What Has Changed over Years on Complementary Feeding in Italy: An Update

**Background:** Complementary feeding (CF) is a critical milestone in infant development, influenced by socio-cultural context and paediatrician guidance. In Italy, primary care paediatricians (PCPs) counsel families on CF methods, which include traditional spoon-feeding, traditional spoon-feeding with adult food tastings, baby-led weaning (BLW), and self-weaning. A prior survey (2015–2017) described regional variation in CF practices. Given rapid changes in CF trends, this study aimed to update those data and assess how practices evolved nationwide and regionally by 2022.

**Methods:** A four-item questionnaire was administered via Pediatotem software (used by ~1600 PCPs, ~22% of Italy's ~7300 active PCPs) from January to October 2022. Items covered: (1) recommended CF method, (2) suggested age for CF introduction, (3) provision of written information to families, and (4) endorsement of commercial baby foods. Italy was divided into three geographical areas (North, Centre, South). Categorical variables were analyzed with χ² tests; differences from the 2015–2017 survey were assessed via difference of proportions. A p-value < 0.01 was considered significant.

**Key Results:** A total of 595 responses were collected (225 from the North, 148 from the Centre, 222 from the South), representing ~8% of all Italian PCPs. Traditional spoon-feeding was recommended by 41% of paediatricians overall (244/595), down from 60% in 2015–2017 (p < 0.01). This decline was steepest in the North (from 48% to 25.8%), while the South still showed the highest rate (53.6%). Spoon-feeding with adult food tastings rose from 28% to 37.6% nationally, becoming the most common method in the North (49.3%). Self-weaning (BLW) increased from 11% to 21.2% overall, with significant growth only in Central Italy (from 11% to 22.3%). BLW remained least common in the South (16.7%). The age for starting CF was unchanged: 91.5% recommended beginning between the 5th and 6th month. Written information was provided by 86.1% of PCPs, similar to prior years. Endorsement of commercial baby foods dropped significantly from ~67% to 51.3% nationally, with the largest decline in the South (from 81% to 58.1%). In the North, a majority (57.8%) now do not recommend commercial baby foods.

**Clinical Implications:** Italian paediatricians are shifting away from traditional spoon-feeding and commercial baby foods toward more infant-led and family-food-based approaches, particularly BLW and traditional feeding with adult food tastings. This trend aligns with WHO recommendations for responsive feeding and may support healthier long-term eating habits, though current evidence does not conclusively favor BLW over traditional methods for preventing obesity or improving growth. Regional differences persist, likely reflecting socio-economic disparities, breastfeeding rates, and family preferences. The authors suggest that traditional spoon-feeding with adult food tastings represents a balanced "middle way" that ensures nutritional adequacy while respecting family traditions and multicultural diversity. Paediatricians should continue to provide individualized, evidence-based guidance during this critical developmental period.