Complementary Feeding Interventions for Infants and Young Children Under Age 2: Scoping of Promising Interventions to Implement at the Community or State Level (2023)

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Complementary Feeding Interventions for Infants and Young Children Under Age 2 Scoping of Promising Interventions to Implement at the Community or State Level David A. Savitz and Katherine M. Delaney, Editors Committee on Complementary Feeding Interventions for Infants and Young Children Under Age 2 Food and Nutrition Board Health and Medicine Division Consensus Study Report 

NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by a contract between the National Academy of Sciences and the Centers for Disease Control and Prevention and the National Academy of Sciences W.K. Kellogg Foundation Fund. 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: 978-0-309-71017-6 International Standard Book Number-10: 0-309-71017-0 Digital Object Identifier: https://doi.org/10.17226/27239 This publication is available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334- 3313; http://www.nap.edu. Copyright 2023 by the National Academy of Sciences. National Academies of Sciences, Engineering, and Medicine and National Academies Press and the graphical logos for each are all trademarks of the National Academy of Sciences. All rights reserved. Printed in the United States of America. Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. Complementary feeding interventions for infants and young children under age 2: Scoping of promising interventions to implement at the community or state level. Washington, DC: The National Academies Press. https://doi.org/10.17226/27239. 

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COMMITTEE ON COMPLEMENTARY FEEDING INTERVENTIONS FOR INFANTS AND CHILDREN UNDER AGE 2 DAVID A. SAVITZ (Chair), Professor, Brown University School of Public Health, Providence, Rhode Island LAURA E. CAULFIELD, Professor, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland VALERIE J. FLAHERMAN, Professor, University of California, San Francisco FRANK R. GREER, Professor Emeritus, University of Wisconsin School of Medicine, Madison ELIZABETH YAKES JIMENEZ, Professor, University of New Mexico Health Sciences Center, Albuquerque RAFAEL PÉREZ-ESCAMILLA, Professor, Yale School of Public Health, New Haven, Connecticut LORRENE D. RITCHIE, Director, Nutrition Policy Institute, University of California, Division of Agriculture and Natural Resources, Oakland, California CHARLENE M. RUSSELL-TUCKER, Commissioner of Education, Connecticut State Department of Education, Hartford SHANNON E. WHALEY, Director of Research and Evaluation, PHFE WIC, Irwindale, California Study Staff KATHERINE M. DELANEY, Study Director JENNIFER STEPHENSON, Research Associate (since April 2023) MELANIE ARTHUR, Senior Program Assistant ANNE MARIE HOUPPERT, Senior Librarian MELISSA MAITIN-SHEPARD, Science Writer ANN L. YAKTINE, Director, Food and Nutrition Board v 



Reviewers This Consensus Study Report was reviewed in draft form by indi- viduals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical com- ments 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: SARA BENJAMIN-NEELON, Johns Hopkins Bloomberg School of Public Health MAUREEN BLACK, University of Maryland School of Medicine; RTI International KATHRYN DEWEY, University of California, Davis FRANCES FLEMING-MILICI, University of Connecticut SUSAN GOLDIN-MEADOWS, The University of Chicago SUSAN L. JOHNSON, University of Colorado at Anschutz School of Medicine MEGAN LOTT, Healthy Eating Research, Duke Global Health Institute ANGELA ODOMS-YOUNG, Cornell University ALISON K. VENTURA, California Polytechnic State University vii 

viii REVIEWERS Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclu- sions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by RONALD KLEINMAN, Harvard Medical School, and CATHERINE E. WOTEKI, Iowa State University. 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 com- ments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. 

Foreward The translation of research findings into policy is a challenging but essential step in the pathway by which scientific evidence advances soci- etal goals, in this case, promoting the nutritional health of young children. The particular challenge for the Committee on Complementary Feed- ing Interventions for Infants and Young Children Under Age 2 (years) was to identify, describe, evaluate, and apply relevant research to future efforts to optimize complementary feeding in infants and children under 2 years of age. The committee was asked not just to assess the quality of the research, but, just as importantly, to offer our perspective on how the insights could be used to develop public health programs that could be scaled up for the entire population and mitigate health disparities. The committee members have an abundance of diverse disciplin- ary expertise, with an unusually wide range of professional homes, but a shared desire to straddle the divide between academic research and programmatic interventions. There were considerable challenges in con- necting a heterogeneous body of studies to promising strategies for imple- mentation, but through the individual, and particularly the collective, insights of the committee, we believe we have identified a constructive way forward. The influences on complementary feeding are diverse and complex, involving caregivers, health care providers, educators, and a wide range of government agencies, and the committee believes that by working toward a complementary and coherent engagement of all these entities, there is an exciting opportunity for progress. The conscientious efforts of the committee that made it possible to develop this report over a relatively brief period are remarkable. Despite ix 

x FORWARD many competing demands, all members contributed creative ideas com- bined with hard work to develop a harmonized document that provides a unified perspective. The same combination of innovative thinking and substantive contributions from the study director, Katie Delaney, and the talented colleagues at the Academies with whom she worked, Jen Ste- phenson, Melanie Arthur, and Anne Marie Houppert, as well as Melissa Maitin-Shepard (science writer), were essential at every step along the way from identifying the literature to refining the document and every- thing in between. It is always remarkable and highly gratifying to watch the process unfold, the way that each of the committee members and staff finds a rhythm for working together toward a common goal, each of us adding an instrument to the orchestra toward our shared goal of creat- ing a symphony. Despite the seriousness of our purpose and demands in developing the report, the committee and staff made the process enjoy- able as well as gratifying. David A. Savitz, Chair Committee on Complementary Feeding Interventions for Infants and Young Children Under Age 2 

Contents SUMMARY  1 1 INTRODUCTION  19 Complementary Feeding of Infants and Children, 19 Background for the Study, 22 The Committee’s Task and Approach, 23 Organization of the Report, 25 References, 25 2 METHODOLOGICAL APPROACH  29 Committee’s Interpretation of the Task, 29 Search Approach, 30 Screening and Data Extraction, 31 Assessment of the Evidence, 33 References, 35 3 CONSIDERATIONS  37 Factors Considered in Mapping All Interventions, 37 Factors Considered in Assessing Informative Examples, 54 Summary, 60 References, 61 xi 

xii CONTENTS 4 OVERVIEW OF INTERVENTIONS IDENTIFIED IN THE SCOPING REVIEW  67 Overall Description of Identified Studies, 67 Description of Identified Studies by Setting, 70 Summary, 105 References, 106 5 IDENTIFIED INFORMATIVE STUDIES AND ELEMENTS  113 Informative Studies, 114 Select Informative Elements from Identified Studies in This Report, 126 Summary, 136 References, 136 6  ONSIDERATIONS FOR SCALING INFANT AND YOUNG C CHILD FEEDING INTERVENTIONS  141 Shifting Perspective from Settings to Systems, 141 Factors for Successful Scaling of Infant and Young Child Feeding Interventions, 144 Next Steps for Scaling Complementary Feeding Interventions, 147 Summary, 148 References, 148 7 I MPLICATIONS AND CONSIDERATIONS FOR DESIGN OF INTERVENTIONS TO IMPROVE INFANT AND YOUNG CHILD FEEDING BEHAVIOR IN THE UNITED STATES  153 Building from Existing Systems and Infrastructure: Opportunities and Challenges, 153 Collection and Application of Standardized Infant and Young Child Feeding Outcomes, 165 Reaching Underserved Populations, 168 Additional Considerations, 171 Going Forward: Final Considerations, 174 Summary, 177 References, 177 APPENDIXES A Committee Member Biographies 191 B Open Session Materials  197 C Literature Search Strategies and Results  215 D Data Extraction Criteria  235 E Data Extraction Tables  243 F Scalability Assessments for Informative Studies  453 

Acronyms and Abbreviations AAP American Academy of Pediatrics BFF Brighter Future Family Center BMI body mass index CACFP Child and Adult Care Food Program CDC Centers for Disease Control and Prevention CE cooperative extension COM-B COM-B behavior model ECE early care and education ECHO Early Childhood Obesity Prevention Program EFNEP Expanded Food and Nutrition Education Program EHS Early Head Start EPSDT Early and Periodic Screening, Diagnostic and Treatment FFQ food frequency questionnaire FPL federal poverty level HHS Department of Health and Human Services HomVEE Home Visiting Evidence of Effectiveness INFANT INfant Feeding Activity and Nutrition (program) IT information technology xiii 

xiv ACRONYMS AND ABBREVIATIONS NFN Nurturing Families Network NIH National Institutes of Health RCT randomized controlled trial RE-AIM Reach, Effectiveness, Adoption, Implementation, and Maintenance SDOH social determinants of health SES socioeconomic status SMS short messaging service SNAP-Ed Supplemental Nutrition Assistance Program–Education SOP standard operating procedure SSB sugar-sweetened beverage TIDierR Template for Intervention Description and Replication USDA U.S. Department of Agriculture WHO World Health Organization WIC Special Supplemental Nutrition Program for Women, Infants, and Children