FEEDING INFANTS
AND CHILDREN
FROM BIRTH TO 24 MONTHS
Summarizing Existing Guidance
Kathryn Dewey and Meghan Harrison, Editors
Committee on Scoping Existing Guidelines for Feeding
Recommendations for Infants and Young Children Under Age 2
Food and Nutrition Board
Health and Medicine Division
A Consensus Study Report of
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by contracts between the National Academy of Sciences and the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention (200-2011-38807/75D301 20F00082), the Office of Dietary Supplements at the National Institutes of Health (HHSN263201800029I/75N98019F00857), and by the Kellogg Endowment Fund of the National Academies of Sciences, Engineering, and Medicine’s Health and Medicine Division. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-67538-3
International Standard Book Number-10: 0-309-67538-3
Digital Object Identifier: https://doi.org/10.17226/25747
Library of Congress Control Number: 2020941774
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Feeding infants and children from birth to 24 months: Summarizing existing guidance. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25747.
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COMMITTEE ON SCOPING EXISTING GUIDELINES FOR FEEDING RECOMMENDATIONS FOR INFANTS AND YOUNG CHILDREN UNDER AGE 2
KATHRYN DEWEY (Chair), Distinguished Professor Emerita, Department of Nutrition, University of California, Davis
STEPHANIE A. ATKINSON, Professor, Pediatrics, McMaster University, Hamilton, Ontario, Canada
SUSAN BAKER, Professor, Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-SUNY
SARA BENJAMIN-NEELON, Associate Professor, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
LISA BODNAR, Professor, Department of Epidemiology, University of Pittsburgh, PA
RONETTE BRIEFEL, Senior Fellow, Mathematica, Washington, DC
FRANK GREER, Emeritus Professor of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
DEBRA HAIRE-JOSHU, Joyce Wood Professor of Public Health and Medicine, Director of Center for Diabetes Translation Research; Center for Obesity Prevention and Policy Research; and Brown School, Washington University in St. Louis, MO
RAFAEL PÉREZ-ESCAMILLA, Professor and Director, Office of Public Health Practice, Global Health Concentration, Yale School of Public Health, New Haven, CT
CHARLENE RUSSELL-TUCKER, Deputy Commissioner, Connecticut State Department of Education, Hartford
ELIZABETH YAKES JIMENEZ, Research Associate Professor, Department of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque
Study Staff
MEGHAN HARRISON, Study Director
ALICE VOROSMARTI, Associate Program Officer
ZARIA FYFFE, Senior Program Assistant
REBECCA MORGAN, Senior Librarian
ANN YAKTINE, Director, Food and Nutrition Board
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Reviewers
This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.
We thank the following individuals for their review of this report:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by DIANE BIRT, Iowa State University, and BARBARA ABRAMS, University of California, Berkeley. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.
Contents
Importance of Feeding Practices for Children Under 2 Years of Age
Challenges of Understanding What and How to Feed Infants and Young Children
Recent Efforts and Work on Feeding Guidance from Birth to 24 Months
The Committee’s Task and Approach
Searches for Guideline Documents
Identifying the Span of Topics Covered and Consistency of Recommendations
3 CHARACTERISTICS OF INCLUDED GUIDELINE DOCUMENTS
Guideline Document Methodologies
Declaration of Conflicts of Interest
Evidence Mapping to Each Recommendation
Inclusion of Guidance on Communication and Dissemination
Inclusion of Research Recommendations
4 EXISTING RECOMMENDATIONS ON WHAT TO FEED
Supplementary Formula Feeding of Breastfed Infants
Duration of Infant Formula Use
Toddler Milks and Follow-On Formulas
Fluids: Water, Juice, Sugar-Sweetened Beverages, and Other Nonmilk Beverages
Variety and Healthy, Nutritious Foods
Foods Associated with Food Allergy and Celiac Disease
5 EXISTING RECOMMENDATIONS ON HOW TO FEED
Safety of Foods and Feeding Practices
6 COMMUNICATION AND DISSEMINATION
Identified Communication and Dissemination Strategies for Various Target Audiences
Considerations for Communication and Dissemination Strategies
7 CONCLUSIONS AND FUTURE DIRECTIONS
Consistency Among Existing Feeding Recommendations and Types of Evidence Used
Harmonizing the Development of Future Feeding Guidelines
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Boxes, Figures, and Tables
BOXES
4-1 Committee’s Terminology Related to Consistency of Recommendations
5-1 Committee’s Terminology Related to Consistency of Recommendations
7-1 Examples of Inconsistencies Across Feeding Recommendations
FIGURES
2-1 Flow diagram of guideline document search and screening process
TABLES
2-1 Summary of Database Searches
2-2 Guideline Document-Level Eligibility Criteria
2-3 Recommendation-Level Eligibility Criteria
3-1 Characteristics of Included Guideline Documents
B-1 Recommendations Related to Exclusive Breastfeeding
B-2 Recommendations Related to Continuation of Breastfeeding
B-3 Recommendations Related to Supplementary Formula Feeding of Breastfed Infants
B-4 Recommendations Related to Duration of Infant Formula Use
B-5 Recommendations Related to Type of Infant Formula
B-6 Recommendations Related to Toddler Milks and Follow-On Formulas
B-7 Recommendations Related to Milk and Milk-Based Products
B-9 Recommendations Related to Substances to Avoid or Limit
B-10 Recommendations Related to Variety and Healthy, Nutritious Foods
B-13 Recommendations Related to Foods Associated with Food Allergy and Celiac Disease
B-14 Recommendations Related to Iron and Iron-Fortified Formula
B-15 Recommendations Related to Vitamin D
B-16 Recommendations Related to Iodine
B-17 Recommendations Related to Supplementation
B-18 Recommendations Related to Dietary Fat
B-19 Recommendations Related to Bottle Use and Propping
B-20 Recommendations Related to Cup Use
B-21 Recommendations Related to Safety of Foods and Feeding Practices
B-22 Recommendations Related to Introduction of Complementary Foods (CFs)
B-23 Recommendations Related to Food Consistency and Texture
B-24 Recommendations Related to Meal Frequency
B-25 Recommendations Related to Hunger and Satiety Cues
B-26 Recommendations Related to Responsive Feeding Practices
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