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.

Objective: The objective of this study is 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 years were used (n=7253). Age at introduction of solid food and the type of first food were weighted, 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 months 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 months (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) do so late (≥7 months). Higher odds of late introduction of iron-rich foods in this subgroup were associated with mothers who were single, never married, of lower education, immigrated >5 years ago, Black or South Asian race.

Conclusion: Most infants in Canada are introduced to an iron-rich solid food first at about 6 months 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 months of age.