritional science, Chew underlined the importance of collaboration between industry and government. He stressed that the industry’s role is to work alongside regulators to ensure products meet national standards, not to drive public health policy.
“The last thing we want is to have a public spat with public health [academics and activists] around this because ultimately, it's not for industry to set this guidance for consumers. It's for industry to work with government, and for government to set this guidance.
"And we [INC] support the Australian government's guidance around the introduction of cow's milk, and more broadly, the infant feeding guidelines that they have developed and the advice that they provide to healthcare professionals,” said Chew.
At this point, the INC continues to have concerns about the recommendations coming from the WHO secretariat with respect to infant feeding. When WHO recommendations contradict national guidelines or national advice, the INC supports national governments as the best decision makers to look at locally appropriate evidence in determining guidelines for the local population.
"The Australian national guidance for infant formula is backed by relevant, local evidence. On the other hand, the WHO caters to a global population, and its guidance is not always well suited to developed economies like Australia.
“And as such, we believe that interested stakeholders should always preference national government advice above WHO recommendations where there is a conflict,” said Chew.
This is not the first time Australian products have come under scrutiny for not aligning with WHO recommendations.
A recent study found that none of the infant and toddler foods sold in Australian supermarkets met WHO standards. Researchers have called for stricter regulations to enhance the nutritional profiles of these products and to curb misleading labelling practices.
As the debate around infant nutrition guidelines continues, the divergence between WHO recommendations and local standards in countries like Australia remains a contentious issue.
The INC firmly supports national guidance based on locally relevant evidence, emphasising that the needs of developed economies may not always be adequately addressed by global recommendations.
