Copyright © 2009 by Lippincott Williams & Wilkins.Unauthorized reproduction of this article is prohibited. Infant Feeding Practices and Associated Factors Through the First 9 Months of Life in Bavaria, Germany  Barbara Rebhan,  Martina Kohlhuber,  Ursula Schwegler, y Berthold V. Koletzko, and  Hermann Fromme  Department of Environmental Health, Bavarian Health and Food Safety Agency, Oberschleissheim, and { Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany ABSTRACT Objectives: To investigate infant feeding and breast-feeding practices during the first 9 months of life in Bavaria, Germany, in relation to recommendations and to identify factors associated with early feeding of semisolid food. Materials and Methods: Data from 3103 infants throughout Bavaria, Germany, were collected in a prospective cohort study. Questionnaires were administered at the age of 6 days, and 2, 4, 6, and 9 months. Results: There was a considerable variety concerning the time when complementary feeding was introduced. Only 16.4% of the infants ate solid/semisolid food before the age of 5 months. Most of the infants received as their first solid food a mash of vegetable, meat, and potato. Compared to national guidelines fluids were introduced early. More than 37% of the breast-fed infants received additional fluids/formula. The strongest risk factor associated with complementary feeding before the fifth month was breast-feeding duration of less than 4 months (any breast-feeding) with an odds ratio of 8.57 (95% confidence interval 6.16–11.94). Other factors were low level of education, young age of the mother, smoking habit of the mother, and mother not being born in Germany. Conclusions: Further improvements in nutrition of infants may be achieved in 2 ways: promotion of breast-feeding according to current recommendations and better counselling on the correct timing of introduction of semisolid food— especially for parents of not- or short-time breast-fed babies and focused on young mothers with low levels of education. JPGN 49:467–473, 2009. Key Words: Beikost—Breast- feeding—Complementary feeding—Liquids. # 2009 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Adequate nutrition during early life is of key importance for growth and development and for preventing adult diseases (1–3). Full breast-feeding for up to 6 months along with timely introduction of complementary food and continued breast-feeding thereafter is recommended as the optimal form of infant feeding (4–7). Wide variations have been reported with respect to infant feeding practices and breast-feeding rates between countries, as well as inequal- ities among subgroups of populations (8–10). In Germany data are available from the SuSe-Study (11,12), from the MAS-90 study (13), and from the DONALD project (14). During the last 10 years feeding practices were evaluated in different European countries (15–19). A recent article focused on the different feeding habits in several European countries (20). In line with international recommendations the German National Committee of Breast-feeding and the German Society for Paediatric and Adolescent Medicine (DGKJ) recommend exclusive breast-feeding for the first 6 months as desirable feeding for the majority of infants, and introduction of complementary feeding not later than beginning of the seventh month of life, but not before the beginning of the fifth month of life (21,22). The objective of the present study is to describe infant feeding practices during the first 9 months of life in Germany and the most important risk factors for intro- ducing complementary feeding before the age of 4 com- pleted months. PATIENTS AND METHODS Subjects and Design This study is a part of the Bavarian Breastfeeding Study, a prospective cohort study, which was conducted in 2005 and Received May 17, 2008; accepted December 11, 2008. Address correspondence and reprint requests to Barbara Rebhan, Department of Environmental Health, Bavarian Health and Food Safety Agency, Veterinaerstraße 2, D-85764 Oberschleissheim, Germany (e-mail: Barbara.Rebhan@lgl.bayern.de). The study was financed and supported by the Bavarian State Ministry of Environment, Public Health and Consumer Protection, Munich, Germany. Berthold Koletzko is the recipient of a Freedom to Discover Award of the Bristol-Myers Squibb Foundation, New York. The authors report no conflicts of interest. Journal of Pediatric Gastroenterology and Nutrition 49:467–473 # 2009 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 467