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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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3

Considerations

This chapter provides context and considerations for the current report and background information that informed interpretation and approach to the Statement of Task taken by the committee (see Chapter 1, Box 1-1). The chapter begins with a discussion of settings, interventions, and outcomes considered across all identified studies. The subsequent section describes methodological considerations and scalability aspects considered for the informative examples.

FACTORS CONSIDERED IN MAPPING ALL INTERVENTIONS

The committee reviewed all trials testing interventions aimed at improving infant and young child feeding behavior and extracted information from each related to the study setting, intervention, and outcomes. The following section describes the factors considered for each of these three domains.

Setting

The Statement of Task (see Chapter 1, Box 1-1) specifies that the current scoping review should include only interventions occurring in U.S.-specific contexts (the committee limited the search to high-income countries as defined by the World Bank) and focused on what to feed and/or how to feed infants and young children under age 2 years. Three settings were pre-specified including (1) health care systems that influence feeding,

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

(2) early care and education (ECE) settings, and (3) university cooperative extension (CE) programs that include nutrition and feeding for young children. In addition, the committee included in its review interventions that occurred in two aligned settings (Special Supplemental Nutrition Program for Women, Infants, and Children [WIC] and home-visiting programs) because the Statement of Task sought to identify characteristics of interventions conducted in the three pre-specified settings that would complement activities in the two aligned settings. In addition, the two aligned settings have existing infrastructure nationwide that could facilitate scaling up and their staff have frequent contact with families who have children from birth to 2 years of age. The WIC interventions that were examined expanded on standard WIC counseling and education practice. For completeness, because CE programs can operate in any setting that reaches high-need populations, and it may not always be obvious that a study included a researcher affiliated with CE, interventions that directly addressed what to feed and/or how to feed children under age 2 years but did not occur in any of three pre-specified settings or the two aligned settings were also described and categorized as occurring in other settings. Box 3-1 describes considerations related to mapping of interventions to settings. In addition to mapping interventions to these settings, the committee sought to describe each intervention’s potential ability to reach underserved populations to reduce inequities, and to complement existing federal-level programs, including WIC and home visiting models. A brief description of each setting as it manifests in the United States is below.

Health Care Systems

The U.S. health care system consists of varied health care delivery systems and both public and private payers. A recent study reported that the United States has 580 unique health care systems, which vary widely with respect to performance and quality of care; a number of hospitals and practicing physicians function independently of a health care system, and thus there is likely even wider variation in performance and quality (Beaulieu et al., 2023). U.S. health insurance coverage also varies widely by geographic location, as well as patient age and socioeconomic status. While most U.S. children (61.9 percent) are covered by private health insurance, primarily through employer-based coverage, 36.4 percent have public insurance coverage, primarily through Medicaid (35.9 percent), and 5.0 percent are uninsured. There is substantial state-by-state variation in patterns of coverage (Keisler-Starkey and Bunch, 2022).

U.S. children receive preventive care from pediatricians, family medical doctors, physician assistants, and nurse practitioners. Unlike in many European countries, general practitioners and midwives are not a com-

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

mon source of preventive care for children in the United States (AAP, 2022; Wolfe et al., 2013). For pediatric office or clinic visits in the United States, the Bright Futures Guidelines for Health Supervision of Infants Children and Adolescents Counseling1 plays a critically important role. As a national health promotion and prevention initiative led by the independent American Academy of Pediatrics (AAP), Bright Futures is supported by the U.S. Department of Health and Human Services (HHS), the

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1 See https://downloads.aap.org/AAP/PDF/Bright%20Futures/BF4_Introduction.pdf (accessed July 21, 2023).

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Health Resources and Services Administration (HRSA), and the Maternal and Child Health Bureau (MCHB) to provide guidance on which preventive services are recommended for pediatric well-child checkups (AAP, 2023). When a preventive service is recommended by Bright Futures, U.S. law mandates that most public and private insurers provide coverage for that service without cost sharing.

Currently, Bright Futures recommends a well-child visit shortly after birth and nine subsequent well-child visits in the child’s first 24 months of life (at 1, 2, 4, 6, 9, 12, 15, 18 and 24 months of age), as well as anticipatory guidance related to healthy nutrition (NCEMCH, 2002). For U.S. children who are publicly insured, preventive health care is also determined by the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit of Medicaid, which specifies the components of clinical care during routine well-child visits. Enacted in 1967 and periodically updated, EPSDT requires that children receive a comprehensive health and developmental history, a comprehensive unclothed exam, anticipatory guidance regarding accident prevention, child development and healthy lifestyles, and diagnosis and treatment of any diseases identified (Commonwealth Fund, 2005). EPSDT requires that all services be provided according to a periodicity schedule that meets reasonable medical standards, such as Bright Futures, which is used by all states as of July 2023 (CMS, n.d.). In the United States, the availability of home visiting nurse services varies widely by geographic location as do the criteria for eligibility for such services; the majority of preventive care for U.S. children is delivered in a provider’s office or clinic (HRSA, 2023).

Early Care and Education Systems

ECE systems include settings in which multiple children are cared for and taught by individuals other than their parents or the primary caregivers they reside with (Morrissey, 2019). While definitions vary by state, the National Resource Center for Health and Safety in Child Care and Early Education describes ECE facilities or settings as:

  1. Small family child care home: provides care and education of 1 to 6 children, including the caregiver’s/teacher’s own children in the home of the caregiver/teacher. Family members or other helpers may be involved in assisting the caregiver/teacher, but often there is only one caregiver/teacher present at any one time;
  2. Large family child care home: provides care and education of 7 to 12 children, including the caregiver’s/teacher’s own children in the home of the caregiver/teacher, with one or more qualified adult assistants to meet child:staff ratio requirements; and
Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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  1. Center: provides care and education of any number of children in a nonresidential setting, or 13 or more children in any setting if the facility is open on a regular basis (NRC, n.d.).

Morrissey (2019) noted that there are three main public programs for ECE in the United States: Head Start and Early Head Start, public preschools, and child care subsidies.

In 2019, a study based on parental report found that nearly 55 percent of children aged 1–2 years were in at least one weekly nonparental care arrangement. Among children in a weekly nonparental care arrangement, 62 percent were attending center-based care (e.g., child care center, preschool), 38 percent were cared for by a relative, and 20 percent were in a nonrelative care or family child care home (NCES, n.d.). These child care arrangements offer developmentally appropriate care and education for young children, as outlined below.

According to the Centers for Disease Control and Prevention (CDC), ECE settings can help young children build a foundation for healthy living (CDC, 2023b). Children who attend ECE programs often have much of their daily food and drink intake and many of their opportunities for physical activity and outdoor time while in care, making ECE programs key settings for the development of healthy habits (CDC, 2023a). ECE programs can provide nutritious foods, promote physical activity, limit screen time, support human milk feeding, create opportunities for outdoor learning, and participate in the Child and Adult Care Food Program (CACFP). Analogous to the National School Lunch and School Breakfast Programs, CACFP is a federal program that provides reimbursements for nutritious meals and snacks served to eligible children at participating ECE centers and family child care homes (USDA, n.d.-a).

Early Head Start (EHS) serves children ages 0–3 years and is a center- or home-based program administered by HHS to promote school readiness for children in families with low income. In 2020–2021, EHS served approximately 120,000 children in the United States (ACF, 2022). Participation in EHS has been shown to result in long-term cognitive, language, and emotional development outcomes (HHS, n.d.), but there has been no assessment of its impacts on dietary outcomes. EHS sites are required to participate in CACFP and Head Start sites have been found to provide healthier meals and snacks than most other types of child care (Ritchie et al., 2012). By supporting healthy eating and physical activity, ECE programs can support healthy growth and development, obesity prevention, and lifelong health (CDC, 2023b).

Finally, CDC indicates that ECE providers (such as a child care provider, Head Start teacher, or other educators in the child care setting) are pivotal to providing support for children’s development by helping them

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

learn, explore, get along with others, and build other needed skills (CDC, 2023a). In the context of the current report, Morrissey (2019) states that:

While ECE programs are not necessarily designed to improve child health, a growing body of research indicates that they may lead to short- and long-term improvements in health-related outcomes.

University Cooperative Extension Programs

CE is a nationally funded system overseen by the U.S. Department of Agriculture’s (USDA’s) National Institute of Food and Agriculture (NIFA) and implemented by a land-grant university in each state with local offices in nearly every county of the United States (see Figure 3-1) (NIFA, n.d.). Initiated more than 100 years ago to support and improve agriculture, CE services have expanded to include the conduct and translation of research to protect natural resources, address climate change, and improve community economic development, youth development, food safety, nutrition, and health (Buys and Rennekamp, 2020; NIFA, n.d.). University faculty and county-based academics and educators collaborate as trusted partners with local communities to determine needs, identify assets and issues, evaluate interventions, and prioritize future research.

The Expanded Food and Nutrition Education Program (EFNEP) is an example of a program administered by the CE system in all 50 states and 6 territories (NIFA, n.d.). Focusing on youth, adults, and families with low-income, through nutrition education classes and outreach, EFNEP is intended to improve nutrition behaviors and food safety practices,

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FIGURE 3-1 Cooperative extension system.
SOURCE: NIFA, n.d.
Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

increase diet quality, stretch food dollars, and promote physical activity (NIFA, 2023). EFNEP uses a peer educator model wherein members of the communities being served are trained and supervised by CE professionals with nutrition expertise to deliver evidence-based nutrition education. There are more than 1,200 EFNEP nutrition educators nationwide (NIFA, 2023). EFNEP peer-educators deliver a series of lessons in group or one-on-one settings. The focus of the classes is on families with low incomes and caregivers of young children, pregnant women and teens, and school-age youth. Coordination and collaboration with community partners and volunteers strengthen participants’ support system for enhancing and sustaining healthy eating and food security and address social and health disparities (NIFA, 2021). Program evaluation data are collected annually using an integrated local, state/territory, and federal reporting system to assess program reach and outcomes/impacts. EFNEP funding, which totaled $69.4 million in fiscal year 2022, pays for the peer educators and their support (NIFA, 2023). In 2022, EFNEP educators worked directly with 45,421 adults and 187,663 youths, the majority of whom were from historically marginalized populations (NIFA, 2023). EFNEP has been shown to be effective in improving participant nutrition. For example, based on pre-post class surveys, nearly all (>90 percent) adults exposed to ENFEP direct education improved their diet and food resource management practices (NIFA, 2023).

The Supplemental Nutrition Assistance Program–Education (SNAP-Ed) is another program implemented by CE in most states as well as by public health departments and other community organizations. SNAP-Ed is designed to provide evidence-based education, social marketing and policy, and systems and environmental change to support the nutrition and health of populations with low incomes (USDA, n.d.-b). Much as in the case with EFNEP, CE professionals oversee and supervise community educators to deliver evidence-based SNAP–Ed activities focused on promoting healthy eating, increasing physical activity, reducing sedentary behavior, and improving food safety and food security (Yetter and Tripp, 2020). SNAP–Ed funding totaled $433 million in fiscal year 2019, 98 percent of which went to CE (Yetter and Tripp, 2020). On average each land-grant university employed 57 full-time equivalent (FTE) personnel and an additional 31 FTE in volunteers to implement SNAP-Ed programming. This programming reached an average of over 47,000 individuals per state (Yetter and Tripp, 2020).

CE professionals and paraprofessionals work in a variety of settings, including ECE, schools, neighborhoods, and households to achieve impacts at levels ranging from local to the state and national (NIFA, 2023). For example, EFNEP has been delivered through partnerships with health care providers (Shilts et al., 2021), SNAP-Ed interventions have been

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

implemented in child care settings (Molitor and Doerr, 2020), and CE faculty have been involved in developing and evaluating nutrition education interventions with WIC participants (Au et al., 2016).

Special Supplemental Nutrition Program for Women, Infants, and Children

WIC, a USDA nutrition assistance program, serves pregnant and postpartum women, infants, and children under age 5 years living in households with low incomes and who are at nutrition risk (USDA, 2020). WIC participants receive benefits redeemable for supplemental foods and beverages designed to meet their special nutritional needs (referred to as the WIC food package), nutrition education and counseling, human milk feeding support, and referrals to other health and social services (Oliveira and Frazão, 2015). In 2020, 43 percent of U.S. infants and 30 percent of U.S. toddlers participated in WIC, and the participation rates among those eligible for services are high, with 81.9 percent of eligible infants less than 12 months of age and 56.9 percent of eligible toddlers 12 through 23 months participating in the program (USDA, 2023; USDA and FNS, 2020).

WIC food benefits can be used only for specific foods, including fruits and vegetables, whole grains, cereal, eggs, milk, cheese, yogurt, peanut butter, beans, and 100 percent juice (USDA, 2022). Infants who are not fully human milk fed also receive infant formula (USDA, 2022). Unlike with other federal nutrition assistance programs available to families with young children, such as SNAP-Ed, nutrition education is a requirement of WIC program participation. Caregivers, individually and/or in groups, meet with a nutritionist, registered dietitian, or trained paraprofessional to learn about important relationships between nutrition and feeding and early childhood growth and health (USDA, 2019). Using anticipatory guidance techniques formalized through the Value Enhanced Nutrition Assessment counseling guidance (USDA and FNS, n.d.), WIC staff and participants discuss issues such as developing healthy eating habits in infants and young children, responsive feeding strategies, reading food labels when shopping, and preparing healthy meals.

There is an expansive published literature on WIC and its impacts, including a recent systematic review of maternal and child health outcomes associated with program participation (Caulfield et al., 2022). However, WIC’s broad availability to families with low-income and the high participation rates among eligible children less than 24 months of age make randomized clinical trials on WIC’s impact on complementary feeding difficult to conduct. The available evidence shows that WIC participation is associated with numerous benefits, including improving the diet quality of infants and young children (Anderson et al., 2022; Au et al., 2019; Caulfield et al., 2022; Weinfield et al., 2020).

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Home Visiting Programs

In the United States, early childhood home visiting programs provide services to some families with pregnant individuals and/or children under 5 years old (NHVRC, 2018, n.d.-b). Exactly which services are provided varies by geographic location and program. The services may include facilitating access to obstetric and pediatric health care services, parental education and coaching, emotional support, developmental and behavioral health screening and referrals, advice on selecting high quality child care and preschools, referrals to other community services, and education and support around human milk feeding, complementary feeding (both what and how to feed), and mitigating food insecurity (Kåks and Målqvist, 2020; NHVRC, 2018; Salvy et al., 2017). Home visiting services are delivered in the family’s home, other private meeting place, or virtually by individuals with relevant professional training (e.g., a nurse or social worker) or trained paraprofessional staff (NHVRC, 2018). In 2022 a large majority (75 percent) of home visits were virtual (NHVRC, n.d.-c). Eligible families can be connected with home visiting through a variety of sources, including medical providers, managed care organizations, early childhood services and schools, child protective services, law enforcement, the court system, public health services, community members, outreach events, or self-referral. Participation is voluntary and services are provided at no cost to families through a variety of funding streams (NHVRC, 2018). Federal sources of funding for home visiting include the Maternal, Infant, and Early Childhood Home Visiting Program, Title V of the Maternal and Child Health Block Grant Program, Temporary Assistance for Needy Families, Medicaid, Healthy Start, and the Community-Based Child Abuse Prevention Program (NHVRC, 2018). In addition, states use other funding sources (e.g., tobacco settlement funds, taxes, lotteries, and budget line items) and philanthropic funding to supplement federal dollars in paying for these programs (NHVRC, 2018).

Home visiting programs in the United States conduct activities using a wide range of models which vary in their target audience, prioritized outcomes, and the duration and frequency of the home visits they offer. To promote high quality home visiting services HHS conducts a rigorous review of the evidence base on the impact of home visiting models through the Home Visiting Evidence of Effectiveness (HomVEE) project (NHVRC, 2018). The HomVEE project uses a systematic review of the literature to determine whether models have enough high- or moderate-quality impact studies providing evidence of favorable, statistically significant impact on at least one of the following domains: child development and school readiness; child health; family economic self-sufficiency; linkages and referrals; maternal health; positive parenting practices; reductions in child maltreat-

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

ment; and reductions in juvenile delinquency, family violence, and crime (ACF, 2022; Sama-Miller et al., 2021). As of November 2022, about half (24 of 53) of the U.S. home visiting models that have been reviewed met the HHS criteria to be designated as an evidence-based early childhood home visiting service delivery model (ACF, 2022). Of those 24 home visiting models, 17 had impact studies examining the domain of child health, which could include diet and feeding measures. Fourteen of 17 models (82 percent) had at least one favorable outcome related to child health (HHS, n.d.), demonstrating the potential for home visiting programs to play an important role in promoting recommended infant feeding practices and behaviors. Of the home visiting models that have had impact studies conducted to examine their effectiveness specifically with Tribal populations, one home visiting model (Family Spirit Nuture) met HHS criteria to be designated as evidence-based (Bleiweiss-Sande et al., 2022). Evidence-based home visiting programs are available in all 50 U.S. states plus Washington, DC, more than 130 Tribal communities, and 5 U.S. territories (Ingalls et al., 2019; NHVRC, n.d.-a; Rosenstock et al., 2021). It is estimated that there is access to evidence-based home visiting programs within about 62 percent of zip codes across the United States (NHVRC, n.d.-c).

Other Settings

Interventions that met the criteria of taking place in high-income countries and focusing on what or how to feed but that did not take place in the context of any of the settings or programs noted above were included in the review and categorized as “other.” Interventions in this category include those that were entirely electronic (website, video, or short message/messaging service) or that involved an in-person or telephone intervention conducted by a researcher unaffiliated with any of the pre-specified or aligned settings. The committee decided to include these additional studies both because of the complexity in defining the setting for some interventions (e.g., recruitment occurred in clinical as well as non-clinical locations) and because the Statement of Task specified that the committee provide information on interventions that could be scaled up for community or statewide implementation, which would include those conducted in other settings. In addition, there is potential for these interventions in the “other” setting to be conducted in many of the settings, such as through the CE system.

Setting Considerations

In view of these factors, while scoping the literature, the committee included and mapped each identified intervention to health care, ECE, CE,

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

WIC, home visiting, and other settings provided they took place in U.S.-specific contexts (i.e., high-income as defined by the World Bank) and focused on what to feed and/or how to feed children under age 2 years (see Box 3-1).

Country

The Statement of Task requested that the committee reviews interventions conducted in U.S.-specific contexts. The committee interpreted this to exclude interventions that took place in any country not classified as high-income by the World Bank.2 Since the infrastructure (e.g., health care system, ECE programs) in other high-income countries may differ from that of the United States, the committee described potential considerations for the interpretation of results obtained outside of the United States in each relevant section as applicable.

Interventions

In reviewing interventions aimed at improving infant and young child feeding behavior, the committee considered each intervention’s type, mode, duration, location, and theoretical frameworks, as well as the rigor of the study design evaluating it.

Type of Intervention

While scoping the literature, the committee reviewed interventions aimed at improving what to feed and/or how to feed infants and young children after the initiation of complementary feeding. Many interventions on this topic provided counseling or education to parents regarding what to feed (e.g., increase variety, recommended food groups) and/or how to feed (e.g., responsive feeding, food preparation) infants and young children. Counseling or education interventions might provide information on these topics independently or as reinforcement of information given by another program (e.g., WIC). Information might be provided by one-way educational courses, sessions, or electronic distribution of information or through interactive sessions involving discussion and feedback.

In addition to the counseling interventions identified, the committee also identified behavioral interventions intended to influence complementary feeding behaviors, mostly related to how to feed (including observations of an infant’s or child’s acceptance of foods, repeated exposure to target foods, and associative conditioning).

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2 See https://data.worldbank.org/income-level/high-income (accessed August 18, 2023).

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Mode of Delivery

Another characteristic the committee considered when reviewing the interventions aimed at improving complementary feeding was the mode of delivery of counseling or education. The committee identified four categories of intervention delivery modes for influencing complementary feeding:

  1. Live (e.g., in-person sessions, either group or individual)
  2. Remote-live interactive (e.g., via telephone [human to human])
  3. Remote-tech interactive (e.g., interactive apps or websites, two-way texting)
  4. Remote-tech noninteractive (e.g., video, books, noninteractive websites, one-way texting)

Duration of the Intervention

Interventions ranged in duration from a single, brief interaction to an intervention that lasted 2 years; some interventions included contact with a single individual and others included multiple study staff, medical professionals, nutrition educators, community workers, or other professionals or paraprofessionals. Interventions influencing infant and young child feeding behaviors occurred at a variety of time points prenatally and throughout the first 2 years of life. Outcome assessments beyond 2 years of age, if any, typically occurred before 5 years of age.

Place and Delivery of the Intervention

Within each of the setting categories described previously, the committee considered the various physical locations where the interventions took place (e.g., doctor’s office, ECE center, home). Multifaceted interventions often included more than one place of delivery (e.g., doctor’s office and home). In addition to the physical location of the intervention, the committee considered the staff needed to deliver each intervention (e.g., doctors, nurses, registered dietitians, nutrition educators, community health workers or home visitors).

Theoretical Frameworks

The studies in the scoping review identified a variety of theoretical frameworks and models (see Box 3-2), which can be useful for informing an intervention’s design by guiding the selection of targets to address and of strategies to use to achieve behavior change (NCI, 2018). Some studies included one or more theoretical frameworks or models, while others identified none.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Study Design

The studies reviewed in the current report used a variety of designs, with varying strengths and limitations, to assess the impact of interventions on infant outcomes. These are listed in Box 3-3 in order of the strength of the evidence provided.

Comparator

An important aspect the committee considered while reviewing the interventions was the type of comparator used within the interventions. Comparators included no intervention, usual care, a similar intervention(s) on a different topic or using different feeding or parenting strategies, or interventions with and without additional components.

Outcomes

Complementary feeding intervention studies focusing on infants and young children under age 2 years have evaluated a variety of outcomes. The outcomes examined in this scoping review include any nutrition-related measure of the impact of the intervention on the target population. Because young children are dependent on their caregivers for nutrition, caregivers are often the targets of interventions, and caregiver knowledge, attitudes,3 and behaviors relating to child nutrition are common outcomes. Outcomes related to the child are also commonly evaluated.

Within each of these populations (caregiver and child), outcomes were further stratified into measures of what to feed or eat and how to feed or eat (feeding practices and behaviors) (see Table 3-1). Discrete outcomes regarding what to feed or how to feed can further be classified by how the data are obtained: self-report by caregiver or observed or measured by a trained researcher or other professional.

An objective assessment by a trained professional who is blind to the intervention group is typically preferred to avoid reporting bias, but for many outcomes this may not be feasible or else may be difficult to implement.

In addition to dietary measures, the nutrition-related outcomes considered by the committee included child growth and development. Common measures of child growth are weight and length4 which can be compared to World Health Organization (WHO) child growth standards to assess a

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3 Knowledge and attitude changes, while often precursors to behavior change, do not necessarily result in behavior change. Knowledge and attitude changes were only outcomes of interest in this scoping review if the study also examined other outcomes, such as changes in behavior.

4 Standing height is not used until a child is 2 years old.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

child’s weight or length or weight-for-length in relation to healthy children of the same age and gender (WHO, n.d.-a). For children under the age of 24 months, weight-for-length can be categorized as low, normal, or high (WHO, n.d.-b). Although body mass index (BMI) relative to age and gender-based standards is used to interpret growth at older ages and was used in some included studies, it is not a recommended metric for assessing children under 24 months of age (CDC, 2015). Developmental observations and tests can also be used to assess the impacts of nutrition interventions on young children’s cognitive and social development relative to norm-referenced peers.

For the purposes of this scoping review, the committee did not consider interventions related to some important outcomes including human

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

TABLE 3-1 Examples of Nutrition Intervention Outcomes

Outcomes Caregiver-Focused Child-Focused
What to feed/eat
  • Avoidance/reduction in provision of unhealthy foods/beverages (e.g., foods with added sugars, salt, saturated and trans fats)
  • Offering age-appropriate foods and beverages
  • Provision of a variety of nutrient dense foods (e.g., fruits, vegetables, whole grains) from one or more food groups
  • Provision of foods with a variety of textures and flavors
  • Frequency or amount of foods/beverages consumed, by types and in relation to recommendations
  • Amount of nutrients consumed in comparison to recommendations
  • Overall diet quality
How to feed/eat
  • Use of responsive feeding practicesa
  • Providing appropriate portion sizes
  • Repeated exposure to new foods or flavors
  • Weaning from the bottle and other bottle-feeding practices
  • Family meals
  • Eating without TV or other screens
  • Caregiver/family modeling of healthy eating
  • Mealtime conversations about healthy eating
  • Meal and snack frequency and regularity
  • Involving child in meal preparation
  • Timely transitions to self-feeding (e.g., self-feeding finger foods, using utensils and plates/bowls at meals, drinking from a cup)b
  • Eating same foods at the table with family
  • Food responsiveness/emotional overeating
  • Enjoyment of food
  • Desire to drink
  • Satiation responsiveness, slowness in eating
  • Emotional undereating
  • Food fussiness

a Responsive feeding describes a feeding process with reciprocity between parent and child in order to encourage the child to develop the skills needed to maintain a healthy dietary intake independently. Responsive feeding anticipatory guidance may include counseling parents to follow hunger/satiation cues and encourage self-directed feeding while avoiding using food as a reward or pressuring a child to eat. SOURCE: Pérez-Escamilla et al., 2017. Additional examples of responsive feeding behaviors can be found in the NASEM (2020) report.

b Timely transition to self-feeding involves the parent role being reduced and the baby taking more of a direct role in feeding. Examples of the transition to self-feeding would be “baby puts food in mouth with hands,” “baby holds spoon to put food in her mouth,” and “parent allows baby to grab spoon away from parent while feeding.”

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

milk feeding, formula feeding, the timing of introduction of complementary foods or beverages, food allergies and safety, sleep, physical activity, or screen use behaviors because these topics have been covered in other reviews (Eichner-Seitz et al., 2023; Fenton et al., 2020; Field, 2017; Foisy et al., 2011; Pérez-Escamilla et al., 2023; Renfrew et al., 2012; Webb Girard et al., 2020) and are outside the scope of the Statement of Task.

FACTORS CONSIDERED IN ASSESSING INFORMATIVE EXAMPLES

The committee reviewed each identified intervention aimed at improving infant and young child feeding behavior, assessed the strengths and weaknesses of the studies evaluating these interventions, and considered the aspects important for effectiveness and scalability.

Intervention Methodology

This section describes the committee’s approach to the evaluation of study methods for the purpose of assessing internal validity, defined as the extent to which the design, implementation, and analysis of the study results provide an accurate indication of the impact of the intervention on the outcomes considered. This evaluation is distinct from the committee’s evaluation of the factors influencing the generalizability or external validity of the study’s findings, defined as whether the knowledge that has been gained is applicable beyond the specific population and setting in which the study was conducted. Although there are distinctive features of any study that may affect its internal validity, a few specific features described below were examined and summarized across all studies identified in this report (see Appendix E).

Comparator

For ethical and practical reasons, it is frequently not possible to include a “true control” or placebo group in nutrition studies (Lichtenstein et al., 2021). Thus, any interventions received by the comparison group need to be adequately described. For example, if the comparison group receives “usual care,” it is useful to understand the “usual care” in the population studied, especially if the usual care may reasonably be thought to influence study outcomes and potentially reduce differences observed between study groups. Thus, the content and contact time of any education or counseling received by the comparison group should be noted. If the level of participant contact with the study team or other personnel involved in delivering the intervention is very different between

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

study groups, this has the potential to influence the findings. Specifically, there is the potential that attention from researchers and other personnel and the questions asked of participants can influence behavior, rather than the content of the study intervention (i.e., the Hawthorne effect) (McCarthy et al., 2022; Sedgwick and Greenwood, 2015). Finally, it is important to understand the potential for contamination between study groups. Depending on how much contact exists between individuals assigned to different groups, individuals in the comparison group may be exposed to intervention content during the study. Any interactions between individuals in different groups should be assessed and reported, if possible. Generally, the potential for contamination is greater in individually randomized trials than in cluster-randomized trials (Hahn et al., 2005; Torgerson, 2001).

Quality of Outcome Assessment Instruments

If valid conclusions are to be drawn from a study, the instruments used to measure the outcomes (e.g., feeding behaviors, child development) should assess them as accurately and precisely as possible. Ideally, the instruments used should have been evaluated for validity in populations like the study population, with respect to the child’s age, the family’s education, and cultural and linguistic background. The dietary intake assessment methods selected should be appropriate to the study question. Staff training, standardization, and supervision should be reported when anthropometric measurements or other observations are conducted. When possible, data collectors should be blinded to the study group to avoid influencing the way they ask questions, collect measurements, and record the data. Similarly, participants should be blinded to which group they are in so that their knowledge of that does not affect how they respond to questions. However, blinding of participants is often difficult to achieve with education or counseling-focused interventions.

Fidelity of Intervention Delivery

To properly interpret the impact and scalability of an intervention, it is necessary to understand if the intervention was delivered as intended during the trial. The reporting of measures such as participant adherence to the intervention protocol, attendance at educational or counseling sessions, and whether staff were able to deliver the intervention with a high level of fidelity can indicate whether participants received the intended content and dose of the intervention. These measures can also provide information about the feasibility of completing the intervention for both staff delivering it and participants receiving it.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Validity and Generalizability

There are two aspects of the study size that are of concern regarding validity. First, the number of enrolled participants is a key determinant of precision, with larger studies being less subject to random error and statistical uncertainty than smaller studies. For cluster-randomized trials, a larger number of clusters increases internal validity.

Second, validity can be influenced by the proportion of participants completing follow-up. Selection bias can occur when the intervention or assessment of the outcome, or both, is influenced by self-selection (at the individual or cluster level) among those who enroll and complete the study (Bauer et al., 2010). Outcomes assessed among participants who provide data at the end of the study may generate a different result than would have been found had there been more complete participation. Therefore, for a given study the committee took into account the number of individuals at each stage, specifically:

  • The number of participants approached about participating in the study
  • The number of participants who enrolled in the study
  • The number of participants who contributed to the final results, including both the number who received the intervention and the number in the control group
  • The proportion of those who were enrolled who completed the study in both the intervention and control group

The committee also considered differences in characteristics between individuals who chose to participate versus those who did not and also between individuals who contributed to the results and those who did not.

The study population can affect the study’s generalizability. The key features of a study population include:

  • Geographic setting: country
  • Socioeconomic features: education level, income, occupation (of parents or caregivers)
  • Cultural and linguistic characteristics: race, ethnicity, geographic origins, primary language
  • Family structure: birth order, primary caregiver

If interventions are conducted in the context of an institution, factors such as the size or number of people that the institution serves, its experience with research or program evaluation, and rural-versus-urban setting

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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may affect generalizability. For interventions implemented at a cluster level, such factors may also affect internal validity.

Susceptibility to Biases

There are several types of bias that are common concerns for studies evaluating counseling and education interventions. Among such studies, for example, outcomes assessed by participant report may be vulnerable to reporting bias motivated by social desirability (Nederhof, 1985). Those who receive an intervention that encourages specific behaviors may be inclined to report engaging in the desirable behaviors more than they actually do so because they know the “right thing” to do and want to be perceived as doing the “right thing” (Nederhof, 1985). Recall bias is also an important consideration. When caregivers are asked to remember and report child behaviors or dietary intake over an extended timeframe, their recall of the information may be imperfect (Coughlin, 1990; Paulhus, 1984). Outcome misclassification bias may occur when the instruments used have either systematic or random error (Willett, 2012). In this case, an outcome may be reported as having changed or not changed when the opposite is true, potentially exaggerating or obscuring the impact of the intervention on the outcome. Finally, an important consideration is that researchers may pay undue attention to results that support their hypothesis and ignore results that do not support their hypothesis (i.e., confirmation bias) (Wason, 1968). Some outcomes are more vulnerable than others to various biases, and for each of the major outcomes included in a study it is useful to provide an indication of susceptibility to help in assessing the validity of the results.

Adequacy of Statistical Methods

Good statistical practices can address some factors that can influence the interpretation of the study results. For instance, blinding the study statistician, use of a prespecified analytic protocol with comprehensive reporting of the results, and application of Bonferroni or other corrections for multiple hypothesis testing can help to address confirmation bias (Wason, 1968). Completing a sample size calculation before conducting the study can help to ensure that a study is large enough to detect a treatment effect of clinical or public health significance (Faber and Fonseca, 2014). Intention-to-treat analysis should be reported, including all randomized participants in the analysis, whether they completed the study or not (Gupta, 2011). Per protocol analyses may be helpful at approximating efficacy under ideal conditions but are not a valid substitute for intention-to-treat analyses because per protocol analysis increases the risk of confirmation bias, since

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

investigators decide who will be excluded (Gupta, 2011). When interpreting per protocol analyses, it is important to keep in mind that the comparability of the groups that have been randomized may no longer be valid when individuals not completing the protocol are excluded from the analysis.

Analytic methods should also be appropriate for the study design and for the instruments used to measure outcomes. Cluster-randomized trials should use multilevel models to ensure that correct inferences are made from the data (Wears, 2002). If the structure of the data (e.g., participants clustered within clinics or child care sites) is not accounted for with the statistical approach used, one may overestimate the impact of an intervention. For studies that use a few days of 24-hour recalls to estimate impact on dietary intake, statistical methods should be used to estimate the usual intake of episodically consumed foods (Dodd et al., 2006; Tooze et al., 2006).

Assessment of Intervention Scalability

An important consideration for translating research into practice is scalability, the ability of an intervention shown to be effective in a controlled research study to remain effective when expanded to a larger population under “real-world” conditions. The committee assessed the potential for scalability of each intervention through information extracted from each article using items from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework parameters (RE-AIM, n.d.). In addition, the committee used the Template for Intervention Description and Replication (TIDieR) checklist (Hoffmann et al., 2014) and the WHO ExpandNet checklist (WHO, 2011) to examine how easy or difficult scaling up a project would be (see Appendix F). Of note, a limitation with the assessment of scalability, especially with the WHO ExpandNet checklist, is the requirement of expert judgment, because most studies do not report on these outcomes/items.

Reach

Reach considers whether people participate in the intervention, and whether the people who participate are representative of those for whom the intervention is intended (RE-AIM, n.d.).

Effectiveness

Effectiveness evaluates the impact of the intervention on outcomes (i.e., effectiveness or efficacy) (RE-AIM, n.d.).

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Adoption

Adoption is focused at the systems and institutional levels, examining whether staff, sites, and communities are willing to participate in the intervention and whether those who choose to participate are representative of staff, sites, and communities for whom the intervention is intended (RE-AIM, n.d.).

Implementation

Implementation assesses whether the intervention was delivered as intended, whether adaptations had to be made, and the cost to deliver the intervention (RE-AIM, n.d.). Key measures that the committee evaluated for implementation included the methods of intervention delivery, type of staff needed to deliver the intervention, research staff fidelity in delivering the intervention, participant adherence or attendance, intervention modifications, and the cost of delivering the intervention.

Maintenance

Maintenance examines whether an intervention has lasting effects on individuals or sites after a study or program ends (RE-AIM, n.d.). The key measures that the committee assessed for maintenance include reported post-study intervention effects at the individual or site level (e.g., impacts on individual or site level outcomes 6 months post-study) and adaptations of the intervention at the site level post-study.

Engagement of Stakeholders

Engagement of stakeholders—includes involving them in design and implementation of the intervention and eliciting input from a range of stakeholders—is another factor the committee considered (WHO, 2011).

Cultural Appropriateness and Equity Considerations

Cultural appropriateness and equity are important considerations when assessing the scalability of interventions in the United States. U.S. families have a wide variety of geographic origins, cultural backgrounds, and linguistic preferences, and there are significant variations in food security, income and education, transportation access, and housing stability across the population. Therefore, interventions should be designed or adapted with cultural, linguistic, and other social determinants of health considerations in mind. For example, families with low incomes, that

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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have caregivers with low education levels, or who live in rural areas may require additional support to access interventions. Racism and discrimination are deeply rooted in many U.S. institutions, potentially negatively affecting outcomes for Black, Hispanic, and Indigenous families if systemic issues are not specifically addressed when the interventions are designed, implemented, and scaled.

The study’s RE-AIM, TIDieR, and ExpandNet parameters were examined to determine whether interventions reached, engaged, and equitably affected marginalized U.S. populations or similar populations in countries outside the United States. In addition, the studies were examined for the use of any adaptive or responsive design elements, including co-design with community members, assessment of participant or client satisfaction or acceptability, or implementation sciences, quality improvement, or process evaluation methodology.

Scalability Based on Existing Infrastructure in the United States

Finally, the intervention designs were compared with the existing health care, ECE, and CE infrastructure in the United States to further assess scalability. To determine whether the existing U.S. infrastructure could adequately support scaling of an intervention, the typical intensity of care, available staff, and reach within the population of U.S. institutions were considered and compared with the study intervention requirements. Expert opinion from committee members was used to make final decisions about scalability based on these comparisons.

SUMMARY

In this chapter, the committee discussed the key characteristics of the research that bear on their contributions to addressing the statement of task. These key characteristics include the setting in which the intervention was applied, the specific intervention and outcomes, internal validity, and scalability. There are several clear implications for drawing on this heterogeneous body of research to inform recommendations going forward.

First, the studies considered were notably diverse, covering a wide range of settings, methods, and quality. The very nature of the key questions regarding what to feed and how to feed means that the scope of potentially contributory information needs to be broad. Second, the value of a given study is dependent on a wide range of factors, and different studies contribute to scientific knowledge in different ways. Nonetheless, as discussed in the following chapters, some studies are more informative than others for addressing the statement of task. Third, because of

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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the heterogeneity in methods, the studies generally do not build directly on one another but rather address their theoretical framework with their own methods of intervention and choices of outcomes. The considerations summarized in this chapter form the lens through which the research was evaluated.

REFERENCES

AAP (American Academy of Pediatrics). 2022. Preventive care/periodicity schedule. https://www.aap.org/en/practice-management/care-delivery-approaches/periodicity-schedule (accessed July 21, 2023).

AAP. 2023. American Academy of Pediatrics’ schedule of well-child care visits: AAP, Bright Futures. https://www.aap.org/en/practice-management/care-delivery-approaches/periodicity-schedule (accessed August 18, 2023).

ACF (Administration for Children and Families). 2022. Early childhood home visiting models: Reviewing evidence of effectiveness. Washington, DC: Department of Health and Human Services.

Ajzen, I. 1977. Attitude-behavior relations: A theoretical analysis and review of empirical research. Psychological Bulletin 84(5):888.

Anderson, C. E., C. E. Martinez, L. D. Ritchie, C. Paolicelli, A. Reat, C. Borger, and S. E. Whaley. 2022. Longer Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation duration is associated with higher diet quality at age 5 years. Journal of Nutrition 152(8):1974–1982.

Anderson-Cook, C. M. 2005. Experimental and quasi-experimental designs for generalized causal inference. Journal of the American Statistical Association 100(470):708.

Au, L. E., S. Whaley, N. J. Rosen, M. Meza, and L. D. Ritchie. 2016. Online and in-person nutrition education improves breakfast knowledge, attitudes, and behaviors: A randomized trial of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children. Journal of the Academy of Nutrition and Dietetics 116(3):490–500.

Au, L. E., C. Paolicelli, K. Gurzo, L. D. Ritchie, N. S. Weinfield, K. R. Plank, and S. E. Whaley. 2019. Contribution of WIC-eligible foods to the overall diet of 13- and 24-month-old toddlers in the WIC Infant and Toddler Feeding Practices Study-2. Journal of the Academy of Nutrition and Dietetics 119(3):435–448.

Bandura, A. 1977. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review 84(2):191–215.

Baranowski, T. 2008. How individuals, environments, and health behavior interact. In A. L. McAlister, C. L. Perry, and G. S. Parcel (eds.), Health behavior and health education: Theory, research, and practice. San Francisco, CA: Jossey-Bass. Pp. 169–188.

Bauer, P., F. Koenig, W. Brannath, and M. Posch. 2010. Selection and bias—Two hostile brothers. Statistics in Medicine 29(1):1–13.

Baumrind, D. 1991. The influence of parenting style on adolescent competence and substance use. The Journal of Early Adolescence 11(1):56–95.

Beaulieu, N. D., M. E. Chernew, J. M. McWilliams, M. B. Landrum, M. Dalton, A. Y. Gu, M. Briskin, R. Wu, Z. El Amrani El Idrissi, H. Machado, A. L. Hicks, and D. M. Cutler. 2023. Organization and performance of U.S. health systems. JAMA 329(4):325–335.

Beck, J. S. 1964. Cognitive therapy: Basics and beyond. New York: Guildford Press.

Bleiweiss-Sande, R., E. Sama-Miller, C. Chavez, R. Coughlin, and A. Mraz Esposito. 2022. Assessing effectiveness of early childhood home visiting models implemented with Tribal populations. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, Department of Health and Human Services.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Bodenheimer, T., E. H. Wagner, and K. Grumbach. 2002. Improving primary care for patients with chronic illness. JAMA 288(14):1775–1779.

Bowlby, J. 1969. Attachment. New York: Basic Books.

Bronfenbrenner, U. 1974. Developmental research, public policy, and the ecology of childhood. Child Development 45(1):1–5.

Buys, D. R., and R. Rennekamp. 2020. Cooperative extension as a force for healthy, rural communities: Historical perspectives and future directions. American Journal of Public Health 110(9):1300–1303.

Caulfield, L. E., W. L. Bennett, S. M. Gross, K. M. Hurley, S. M. Ogunwole, M. Venkataramani, J. L. Lerman, A. Zhang, R. Sharma, and E. B. Bass. 2022. Maternal and child outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Rockville, MD: Agency for Healthcare Research and Quality.

CDC (Centers for Disease Control and Prevention). 2015. Using the WHO growth standard charts. https://www.cdc.gov/nccdphp/dnpao/growthcharts/who/using/index.htm (accessed July 21, 2023).

CDC. 2023a. Early care and education (ECE). https://www.cdc.gov/earlycare/index.html (accessed July 21, 2023).

CDC. 2023b. Nutrition and physical activity. https://www.cdc.gov/earlycare/nutrition/index.html (accessed July 21, 2023).

CMS. n.d. Early and periodic screening, diagnostic, and treatment. https://www.medicaid.gov/medicaid/benefits/early-and-periodic-screening-diagnostic-and-treatment/index.html (accessed August 18, 2023).

Cohen, S., and G. McKay. 1985. Social support, stress and the buffering hypothesis: A theoretical analysis. In S. E. Taylor, J. E. Singer, and A. Baum, Handbook of psychology and health, volume IV. Abingdon-on-Thames, UK: Routledge. Pp. 253–267.

Commonwealth Fund. 2005. EPSDT: An overview. https://www.commonwealthfund.org/publications/other-publication/2005/sep/epsdt-overview (accessed July 12, 2023).

Coughlin, S. S. 1990. Recall bias in epidemiologic studies. Journal of Clinical Epidemiology 43(1):87–91.

DiClemente, R. J., R. A. Crosby, and M. C. Kegler. 2002. Emerging theories in health promotion practice and research: Strategies for improving public health. San Francisco, CA: Jossey-Bass.

Dodd, K. W., P. M. Guenther, L. S. Freedman, A. F. Subar, V. Kipnis, D. Midthune, J. A. Tooze, and S. M. Krebs-Smith. 2006. Statistical methods for estimating usual intake of nutrients and foods: A review of the theory. Journal of the American Dietetic Association 106(10):1640–1650.

Eichner-Seitz, N., R. R. Pate, and I. M. Paul. 2023. Physical activity in infancy and early childhood: A narrative review of interventions for prevention of obesity and associated health outcomes. Frontiers in Endocrinology 14:1155925.

Faber, J., and L. M. Fonseca. 2014. How sample size influences research outcomes. Dental Press Journal of Orthodontics 19(4):27–29.

Fenton, T. R., H. Al-Wassia, S. S. Premji, and R. S. Sauve. 2020. Higher versus lower protein intake in formula-fed low birth weight infants. Cochrane Database of Systematic Reviews 2020(6):CD003959.

Field, T. 2017. Infant sleep problems and interventions: A review. Infant Behavior and Development 47:40–53.

Foisy, M., R. J. Boyle, J. R. Chalmers, E. L. Simpson, and H. C. Williams. 2011. The prevention of eczema in infants and children: An overview of Cochrane and non-Cochrane reviews. Evidence-Based Child Health: A Cochrane Review Journal 6(5):1322–1339.

Gupta, S. K. 2011. Intention-to-treat concept: A review. Perspectives in Clinical Research 2(3):109–112.

Hahn, S., S. Puffer, D. J. Torgerson, and J. Watson. 2005. Methodological bias in cluster randomised trials. BMC Medical Research Methodology 5:10.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

HHS (U.S. Department of Health and Human Services). n.d. Effects shown in research — child health domain. https://homvee.acf.hhs.gov/outcomes/child%20health/In%20Brief (accessed July 21, 2023).

Hoffmann, T. C., P. P. Glasziou, I. Boutron, R. Milne, R. Perera, D. Moher, D. G. Altman, V. Barbour, H. Macdonald, M. Johnston, S. E. Lamb, M. Dixon-Woods, P. McCulloch, J. C. Wyatt, A. W. Chan, and S. Michie. 2014. Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ 348:g1687.

HRSA (Health Resources and Services Administration). 2023. Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. https://mchb.hrsa.gov/programs-impact/programs/home-visiting/maternal-infant-early-childhood-home-visiting-miechv-program (accessed July 21, 2023).

Ingalls, A., S. Rosenstock, R. Foy Cuddy, N. Neault, S. Yessilth, N. Goklish, L. Nelson, R. Reid, and A. Barlow. 2019. Family Spirit Nurture (FSN)—A randomized controlled trial to prevent early childhood obesity in American Indian populations: Trial rationale and study protocol. BMC Obesity 6:18.

Janz, N. K., and M. H. Becker. 1984. The health belief model: A decade later. Health Education & Behavior 11(1):1–47.

Kåks, P., and M. Målqvist. 2020. Peer support for disadvantaged parents: A narrative review of strategies used in home visiting health interventions in high-income countries. BMC Health Services Research 20(1):682.

Keisler-Starkey, K., and L. N. Bunch. 2022. Health insurance coverage in the United States: 2021. Washington, DC: U.S. Census Bureau.

Lichtenstein, A. H., K. Petersen, K. Barger, K. E. Hansen, C. A. M. Anderson, D. J. Baer, J. W. Lampe, H. Rasmussen, and N. R. Matthan. 2021. Perspective: Design and conduct of human nutrition randomized controlled trials. Advances in Nutrition 12(1):4–20.

Maccoby, E. and J. Martin. 1983. Socialization in the context of the family: Parent-child interaction. In Handbook of Child Psychology, edited by P. H. Mussen, 1-101. New York: Wiley.

McCarthy, C. M., R. de Vries, and J. D. Mackenbach. 2022. The influence of unhealthy food and beverage marketing through social media and advergaming on diet-related outcomes in children—A systematic review. Obesity Reviews 23(6):e13441.

McGuire, W. J. 1984. Public communication as a strategy for inducing health-promoting behavioral change. Preventive Medicine 13(3):299–319.

Molitor, F., and C. Doerr. 2020. SNAP-Ed policy, systems, and environmental interventions and caregivers’ dietary behaviors. Journal of Nutrition Education and Behavior 52(11):1052–1057.

Morrissey, T. 2019. The effects of early care and education on children’s health. Health Affairs Health Policy Brief, April 25. https://www.healthaffairs.org/do/10.1377/hpb20190325.519221 (accessed August 5, 2023).

Mullis, F. 1999. Active parenting: An evaluation of two Adlerian parent education programs. Individual Psychology 55(2):225–232.

NASEM (National Academies of Sciences, Engineering, and Medicine). 2020. Feeding infants and children from birth to 24 months: Summarizing existing guidance. Washington, DC: National Academies Press.

NCEMCH (National Center for Education in Maternal and Child Health). 2002. Helping your toddler learn about food (1–2 years). National Center for Education in Maternal and Child Health, Georgetown University. https://www.brightfutures.org/nutritionfamfact/pdf/BWEng/EC12bw.pdf (accessed August 18, 2023).

NCES (National Center for Education Statistics). n.d. Child care. https://nces.ed.gov/fastfacts/display.asp?id=4 (accessed July 21, 2023).

NCI (National Cancer Institute). 2018. Theory at a glance: A guide for health promotion practice, 2nd edition. Washington, DC: Department of Health and Human Services.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Nederhof, A. J. 1985. Methods of coping with social desirability bias: A review. European Journal of Social Psychology 15(3):263–280.

NHVRC (National Home Visiting Resource Center). 2018. Home visiting primer. Arlington, VA: James Bell Associates and the Urban Institute. https://nhvrc.org/wp-content/uploads/NHVRC_Primer_FINAL-1.pdf (accessed August 5, 2023).

NHVRC. n.d.-a. About home visiting: Location and reach. https://nhvrc.org/yearbook/2022-yearbook/about-home-visiting/location-reach (accessed August 5, 2023).

NHVRC. n.d.-b. What is home visiting? https://nhvrc.org/what-is-home-visiting (accessed July 21, 2023).

NHVRC. n.d.-c. Who is being served by emerging models? https://nhvrc.org/yearbook/2022yearbook/who-is-being-served/by-emerging-models (accessed July 21, 2023).

NIFA (National Institute of Food and Agriculture). 2021. The Expanded Food and Nutrition Education Program policies. Washington, DC: U.S. Department of Agriculture. https://www.nifa.usda.gov/sites/default/files/program/EFNEP%20Program%20Policies%20(onscreen%20version).pdf (accessed August 5, 2023).

NIFA. 2023. 2022 impacts: Expanded Food and Nutrition Education Program (EFNEP): Improving nutritional security through education. Washington, DC: U.S. Department of Agriculture. https://www.nifa.usda.gov/sites/default/files/2023-03/EFNEP%202022%20Impact%20Report.pdf (accessed August 5, 2023).

NIFA. n.d. Cooperative extension system. https://www.nifa.usda.gov/about-nifa/how-we-work/extension/cooperative-extension-system (accessed July 21, 2023).

NRC (National Resource Center). n.d. Guiding principles. https://nrckids.org/files/CFOC4GuidingPrinciples.pdf (accessed July 21, 2023).

Oliveira, V., and E. Frazão. 2015. The WIC program: Background, trends, and economic issues, 2015 edition. Washington, DC: U.S. Department of Agriculture, Economic Research Service.

Patterson, G. R., B. D. DeBaryshe, and E. Ramsey. 1989. A developmental perspective on antisocial behavior. American Journal of Psychology 44(2):329–335.

Paulhus, D. L. 1984. Two-component models of socially desirable responding. Journal of Personality and Social Psychology 46(3):598–609.

Pérez-Escamilla, R., S. Segura-Pérez, and M. Lott. 2017. Feeding guidelines for infants and young toddlers: A responsive parenting approach. Durham, NC: Healthy Eating Research.

Pérez-Escamilla, R., C. Tomori, S. Hernández-Cordero, P. Baker, A. J. D. Barros, F. Bégin, D. J. Chapman, L. M. Grummer-Strawn, D. McCoy, P. Menon, P. A. Ribeiro Neves, E. Piwoz, N. Rollins, C. G. Victora, and L. Richter. 2023. Breastfeeding: Crucially important, but increasingly challenged in a market-driven world. Lancet 401(10375):472–485.

Prochaska, J. O., and W. F. Velicer. 1997. The transtheoretical model of health behavior change. American Journal of Health Promotion 12(1):38–48.

RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance). n.d. What is RE-AIM? https://re-aim.org/learn/what-is-re-aim (accessed July 21, 2023).

Renfrew, M. J., F. M. McCormick, A. Wade, B. Quinn, and T. Dowswell. 2012. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews 5(5):CD001141.

Ritchie, L. D., M. Boyle, K. Chandran, P. Spector, S. E. Whaley, P. James, S. Samuels, K. Hecht, and P. Crawford. 2012. Participation in the child and adult care food program is associated with more nutritious foods and beverages in child care. Childhood Obesity 8(3):224-229.

Rosenstock, S., A. Ingalls, R. Foy Cuddy, N. Neault, S. Littlepage, L. Cohoe, L. Nelson, K. Shephard-Yazzie, S. Yazzie, A. Alikhani, R. Reid, A. Kenney, and A. Barlow. 2021. Effect of a home-visiting intervention to reduce early childhood obesity among Native American children: A randomized clinical trial. JAMA Pediatrics 175(2):133–142.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

Salvy, S. J., K. de la Haye, T. Galama, and M. I. Goran. 2017. Home visitation programs: An untapped opportunity for the delivery of early childhood obesity prevention. Obesity Review 18(2):149–163.

Sama-Miller, E., J. Lugo-Gil, J. Harding, L. Akers, and R. Coughlin. 2021. Home Visiting Evidence of Effectiveness (HomVEE) systematic review handbook of procedures and evidence standards: Version 2.1. Washington, DC: Department of Health and Human Services, Administration for Children and Families.

Sedgwick, P., and N. Greenwood 2015. Understanding the Hawthorne effect. BMJ 351:h4672.

Shilts, M. K., L. K. Diaz Rios, K. H. Panarella, D. M. Styne, L. L. Lanoue, C. M. Drake, L. Ontai, and M. S. Townsend. 2021. Feasibility of colocating a nutrition education program into a medical clinic setting to facilitate pediatric obesity prevention. Journal of Primary Care and Community Health 12:21501327211009695.

Tooze, J. A., D. Midthune, K. W. Dodd, L. S. Freedman, S. M. Krebs-Smith, A. F. Subar, P. M. Guenther, R. J. Carroll, and V. Kipnis. 2006. A new statistical method for estimating the usual intake of episodically consumed foods with application to their distribution. Journal of the American Dietetic Association 106(10):1575–1587.

Torgerson, D. J. 2001. Contamination in trials: Is cluster randomisation the answer? BMJ 322(7282):355–357.

USDA (U.S. Department of Agriculture). 2019. WIC infant nutrition and feeding guide. https://wicworks.fns.usda.gov/resources/infant-nutrition-and-feeding-guide (accessed July 21, 2023).

USDA. 2020. WIC program. https://www.ers.usda.gov/topics/food-nutrition-assistance/wic-program.aspx (accessed July 21, 2023).

USDA. 2022. WIC food packages—Maximum monthly allowances. https://www.fns.usda.gov/wic/food-packages-maximum-monthly-allowances (accessed July 21, 2023).

USDA. 2023. National and state level estimates of WIC eligibility and program reach in 2020. https://www.fns.usda.gov/wic/eligibility-and-program-reach-estimates-2020 (accessed July 21, 2023).

USDA. n.d.-a. Child and Adult Care Food Program. https://www.fns.usda.gov/cacfp (accessed July 21, 2023).

USDA. n.d.-b. SNAP-Ed connection. https://snaped.fns.usda.gov (accessed July 21, 2023).

USDA and FNS (Food and Nutrition Service). 2020. National and state level estimates of WIC eligibility and program reach in 2020. https://www.fns.usda.gov/wic/eligibility-and-program-reach-estimates-2020 (accessed July 21, 2023).

USDA and FNS. n.d. Value-enhanced nutrition assessment (VENA) guidance. https://wicworks.fns.usda.gov/resources/value-enhanced-nutrition-assessment-vena-guidance (accessed July 21, 2023).

Wason, P. C. 1968. Reasoning about a rule. Quarterly Journal of Experimental Psychology 20(3):273–281.

Wears, R. L. 2002. Advanced statistics: Statistical methods for analyzing cluster and cluster-randomized data. Academic Emergency Medicine 9(4):330–341.

Webb Girard, A., E. Waugh, S. Sawyer, L. Golding, and U. Ramakrishnan. 2020. A scoping review of social–behaviour change techniques applied in complementary feeding interventions. Maternal and Child Nutrition 16(1):e12882.

Weinfield, N. S., C. Borger, L. E. Au, S. E. Whaley, D. Berman, and L. D. Ritchie. 2020. Longer participation in WIC is associated with better diet quality in 24-month-old children. Journal of the Academy of Nutrition and Dietetics 120(6):963–971.

Weinstein, N. D. 1988. The precaution adoption process. Health Psychology 7(4):355–386.

White, H., S. Sabarwal, and T. de Hoop. 2014. Randomized controlled trials (RCTs). Florence: UNICEF Office of Research.

WHO (World Health Organization). 2011. Beginning with the end in mind: Planning pilot projects and other programmatic research for successful scaling up. Geneva, Switzerland: WHO.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×

WHO. n.d.-a. Child growth standards. https://www.who.int/tools/child-growth-standards (accessed July 21, 2023).

WHO. n.d.-b. Weight-for-length/height. https://www.who.int/tools/child-growth-standards/standards/weight-for-length-height (accessed July 21, 2023).

Willett, W. 2012. Nutritional epidemiology. New York: Oxford University Press.

Wolfe, I., M. Thompson, P. Gill, G. Tamburlini, M. Blair, A. van den Bruel, J. Ehrich, M. Pettoello-Mantovani, S. Janson, M. Karanikolos, and M. McKee. 2013. Health services for children in Western Europe. Lancet 382(9873):1224–1234.

Yetter, D., and S. Tripp. 2020. SNAP-Ed FY 2019 Supplemental Nutrition Assistance Program Education through the land grant university system: A retrospective review of land-grant university SNAP-Ed programs and impacts. Washington, DC: U.S. Department of Agriculture.

Zajonc, R. B. 2001. Mere exposure: A gateway to the subliminal. Current Directions in Psychological Science 10(6):224–228.

Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
Page 62
Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Suggested Citation:"3 Considerations." 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. doi: 10.17226/27239.
×
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Complementary feeding refers to the introduction of foods other than human milk or formula to an infants diet. In response to a request from the Centers for Disease Control and Prevention, the National Academies Health and Medicine Division convened the Committee on Complementary Feeding Interventions for Infants and Young Children under Age 2 to conduct a consensus study scoping review of peer-reviewed literature and other publicly available information on interventions addressing complementary feeding of infants and young children. The interventions studied took place in the U.S. and other high-income country health care systems; early care and education settings; university cooperative extension programs; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); home visiting programs; and other settings. This consensus study report summarizes evidence and provides information on interventions that could be scaled up or implemented at a community or state level.

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