Effectiveness of Starting Weaning at 4 Months Compared to 6 Months to Reduce Anemia among Infants: An Evidence-Based Case Report

Nadya Johanna, Taufik MS, Maulana MS, Samban JLT, Nurul Ratna Manikam


Aim: Comparing the effectiveness of introducing complementary foods at four months of age compared to six months of age to reduce the incidence of iron-deficiency anemia among healthy full-term infants.

Methods: A systematic search was conducted on PubMed, EBSCO, and Cochrane on 28th September 2017. After the selection of title and abstract was done using the predefined inclusion and exclusion criteria. Twelve original articles were found, but after full-text assessment, only two studies were considered relevant. These two studies were further critically appraised for its validity, importance, and applicability to measure its usability degree in this study.

Results: These two included studies showed no significant difference of iron-deficiency anemia incidence between the two complementary feeding groups. This can be shown by the absolute risk reduction which varied from -3.1% to 13.4%, relative risk reduction which varied from -22.8% to 18.4%, and number needed to treat which varied from -33 to 8. Both studies found that the ferritin was significantly different between both groups. However, the hemoglobin concentration was significantly higher in the complementary fed group in only one study.

Conclusion: The introduction of complementary feeding at 4 months of age is not effective to reduce the incidence of iron-deficiency anemia.


infant, complementary feeding, iron-deficiency anemia, hemoglobin, ferritin


World Health Organization. Worldwide prevalence of anaemia 1993–2005. 2008.

World Health Organization. Iron Deficiency Anemia: Assessment, Prevention, and Control—A Guide for Program Managers. Geneva, Switzerland: World Health Organization; 2001. WHO/NHD/01.3

World Health Organization. The World Health Report 2002: Reducing risks, promoting healthy life. Geneva, World Health Organization, 2002.

Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers. Geneva, World Health Organization, 2001 (WHO/NHD/01.3).

World Health Organization. Worldwide Prevalence of Anaemia 1993–2005. WHO: 2008; p 1.

Marques RFSV, Taddei JAAC, Lopez FA., Braga JAP. Breastfeeding exclusively and iron deficiency anemia during the first 6 months of age. Rev. Assoc. Med. Bras. 2014 Feb 10; 60(1): 18-22.

Olaya GA, Lawson M, Fewtrell M. Iron Status at Age 6 Months in Colombian Infants Exclusively Breast-fed for 4 to 5 Versus 6 Months. J Pediatr Gastroenterol Nutr. 2017 Mar;64(3):465–71.

Qasem W, Fenton T, Friel J. Age of introduction of first complementary feeding for infants: a systematic review. BMC Pediatr. 2015 Sep 2;15.

Jonsdottir OH, Thorsdottir I, Hibberd PL, Fewtrell MS, Wells JC, Palsson GI, et al. Timing of the introduction of complementary foods in infancy: a randomized controlled trial. Pediatrics. 2012 Dec;130(6):1038–45.

Dewey KG, Cohen RJ, Rivera LL, Brown KH. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. Am J Clin Nutr. 1998 May;67(5):878–84.

Trinidad TP, Kurilich AC, Mallillin AC, Walcyzk T, Sagum RS, Singh NN, et al. Iron absorption from NaFeEDTA-fortified oat beverages with or without added vitamin C. Int J Food Sci Nutr. 2014 Feb;65(1):124–8.

WHO. Global strategy for infant and young child feeding. WHA55/ 2002/ REC/1, Annex 2.

WHO. Complementary feeding [Internet]. WHO. [cited 2017 Oct 5]. Available from: http://www.who.int/nutrition/topics/complementary_feeding/en/

Motee A, Jeewon R. Importance of Exclusive Breastfeeding and Complementary Feeding among Infants. Curr Res Nutr Food Sci. 2014 Aug 28;2(2):56–72.

WHO Guideline: Daily iron supplementation in infants and children [Internet]. WHO. [cited 2018 August 14]. Available from:http://www.who.int/nutrition/publications/micronutrients/guidelines/daily_iron_supp_childrens/en/

DOI: https://doi.org/10.25220/WNJ.V02.i1.0005


  • There are currently no refbacks.

Copyright (c) 2018 Nadya Johanna, Taufik MS, Maulana MS, Samban JLT, Nurul Ratna Manikam

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

View My Stats