National Academies Press: OpenBook
« Previous: 3 Considerations
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

4

Overview of Interventions Identified in the Scoping Review

The committee conducted a scoping review with the objective of identifying interventions aimed at improving infant and young child feeding behaviors. At the request of the sponsors, and consistent with the Statement of Task (see Chapter 1), the scoping review was limited to U.S.-specific contexts and interventions occurring within health care systems, early care and education (ECE) settings, and university cooperative extension (CE) programs that include nutrition and feeding for young children. The committee also identified and included interventions occurring in the two associated settings (Special, Supplemental Nutrition Program for Women, Infants, and Children [WIC] and home visiting) as well as other settings (see Chapters 2 and 3). This chapter describes the results of the scoping review.

OVERALL DESCRIPTION OF IDENTIFIED STUDIES

In total, the scoping review included 83 publications covering 58 studies (see Table 4-1). Several studies resulted in multiple publications. In this section, the committee describes each included publication by geographic location, intervention mode, and outcomes of interest.

Geographic Location

A noteworthy feature of the literature is that 35 percent of the publications were based in the United States (29 publications). Given that the statement of task requested the review be limited to U.S.-specific contexts, the committee limited the review to higher-income countries as

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-1 Number of Studies and Publications Identified by Setting

Setting Number of Studies Number of Publications
Health Care 16 27
Early Care and Education 5 5
University Cooperative Extension 1 1
Home Visit 12 18
WIC 2 4
Other 23 28
TOTAL 58 83

NOTE: WIC = Special Supplemental Nutrition Program for Women, Infants, and Children.

defined by the World Bank. Most of the studies identified in the scoping review had been done outside of the United States and had taken place in Europe (29 publications) or Australia (15 publications) with a smaller number of studies in New Zealand, Canada, Israel, and South Korea. This geographic diversity may affect the applicability of the findings to the U.S. population, based on demographic or cultural differences, complementary feeding recommendations, or distinctive features of the health care or social support systems in the country where the program was conducted.

Intervention Modality

The committee determined that the studies used one or more of the following four modalities:

  1. Live (e.g., in-person sessions, either group and 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)

As shown in Table 4-2, most studies used live and/or remote-tech noninteractive modalities.

Outcomes of Interest

The scoping review focused on outcomes related to what to feed, how to feed, and related health outcomes, such as obesity prevention, in infants and young children. Table 4-3 describes intervention outcomes related to what to feed infants and young children. Many of the outcomes targeted by each study regarding what to feed were focused on the care-

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-2 Number of Publications by Mode of Intervention

Intervention Mode Live Remote-Live Remote-Tech Interactive Remote-Tech Noninteractive
Health Care 26a 4b 6c 25d
Early Care and Education 4e 0 0 2f
University Cooperative Extension 1g 0 0 1g
Home Visit 18h 2i 0 14j
WIC 0 0 3k 1l
Other 19m 4n 0 19o
TOTAL 68 10 9 61

SOURCES:

a Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014, 2015; de Franchis et al., 2022; Dodd et al., 2014, 2018; Fiks et al., 2017; Fildes et al., 2015; French et al., 2012; Globus et al., 2019; Hesketh et al., 2020; Hoffmann et al., 2021; Magarey et al., 2016; Maguire et al., 2010; Messito et al., 2020; Morandi et al., 2019; Schroeder et al., 2015; Spence et al., 2013, 2014; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

b de Franchis et al., 2022; Dodd et al., 2018; Hesketh et al., 2020; Hoffmann et al., 2021.

c Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014, 2015.

d Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014, 2015; Dodd et al., 2014; Fiks et al., 2017; Fildes et al., 2015; French et al., 2012; Globus et al., 2019; Hesketh et al., 2020; Hoffmann et al., 2021; Magarey et al., 2016; Maguire et al., 2010; Messito et al., 2020; Morandi et al., 2019; Sanghavi, 2005; Schroeder et al., 2015; Spence et al., 2013, 2014; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

e Ahern et al., 2014; Caton et al., 2013; Roset-Salla et al., 2016; Verbestel et al., 2014.

f Clark et al., 2009; Verbestel et al., 2014.

g Horodynski and Stommel, 2005.

h Cloutier et al., 2018; Fangupo et al., 2015; Harris et al., 2020; Hernandez et al., 2022; Hohman et al., 2017, 2020; LoRe et al., 2019; Morison et al., 2018; Remy et al., 2013; Rosenstock et al., 2021; Savage et al., 2016, 2018; Taylor et al., 2017; Tussing-Humphreys et al., 2019; Van Vliet et al., 2022; Watt et al., 2009; Wen et al., 2011; Williams Erickson et al., 2018.

i Cloutier et al., 2018; Taylor et al., 2017.

j Cloutier et al., 2018; Fangupo et al., 2015; Hernandez et al., 2022; Hohman et al., 2017, 2020; LoRe et al., 2019; Morison et al., 2018; Rosenstock et al., 2021; Savage et al., 2018; Tussing-Humphreys et al., 2019; Van Vliet et al., 2022; Watt et al., 2009; Wen et al., 2011; Williams Erickson et al., 2018.

k Gibby et al., 2019; Macchi et al., 2022; Palacios et al., 2018.

l Scheinmann et al., 2010.

m Barends et al., 2013, 2014; Beinert et al., 2017; Coulthard et al., 2014; Forestell and Mennella, 2007; Hetherington et al., 2015; Johansson et al., 2019; Johnson et al., 2021; Kalhoff et al., 2021; Koehler et al., 2007; Krebs et al., 2006; Maier et al., 2008; Mennella et al., 2008, 2017; Øverby et al., 2017; Rapson et al., 2022; Røed et al., 2020, 2021; Tournier et al., 2021.

n Cauble et al., 2021; Rapson et al., 2022; Røed et al., 2020; Wen et al., 2020.

o Barends et al., 2014; Beinert et al., 2017; Cauble et al., 2021; Coulthard et al., 2014; Forestell and Mennella, 2007; Harris et al., 2022; Helle et al., 2019a,b; Hetherington et al., 2015; Maier et al., 2008; Mennella et al., 2008, 2017; Owen et al., 2018; Ra, 2021; Røed et al., 2020, 2021; Verrall and Gray-Donald, 2005; Verrall et al., 2006; Wen et al., 2020.

NOTE: WIC = Special, Supplemental Nutrition Program for Women, Infants, and Children.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

giver (any individual caring for the child (e.g., parent, guardian, child care provider). Caregiver-focused outcomes included increasing the provision of nutrient-dense foods, increasing the variety of foods, and reducing the provision of foods with added sugars, salt, and saturated and trans fats. Most child-focused interventions were aimed at getting the infant or young child to consume a high-quality diet.

Table 4-4 describes infant and young child intervention outcomes related to how to feed. The most frequent behavior change outcome targeting caregivers was responsive feeding, which was examined in nearly all settings. Caregiver-targeted interventions occurred mostly in the health care and home visiting settings and included repeated exposure and increasing infant/young child acceptance of nutrient-dense foods. There were no child-focused behavior change interventions conducted in ECE, WIC, or CE settings. Only a few interventions focused on the appropriate use of bottles/cups.

Although all publications identified in the scoping review targeted what to feed and/or how to feed outcomes, many also examined other outcomes, such as obesity-related outcomes. Approximately 37 percent of included publications’ objectives stated obesity prevention. This outcome was the most prevalent in the health care and WIC settings. About half of the included publications in the home visiting setting were focused on obesity prevention, whereas the ECE setting studies were mainly focused on improving infant feeding behaviors (only one of five was focused on obesity prevention).

DESCRIPTION OF IDENTIFIED STUDIES BY SETTING

The committee mapped each included publication to the following settings: health care, ECE, CE, WIC, home visiting, and other, as described in Chapters 2 and 3. The information extracted from each included publication can be found in Appendix E. This section of the report describes the key characteristics of each study and associated publication included in the scoping review for each setting.

Health Care

The committee reviewed interventions occurring within the health care setting that met the inclusion criteria, which includes studies at large medical centers, individual hospitals, clinics, private medical office practices, or consortiums of these locations. It also includes home visiting if interventions were conducted by health care setting personnel or considered a medical model. These studies leverage the family’s connection with their health care provider to alter caregiver knowledge and behavior, which subsequently alters the child’s eating behavior and improves nutritional intake. The committee identified 27 publications from 16 studies (see Table 4-5) that occurred in a health care setting.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-3 Number of Publications Targeting What to Feed by Outcome and Setting

What to Feed Outcomes Caregiver Child
Increasing provision of nutrient-dense foods and beverages Increasing variety of foods (types, textures, flavors) Reducing provision of foods and beverages with added sugars, salt, saturated and trans fats Consuming a high-quality diet with appropriate amounts and an increased variety of nutrient-dense foods and beverages
Health Care 12a 7b 7c 14d
Early Care Education 2e 0 0 4f
University Cooperative Extension 0 1g 0 0
Home Visit 10h 0 3i 11j
WIC 0 0 3k 0
Other 0 4l 3m 19n
TOTAL 24 12 16 48

SOURCES:

a Daniels et al., 2015; Dodd et al., 2014; Fiks et al., 2017; French et al., 2012; Hesketh et al., 2020; Hoffmann et al., 2021; Morandi et al., 2019; Spence et al., 2013; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

b Dodd et al., 2014; Schroeder et al., 2015; Spence et al., 2013; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

c Fildes et al., 2015; French et al., 2012; Hesketh et al., 2020; Magarey et al., 2016; Messito et al., 2020; Sanghavi, 2005; Schroeder et al., 2015.

d Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014; de Franchis et al., 2022; Dodd et al., 2014, 2018; Spence et al., 2013, 2014; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

e Clark et al., 2009; Roset-Salla et al., 2016.

f Ahern et al., 2014; Caton et al., 2013; Roset-Salla et al., 2016; Verbestel et al., 2014.

g Horodynski and Stommel, 2005.

h Hernandez et al., 2022; Hohman et al., 2017, 2020; LoRe et al., 2019; Morison et al., 2018; Savage et al., 2016, 2018; Taylor et al., 2017; Wen et al., 2011; Williams Erickson et al., 2018.

i Fangupo et al., 2015; Rosenstock et al., 2021; Savage et al., 2018.

j Cloutier et al., 2018; Fangupo et al., 2015; Hernandez et al., 2022; Hohman et al., 2017, 2020; LoRe et al., 2019; Morison et al., 2018; Remy et al., 2013; Rosenstock et al., 2021; Savage et al., 2016; Van Vliet et al., 2022.

k Gibby et al., 2019; Macchi et al., 2022; Palacios et al., 2018.

l Barends et al., 2013; Helle et al., 2019a,b; Tussing-Humphreys et al., 2019.

m Harris et al., 2022; Mennella et al., 2017; Tussing-Humphreys et al., 2019.

n Barends et al., 2013, 2014; Beinert et al., 2017; Coulthard et al., 2014; Forestell and Mennella, 2007; Hetherington et al., 2015; Johansson et al., 2019; Johnson et al., 2021; Koehler et al., 2007; Krebs et al., 2006; Maier et al., 2008; Mennella et al., 2008; Øverby et al., 2017; Owen et al., 2018; Rapson et al., 2022; Røed et al., 2020, 2021; Verrall and Gray-Donald, 2005; Verrall et al., 2006.

NOTE: WIC = Special, Supplemental Nutrition Program for Women, Infants, and Children.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-4 Number of Publications Targeting How to Feed by Outcome and Setting

Caregiver
Using responsive feeding practices Providing appropriate portion sizes Offering repeated exposures to unfamiliar foods and flavors
Health Care 14a 2b 5c
Early Care and Education 1j 0 2k
University Cooperative Extension 0 0 0
Home Visit 14n 6o 8p
WIC 3u 0 0
Other 7v 1w 6x
TOTAL 39 9 21

SOURCES:

a Dodd et al., 2014; Fiks et al., 2017; French et al., 2012; Globus et al., 2019; Hoffmann et al., 2021; Maguire et al., 2010; Messito et al., 2020; Morandi et al., 2019; Schroeder et al., 2015; Spence et al., 2013; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

b Hoffmann et al., 2021; Schroeder et al., 2015.

c Spence et al., 2013; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

d de Franchis et al., 2022; Dodd et al., 2018; Hoffmann et al., 2021; Sanghavi, 2005.

e Spence et al., 2013; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

f Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014, 2015; de Franchis et al., 2022; Dodd et al., 2018; Fiks et al., 2017; Fildes et al., 2015; Hoffmann et al., 2021; Messito et al., 2020.

g Spence et al., 2013; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

h Hoffmann et al., 2021; Magarey et al., 2016; Sanghavi, 2005.

j Clark et al., 2009.

k Ahern et al., 2014; Caton et al., 2013.

l Verbestel et al., 2014.

m Horodynski and Stommel, 2005.

n Cloutier et al., 2018; Fangupo et al., 2015; Harris et al., 2020; Hernandez et al., 2022; Hohman et al., 2017, 2020; LoRe et al., 2019; Morison et al., 2018; Rosenstock et al., 2021; Taylor et al., 2017; Van Vliet et al., 2022; Watt et al., 2009; Wen et al., 2011; Williams Erickson et al., 2018.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×
Appropriately providing bottle and cup Modeling healthy eating behavior Providing regular meals and snacks Accepting a variety of nutrient-dense foods and beverages Timely transition to self-feeding
4d 5e 12f 5g 4h
0 0 1l 0 0
0 1m 0 0 0
3q 6r 1s 5t
0 0 0 0 0
1y 1z 12aa 5bb
8 12 14 18 14

o Hernandez et al., 2022; Hohman et al., 2017, 2020; LoRe et al., 2019; Morison et al., 2018; Van Vliet et al., 2022.

p Cloutier et al., 2018; Hernandez et al., 2022; Hohman et al., 2017, 2020; LoRe et al., 2019; Morison et al., 2018; Remy et al., 2013; Van Vliet et al., 2022.

q Savage et al., 2016, 2018; Taylor et al., 2017.

r Hernandez et al., 2022; Hohman et al., 2017, 2020; LoRe et al., 2019; Morison et al., 2018; Rosenstock et al., 2021.

s Cloutier et al., 2018.

t Koehler et al., 2007; Taylor et al., 2017; Watt et al., 2009; Wen et al., 2011; Williams Erickson et al., 2018.

u Gibby et al., 2019; Macchi et al., 2022; Palacios et al., 2018.

v Forestell and Mennella, 2007; Helle et al., 2019a,b; Hetherington et al., 2015; Maier et al., 2008; Ra, 2021; Røed et al., 2020.

w Cauble et al., 2021.

x Forestell and Mennella, 2007; Hetherington et al., 2015; Krebs et al., 2006; Mennella et al., 2008; Owen et al., 2018; Rapson et al., 2022.

y Wen et al., 2020.

z Coulthard et al., 2014.

aa Johansson et al., 2019; Johnson et al., 2021; Kalhoff et al., 2021; Koehler et al., 2007; Krebs et al., 2006; Mennella et al., 2008, 2017; Øverby et al., 2017; Owen et al., 2018; Rapson et al., 2022; Røed et al., 2020, 2021.

bb Forestell and Mennella, 2007; Hetherington et al., 2015; Maier et al., 2008; Mennella et al., 2017; Øverby et al., 2017.

NOTE: WIC = Special, Supplemental Nutrition Program for Women, Infants, and Children.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-5 Included Studies and Publications Within the Health Care Setting

Study Name Publications Publication Title
INFANT (INfant Feeding, Activity, and Nutrition Trial) Zheng et al. (2022) Quantifying the overall impact of an early childhood multi-behavioral lifestyle intervention
Hesketh et al. (2020) Long-term outcomes (2 and 3.5 years postintervention) of the INFANT early childhood intervention to improve health behaviors and reduce obesity: cluster-randomized controlled trial follow-up
Spence et al. (2014) Mediators of improved child diet quality following a health promotion intervention: the Melbourne INFANT Program
Cameron et al. (2014) Variation in outcomes of the Melbourne INfant Feeding, Activity, and Nutrition Trial (INFANT) program according to maternal education and age
Spence et al. (2013) A health promotion intervention can affect diet quality in early childhood
Campbell et al. (2013) A parent-focused intervention to reduce infant obesity risk behaviors: A randomized trial
de Franchis et al. (2022) The effect of weaning with adult food typical of the Mediterranean diet on taste development and eating habits of children: A randomized trial
GeliS Hoffman et al. (2021) Infant growth during the first year of life following a pregnancy lifestyle intervention in routine care—Findings from the cluster-randomized GeliS trial
BBOFT Vlasblom et al. (2020) Parenting support to prevent overweight during regular well-child visits in 0–3-year-old children (BBOFT+ program), a cluster randomized trial on the effectiveness on child BMI and health behaviors and parenting
van Grieken et al. (2017) Personalized web-based advice in combination with well-child visits to prevent overweight in young children: Cluster randomized controlled trial
Starting Early Program Messito et al. (2020) Starting early program impacts on feeding at infant 10 months age: A randomized controlled trial
Globus et al. (2019) Effects of early parent training on mother–infant feeding interactions
PROBIT (Preventing Obesity in Toddlers) Morandi et al. (2019) Prevention of obesity in toddlers (PROBIT): A randomized clinical trial of responsive feeding promotion from birth to 24 months
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 Name Publications Publication Title
LIMIT Dodd et al. (2014) Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomized trial
Dodd et al. (2018) Prenatal diet and child growth at 18 months
Grow2Gether Fiks et al. (2017) A social media peer group for mothers to prevent obesity from infancy: The Grow2Gether randomized trial
NOURISH Magarey et al. (2016) Child dietary and eating behavior outcomes up to 3.5 years after an early feeding intervention: The NOURISH RCT
Daniels et al. (2015) An early feeding practices intervention for obesity prevention
Daniels et al. (2014) Child eating behavior outcomes of an early feeding intervention to reduce risk indicators for child obesity: The NOURISH RCT
Daniels et al. (2013) Outcomes of an early feeding practices intervention to prevent childhood obesity
Daniels et al. (2012) Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: Outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules
Growing Leaps and Bounds Schroeder et al. (2015) Early obesity prevention: A randomized trial of a practice-based intervention in 0‒24-month infants
Fildes et al. (2015) An exploratory trial of parental advice for increasing vegetable acceptance in infancy
French et al. (2012) An evaluation of mother-centered anticipatory guidance to reduce obesogenic infant feeding behaviors
First Steps for Mommy and Me Taveras et al. (2011) First steps for mommy and me: A pilot intervention to improve nutrition and physical activity behaviors of postpartum mothers and their infants
TARGet Kids! Maguire et al. (2010) Office-based intervention to reduce bottle use among toddlers: TARget Kids! Pragmatic, Randomized Trial
Sanghavi (2005) Taking well-child care into the 21st century

NOTE: Appendix E has further information on studies in the health care setting.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

The included publications within the health care setting were from 10 countries (see Table 4-6). These publications contained the results from 16 studies, all but three of which were randomized controlled trials (RCTs) (Globus et al., 2019; Sanghavi, 2005; Taveras et al., 2011). Nineteen of the publications were from two countries: Australia and the United States. Three countries (United Kingdom, Greece, and Portugal) participated in a single-group study with one publication (Fildes et al., 2015).

Study Population1

The study populations included parents and their infants and toddlers up to 24 months of age (parent–infant dyads). Studies were generally limited to healthy mothers and healthy term or near-term infants, although not every study clearly stated this requirement in its inclusion criteria. Three studies enrolled pregnant people (LIMIT; Grow2Gether; GeliS), and two of these studies limited their enrollment to people with overweight or obesity during their pregnancy (LIMIT; Grow2Gether). One study (LIMIT) completed all interventions during pregnancy, although infant outcomes were assessed at 18 months, and two studies were limited to first-time parents (LIMIT; NOURISH).

Socioeconomic status (SES) was reported by income level in two trials (Grow2Gether; First Steps for Mommy and Me). Eleven studies used maternal education level as a proxy for SES (INFANT; NOURISH; Starting Early Program; BBOFT; GeliS; de Franchis et al., 2022; Fildes et al., 2015; French et al., 2012; Globus et al., 2019; Sanghavi, 2005; van Grieken et al., 2017). Among studies reporting maternal educational attainment, six (NOURISH; First Steps for Mommy and Me; INFANT; TARGet Kids!; Fildes et al., 2015; Globus et al., 2019) reported that more than half of mothers had completed a college or university education. In addition to maternal

TABLE 4-6 Geographic Location of Included Health Care Studies and Publications

Country Number of Studies Number of Publications
Australia 3 13
United States 5 6
Italy 2 2
Netherlands 1 2
Canada, Germany, Israel, United Kingdom, Greece, and Portugal 1 (each) 1 (each)

NOTE: Appendix E has further information on studies in the health care setting.

___________________

1 Citation references for each study can be found in Table 4-5.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

education, NOURISH also reported on Socio-Economic Indexes for areas in Australia. The Starting Early Program and French et al. (2012) also provided statistics on food assistance utilization. Three trials did not describe the SES of the study population (PROBIT; LIMIT; Growing Leaps and Bounds), although LIMIT provided an index of socioeconomic advantage.

One trial (Starting Early Program) enrolled an entirely Hispanic population. Two trials (Grow2Gether; Growing Leaps and Bounds) enrolled a substantial number of Black individuals, 88 percent and 48 percent of study participants, respectively. One trial enrolled women from a hospital that serves almost exclusively Navajo individuals (Sanghavi, 2005). Sample size varied significantly. Five trials enrolled less than 200 mother–infant dyads (Grow2Gether; First Steps for Mommy and Me; Fildes et al., 2015; Globus et al., 2019; Sanghavi, 2005), whereas three trials enrolled more than 500 mother–infant dyads (NOURISH; BBOFT; GeliS).

Intervention and Study Goals2

The included studies were generally intended to identify effective strategies to improve diet quality and promote healthy eating behavior in the first 2 years of life. Most studies’ goals were to improve both what to feed and how to feed (see Table 4-7). In addition, some studies had the goal

___________________

2 Citation references for each study can be found in Table 4-5.

TABLE 4-7 Study Goals of Included Health Care Studies Related to What and How to Feed

What to Feed Only How to Feed Only Both What and How to Feed
All 2a 1b 13c
Obesity Focused 1d 1e 7f

a de Franchis et al., 2022; Schroeder et al., 2015.

b Taveras et al., 2011.

c Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014, 2015; Dodd et al., 2014, 2018; Fiks et al., 2017; Fildes et al., 2015; French et al., 2012; Globus et al., 2019; Hesketh et al., 2020; Hoffmann et al., 2021; Magarey et al., 2016; Maguire et al., 2010; Messito et al., 2020; Morandi et al., 2019; Sanghavi, 2005; Spence et al., 2013, 2014; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

d Schroeder et al., 2015.

e Taveras et al., 2011.

f Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014, 2015; Dodd et al., 2014, 2018; Fiks et al., 2017; Hesketh et al., 2020; Magarey et al., 2016; Messito et al., 2020; Morandi et al., 2019; Schroeder et al., 2015; Spence et al., 2013, 2014; Taveras et al., 2011; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

NOTE: Numbers refer to studies and references are to publications; some studies had more than one publication.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

of preventing overweight or obesity, while some studies also included more specific goals. For example, the INFANT and NOURISH RCTs were designed to evaluate the effectiveness of a specific, theoretically informed program on infant nutrition (Campbell et al., 2008; Daniels et al., 2009), whereas others were designed to test new technologies (Grow2Gether; BBOFT; Sanghavi, 2005). Some evaluated antenatal education (LIMIT; GeliS) or compared the effect of different strategies for anticipatory guidance delivery (French et al., 2012).

Studies varied widely with respect to both the type and number of interventions directed at what and how to feed. Table 4-8 describes what to feed and how to feed topics that were addressed in health care sector studies include in the scoping review. As noted in the table, multiple stud-

TABLE 4-8 What/How to Feed Topics Addressed in Included Health Care Studies

What to Feed
Topics Addressed Number of Studies (references to associated publications)
Fruits and vegetables 4a
Sweets or sugar-sweetened beverages 7b
Dairy 5c
Juice 3d
Fats/saturated fats 1e
Iron rich foods 1f
Cereal/whole grains 1g
Fiber 1h
Vitamin D 1i
Protein 1j
Mediterranean diet 1k
Portion size 3l
Snacks 1m
Fast food 2n
Homemade baby food 2o
How to Feed
Responsive feeding and recognition of satiation cues 8p
Avoiding feeding to soothe 2q
Avoiding using food as a reward 3r
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×
What to Feed
Topics Addressed Number of Studies (references to associated publications)
Improving the family meal environment (e.g., encouraging regularly scheduled meals, no television viewing during meals, etc.) 5s
Parental monitoring of healthy dietary intake 2t
Parental role in the modeling of healthy food intake 1u
Repeated exposure to healthy foods 1v
Cup introduction 2w

a Cameron et al., 2014; Campbell et al., 2013; Dodd et al., 2014, 2018; Fildes et al., 2015; French et al., 2012; Hesketh et al., 2020; Spence et al., 2013, 2014; Zheng et al., 2022.

b Cameron et al., 2014; Campbell et al., 2013; Fiks et al., 2017; French et al., 2012; Hesketh et al., 2020; Maguire et al., 2010; Morandi et al., 2019; Schroeder et al., 2015; Spence et al., 2013, 2014; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

c Dodd et al., 2014, 2018; French et al., 2012; Maguire et al., 2010; Sanghavi, 2005; Schroeder et al., 2015.

d Fiks et al., 2017; Maguire et al., 2010; van Grieken et al., 2017; Vlasblom et al., 2020.

e Dodd et al., 2014, 2018.

f Globus et al., 2019.

g Hoffmann et al., 2021.

h Dodd et al., 2014, 2018.

i Globus et al., 2019.

j Morandi et al., 2019.

k de Franchis et al., 2022.

l French et al., 2012; Messito et al., 2020; Morandi et al., 2019.

m Cameron et al., 2014; Campbell et al., 2013; Hesketh et al., 2020; Spence et al., 2013, 2014; Zheng et al., 2022.

n de Franchis et al., 2022; French et al., 2012.

o Messito et al., 2020; Vlasblom et al., 2020.

p Daniels et al., 2012, 2013, 2014, 2015; Fiks et al., 2017; French et al., 2012; Globus et al., 2019; Hoffmann et al., 2021; Magarey et al., 2016; Messito et al., 2020; Morandi et al., 2019; Taveras et al., 2011.

q Messito et al., 2020; Taveras et al., 2011.

r Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014, 2015; Hesketh et al., 2020; Magarey et al., 2016; Spence et al., 2013, 2014; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

s Daniels et al., 2012, 2013, 2014, 2015; Fiks et al., 2017; French et al., 2012; Magarey et al., 2016; Messito et al., 2020; van Grieken et al., 2017; Vlasblom et al., 2020.

t Cameron et al., 2014; Campbell et al., 2013; Hesketh et al., 2020; Schroeder et al., 2015; Spence et al., 2013, 2014; Zheng et al., 2022.

u Daniels et al., 2012, 2013, 2014, 2015; Magarey et al., 2016.

v Daniels et al., 2012, 2013, 2014, 2015; Magarey et al., 2016.

w Maguire et al., 2010; Messito et al., 2020.

NOTE: Numbers refer to studies and references are to publications, some studies had more than one publication.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

ies addressed intake of fruits and vegetables, sugar-sweetened beverages (SSB) or sweets, dairy products, juice, snacks, portion size, and homemade baby foods, while a single study addressed each of the other topics. Regarding the specifics of how to feed, most studies focused on altering the feeding behavior of mother and infant. All topics were addressed by more than one study (see Table 4-8).

All 16 studies delivered the intervention through some form of counseling with anticipatory guidance. Approaches to counseling varied widely among studies. The most common intervention included individual counseling by health professionals (e.g., physicians, midwives, nurses, or dietitians) in the context of routine well-child visits (BBOFT; First Steps for Mommy and Me; Starting Early Program; PROBIT; de Franchis et al., 2022; French et al., 2012; Schroeder et al., 2015). One of these studies also held five parent support group sessions moderated by a dietitian during well-child clinic visits (Starting Early Program). Other studies provided counseling by health professionals outside of the context of routine care. The latter included counseling by a dietitian (LIMIT; Globus et al., 2019) or unspecified health care professionals (Fildes et al., 2015). Four studies provided only or primarily peer group interactive sessions moderated by a dietitian (INFANT), a psychologist (Grow2Gether), a psychologist and a dietitian (NOURISH), or a dietitian and a social worker (Globus et al., 2019). The Fiks et al. (2017) study was unique in that the intervention was delivered by interactive group sessions using social media (Facebook) exclusively. One study delivered the intervention through an electronic kiosk in the clinic waiting room (Sanghavi, 2005). Many studies supplemented the counseling intervention with written materials, phone calls, and links to digital information. One study used an eHealth module (BBOFT).

The frequency and duration of the counseling also varied widely. For example, the INFANT RCT (described below in additional detail) provided six 2-hour counseling sessions by registered dietitians beginning around 3 months of age, and one study provided a single counseling session at 9 months of age, with reinforcement at 15 months, if needed (LIMIT). Eleven trials limited the intervention to the antenatal period or the first 12 months of life (NOURISH; GeliS; First Steps for Mommy and Me; Grow2Gether; LIMIT; Starting Early Program; de Franchis et al., 2022; Fildes et al., 2015; French et al., 2012; Globus et al., 2019; Sanghavi, 2005), and the other five trials delivered the intervention throughout the first 24 months of life (INFANT; TARGet Kids!; BBOFT; Growing Leaps and Bounds; PROBIT).

Theoretical Frameworks

A large majority (n=11) of the studies identified within the health care setting did not report a theoretical framework. Descriptions of the

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-9 Reported Theoretical Frameworks that Informed Health Care Studies

Theoretical Framework Number of Studies (references to associated publications)
Social learning theory 1a
Attachment theory 2b
Social cognitive theory 3c
Theory of planned behavior 1d
Not reported 11e

a Messito et al., 2020.

b Daniels et al., 2012, 2013, 2014, 2015; Globus et al., 2019; Magarey et al., 2016.

c Cameron et al., 2014; Campbell et al., 2013; Daniels et al., 2012, 2013, 2014, 2015; Hesketh et al., 2020; Magarey et al., 2016; Spence et al., 2013, 2014; van Grieken et al., 2017; Vlasblom et al., 2020; Zheng et al., 2022.

d Vlasblom et al., 2020.

e de Franchis et al., 2022; Dodd et al., 2014, 2018; Fiks et al., 2017; Fildes et al., 2015; French et al., 2012; Hoffmann et al., 2021; Maguire et al., 2010; Morandi et al., 2019; Sanghavi, 2005; Schroeder et al., 2015; Taveras et al., 2011.

NOTE: Numbers refer to studies and references are to publications, some studies had more than one publication.

theoretical models can be found in Chapter 3. The studies that reported a theoretical framework are presented in Table 4-9. The theoretical framework of the INFANT trial is described in Chapter 5.

Tools and Outcomes3

All of the included studies used questionnaires to assess some or all outcomes (see Appendix E). The questionnaires and assessed outcomes varied from study to study. The most common outcome assessed was dietary intake, measured by 24-hour dietary recall and/or food frequency questionnaires (FFQs). The studies often relied on questionnaire instruments that had been previously evaluated for validity (see Table 4-10 and Appendix E). Questionnaires without previous validation were also used including instruments assessing child dietary intake (INFANT; LIMIT; BBOFT; First Steps for Mommy and Me; Growing Leaps and Bounds; PROBIT; Starting Early Program), parent knowledge (Sanghavi, 2005) and child behavior (Grow2Gether). To improve the accuracy of dietary intake reports, one trial (INFANT) used computer-assisted standardized 24-hour dietary recall (Spence et al., 2013).

Two trials reduced the risk that the outcome assessments of infant

___________________

3 Citation references for each study can be found in Table 4-4.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-10 Instruments Used in Assessing Outcomes of Interest in Health Care Sector Studies

Validated Instruments References
Behavior Risk Factor Surveillance System Fruit and Vegetable Module (4)
Children’s Eating Behaviour Questionnaire (2327)
Infant Feeding Practices Study II Questionnaire (11)
Infant Feeding Style Questionnaire (9, 11)
German Health Interview and Examination Survey for Children and Adolescents (10)
KidMed Questionnaire (1)
Parental Feeding Style Questionnaire (2327)
Chatoor Feeding Scale (8)
Child Feeding Questionnaire (2, 2327).

(1) de Franchis et al., 2022; (2) Schroeder et al., 2015; (3) Taveras et al., 2011; (4) French et al., 2012; (5) Vlasblom et al., 2020; (6) van Grieken et al., 2017; (7) Maguire et al., 2010; (8) Globus et al., 2019; (9) Fiks et al., 2017; (10) Hoffmann et al., 2021; (11) Messito et al., 2020; (12) Morandi et al., 2019; (13) Fildes et al., 2015; (14) Sanghavi, 2005; (15) Zheng et al., 2022; (16) Spence et al., 2013; (17) Spence et al., 2014; (18) Hesketh et al., 2020; (19) Campbell et al., 2013; (20) Cameron et al., 2014; (21) Dodd et al., 2018; (22) Dodd et al., 2014; (23) Daniels et al., 2014; (24) Daniels et al., 2012; (25) Daniels et al., 2013; (26) Daniels et al., 2015; (27) Magarey et al., 2016.

feeding behavior would be socially biased by providing a blinded outcome assessment to accompany the parent’s report. Fildes et al. (2015) assessed responses to unfamiliar foods using a blinded taste test of artichoke puree and peach puree, with intake measured in grams. Globus et al. (2019) assessed child feeding behavior through videotapes of home feedings that were coded by blinded research staff using the Chatoor Feeding Survey which had been previously evaluated for validity.

Key Findings and Implications4

Within the health care setting, 13 studies reported outcomes on what to feed and 11 studies reported outcomes on how to feed (Appendix E), while two studies did not report outcomes on what or how to feed that could be used in this report (Dodd et al., 2014; Sanghavi, 2005). Overall, the heterogeneity of both interventions and assessment tools resulted in a wide variety of study outcomes and few consistent findings.

Among the 13 studies reporting outcomes for what to feed, the coun-

___________________

4 Citation references for each study can be found in Table 4-4.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

seling interventions generally led to parents in the intervention groups reporting healthier diets for their children, compared with controls. The two most studied dietary categories were vegetables and SSB. Five studies focused on vegetables, including four studies of interventions intended to increase vegetable intake (NOURISH; INFANT; de Franchis et al., 2022; Fildes et al., 2015; French et al., 2012); one aimed to increase both the intake of a variety of vegetables and preference for vegetables (NOURISH). Of these five, all but one very short-term study (15 days) reported a beneficial impact on vegetable intake in one of its study populations (United Kingdom but not Portugal or Greece) (Fildes et al., 2015). One study found that the increased vegetable intake persisted until 36 weeks post intervention (de Franchis et al., 2022), but another (NOURISH) found that the effect had dissipated at the 5-year follow-up (Magarey et al., 2016). Six studies reported results for SSB, including juice. Of these five studies, four (INFANT; BBOFT; Starting Early Program; Growing Leaps and Bounds) reported decreased consumption of SSB (Campbell et al., 2013; Hesketh et al., 2020; Messito et al., 2020; Schroeder et al., 2015; Spence et al., 2013, 2014; van Grieken et al., 2017; Vlasblom et al., 2020), while one study reported no change in this outcome (PROBIT), and one did not report the outcome (Grow2Gether). Many studies were designed to improve parents’ knowledge of healthy food choices, but only two studies directly assessed knowledge improvement (INFANT; Sanghavi, 2005).

Among the 11 studies reporting outcomes on how to feed, seven reported on interventions designed to improve responsive feeding behaviors (NOURISH; Grow2Gether; Starting Early Program; PROBIT; First Steps for Mommy and Me; French et al., 2012; Globus et al., 2019); all of these interventions were counseling-based. All but one of the how to feed outcomes were assessed by parent report; one study (Globus et al., 2019) also used blinded videotaped maternal-infant interactions. All but two (First Steps for Mommy and Me; PROBIT) of the 11 studies on how to feed demonstrated a positive effect on responsive feeding behavior. One of these two studies used a very early intervention ending at 6 months of age (First Steps for Mommy and Me), while the other began its intervention at 1 month and showed no changes in responsive feeding behavior at 6 and 12 months (PROBIT). Interestingly, the study with blinded outcome assessment found that mothers assigned to the intervention group had more positive mother–infant mealtime interactions as well as were more responsive to infant cues than controls (Globus et al., 2019); however, a limitation of this trial is that it was not randomized.

Improvements in what to feed and how to feed were reported both by time-intensive interventions (e.g., multi-week interventions involving multiple in-person education sessions) (NOURISH; First Steps for Mommy and Me; Starting Early Program; Growing Leaps and Bounds;

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Globus et al., 2019) and less intensive interventions (e.g., participation in a Facebook group, educational messaging; <3 in person visits) (Grow-2Gether; TARGet Kids!; de Franchis et al., 2022). Although a direct comparison of the effectiveness of time-intensive interventions to less time-intensive interventions was beyond the purview of this scoping review, it did not appear that these two types of interventions differed with respect to effectiveness.

Two studies in this sector stand out for their potential to influence future research to determine the best interventions to influence what and how to feed complementary foods (see Chapter 5). The Fiks et al. (2017) RCT may provide one model for an easily accessible intervention because it was conducted using social media, a platform for communication that has become increasingly utilized to guide food choices (Kucharczuk et al., 2022; McCarthy et al., 2022). The INFANT trial, the most comprehensive trial described in this report, found a beneficial impact of the intervention on parent report of overall dietary quality and television viewing time. Notably, these benefits were not apparent in the first 2 years of life and were first identified at a mean age of 3.6 years and persisted until 5 years of age (Hesketh et al., 2020). This ongoing trial has the potential to serve as a model for future work to identify effective and scalable interventions on what and how to feed complementary foods in the first 2 years of life (Laws et al., 2021; Marshall et al., 2022).

Early Care and Education

The committee reviewed interventions occurring within ECE settings (including child care centers or nurseries). Child care centers typically involve multiple child care providers caring for multiple children in “classroom” types of settings. The committee identified five studies (all with one corresponding publication) conducted in ECE settings that met the inclusion criteria (see Table 4-11). Only one of the five studies was conducted in the United States (Clark et al., 2009); the others were in the United Kingdom, Spain, or Belgium (Ahern et al., 2014; Caton et al., 2013; Roset-Salla et al., 2016; Verbestel et al., 2014).

Two studies investigated how to expose young children to novel vegetables to encourage vegetable intake (Ahern et al., 2014; Caton et al., 2013); the remaining three studies involved testing more comprehensive interventions to improve the diet and health of young children (Clark et al., 2009; Roset-Salla et al., 2016; Verbestel et al., 2014). One of these studies targeted child care center staff providers (Clark et al., 2009), and two studies targeted parents and their children enrolled in the child care centers (Roset-Salla et al., 2016; Verbestel et al., 2014).

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-11 Included Studies and Publications Within the Early Care and Education Setting

Study Name Publications Publication Title
EniM Roset-Salla et al. (2016) Educational intervention to improve adherence to the Mediterranean diet among parents and their children aged 1–2 years: EniM clinical trial
Ahern et al. (2014) The root of the problem: Increasing root vegetable intake in preschool children by repeated exposure and flavour–flavour learning
Verbestel et al. (2014) Prevention of overweight in children younger than 2 years old: A pilot cluster-randomized controlled trial
Caton et al. (2013) Repetition counts: Repeated exposure increases intake of a novel vegetable in UK pre-school children compared to flavour–flavour and flavour–nutrient learning
Clark et al. (2009) Assessing an infant feeding website as a nutrition education tool for child care providers

Study Population

The two studies that targeted child vegetable consumption were conducted in the United Kingdom and their study populations included young children of diverse ages: 108 children ages 9‒38 months (Caton et al., 2013), and 42 children ages 15‒56 months (Ahern et al., 2014). The study by Caton et al. (2013) involved children from six child care centers in multiple locations in West and South Yorkshire in an effort to include children from diverse ethnic and socioeconomic backgrounds, and the study by Ahern et al. (2014) involved children from three child care centers in West and South Yorkshire; no further information was provided on either study sample.

The study in the United States targeted training child care providers and included 38 staff from an unspecified number of child care centers in Colorado (Clark et al., 2009). While the age of the children in the centers was not specified, all child care providers were female; 1 was Asian, 3 were Black, 4 were Hispanic, and 30 were White.

Two studies in Belgium and Spain targeted parents of children attending the child care centers. The study in Belgium involved 203 parents and children (race/ethnicity not described; 17 percent low-income) ages 9‒24 months at baseline from 70 child care centers located in 6 communities in Flanders (half intervention, half control) matched on SES (Verbestel et al., 2014). The study in Spain involved 195 parents of 206 children aged 1 to 2 years at baseline (149 parents and children at 8 months follow-up) from 12 child care centers in Mataró (Roset-Salla et al., 2016). Most study parents

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

(88 percent) were mothers with a mean age of 35 years and a body mass index (BMI) of 24.0 kg/m2; 96 percent had partners, and just over half had a university education; race/ethnicity was not described.

Intervention and Study Goals

The two vegetable-focused studies exposed children repeatedly (6–10 exposures) to novel pureed vegetables over several weeks with or without added sugar or fat (Caton et al., 2013) or a familiar fruit (Ahern et al., 2014). The goal of both studies was to identify effective ways to increase young children’s willingness to eat vegetables.

The U.S. study used a quasi-experimental pre- and post- design with the goal of assessing access to an educational website on child care providers’ infant feeding knowledge, attitudes, and behaviors (Clark et al., 2009). The website focused on human milk feeding and solid food introduction, as well as on responding to infant hunger cues instead of feeding infants on a schedule. Child care providers were asked to view the website for 3 months, as desired.

The Belgian study was a cluster-randomized controlled pilot trial to evaluate a 1-year educational intervention for parents to improve toddlers’ BMI z-score and activity and dietary behaviors (Verbestel et al., 2014). The parent education included guidelines and tips presented on a poster and through a tailored feedback form for parents. The focus of the information was on child intake of water, milk, soft drinks, sweets, savory snacks, fruits, and vegetables, as well as physical activity and screen time.

The study in Spain was a cluster-RCT of an educational intervention for parents whose goal was to improve child and parent adherence to the Mediterranean diet (Roset-Salla et al., 2016). Nurses delivered five educational workshops over a 5-month period. Topics included food groups, the Mediterranean diet, physical activity, food labels, and the progressive introduction of food groups to children.

Theoretical Frameworks

The UK vegetable exposure studies were based on associative learning theory (Ahern et al., 2014; Caton et al., 2013). The website for the U.S. child care providers was based on social learning theory (Clark et al., 2009). The Belgian educational materials were based on theories of information processing, the elaboration likelihood model, and the precaution-adoption process model (Verbestel et al., 2014). The Spanish study used a model of participatory-active education focusing on cognitive, emotional, and skills content (Roset-Salla et al., 2016). All theoretical frameworks are discussed in detail in Chapter 3.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Tools and Outcomes

The United Kingdom vegetable exposure studies compared the weight of the vegetables consumed after each exposure and after a period of follow-up (5 weeks post-intervention in Caton et al., 2013; 1- and 6-month post-intervention in Ahern et al., 2014). In the study in the United States, child care providers completed study-specific surveys (all self-report) on infant feeding knowledge, attitudes, and behaviors before and after accessing the website and 6 months later (Clark et al., 2009). The Belgian study used parent-completed surveys (self-report), which included an FFQ previously evaluated for validity to assess child intake, and questions to assess changes in the amount of daily time that children were physically active and used screens (Verbestel et al., 2014). The study in Spain used parental-completed surveys (self-report): an FFQ previously evaluated for validity to assess parent intake and a modified FFQ to assess child intake; intakes were scored in several ways to assess adherence to the Mediterranean diet (Roset-Salla et al., 2016).

Key Findings and Implications

Repeated exposure to novel vegetables while attending child care can be effective in helping young children learn to like eating vegetables—at least over a relatively short period of time (e.g., several months); however, the long-term impacts on dietary intakes, including outside of child care, were not reported (Ahern et al., 2014; Caton et al., 2013). Providing training to child care providers may influence what young children eat in child care, but the only study identified with this intervention focused on human milk feeding and the timing of introduction to solid foods, factors that are outside of the scope of this report (Clark et al., 2009). Both educational interventions that aimed to reach parents through child care centers achieved positive outcomes; one improved child BMI (a greater decrease in BMI z-score in the intervention compared with the control group), but not diet (Verbestel et al., 2014), and the other improved diet quality, but the impact on parent diet quality was greater than on child diet (Roset-Salla et al., 2016). In both parent interventions, loss to follow-up may have affected the ability to detect differences.

Two studies in the ECE setting stand out for their potential to influence future research to determine the best interventions to influence what and how to feed complementary foods (see Chapter 5). The Roset-Salla et al. (2016) study may provide a model for providing education to parents within an ECE program. The Caton et al. (2013) study may provide a simple technique, repeated exposure of novel vegetables, that can be used in ECE settings.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

University Cooperative Extension

The committee reviewed one study conducted in the United States that described an intervention conducted within the CE system (see Table 4-12). This study is unique in the fact that the children remained in Early Head Start (EHS) care while parents attended lessons aimed at increasing feeding knowledge and self-efficacy.

Study Population

The study (Horodynski and Stommel, 2005) recruited 135 caregivers of children between 11 and 25 months old with low income (at or below 100 percent of the federal poverty level). Most of the caregivers were White (84 percent).

Intervention and Study Goals

The goal of the intervention was to enhance feeding practices by teaching parents to understand and respond to child hunger and satiation cues (Horodynski and Stommel, 2005). The intervention consisted of four nutrition lessons delivered at EHS sites that involved discussions, videos, and hands-on learning activities. Following the lessons, the children joined parents for food preparation and food-tasting lessons. A trained home visitor subsequently provided 18 reinforcement activities over 6 months, with special emphasis on child self-regulation.

Theoretical Frameworks

The study (Horodynski and Stommel, 2005) cited Bandura’s self-efficacy theory, which states that a combined effect of a parent’s knowledge and confidence can influence behavior (see Chapter 3).

Tools and Outcomes

Parental knowledge was assessed by the Facts on Feeding Children tool, which was developed for this study. Parental feeding self-efficacy

TABLE 4-12 Included Studies and Publications Within the University Cooperative Extension Setting

Study Name Publications Publication Title
NEAT (Nutrition Education Aimed at Toddlers) Horodynski and Stommel (2005) Nutrition Education Aimed at Toddlers: An intervention study
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

was assessed by the Feeding Self-Efficacy questionnaire. The Child-Parent Mealtime Behavior Questionnaire, which was adapted from the Children’s Eating Behavior Inventory, was used to measure child feeding self-regulation.

Key Findings and Implications

The intervention increased both parental knowledge and self-efficacy, although there was no impact on parent-report of child self-regulation (Horodynski and Stommel, 2005). Both parental knowledge and self-efficacy are potential mediators of feeding behaviors. Furthermore, participants stated they learned something new and felt that they had changed their behavior in response to the classes and home lessons. However, the intervention had several limitations, such as reinforcement activities being too long and not delivered as intended and challenges with participant attrition (only 43 of 62 caregivers in the intervention group completed the lesson and most of the reinforcement activities).

One unique feature of the study in this sector was that children remained under EHS care while the parents participated in four education and food preparation/tasting lessons, which were found to increase parental knowledge but had no impact on child self-regulation. The intervention is noteworthy given the wide-reaching EHS system and infrastructure.

Special Supplemental Nutrition Program for Women, Infants, and Children

The committee reviewed two studies (four publications) in the (WIC) setting that met the inclusion criteria (see Table 4-13). The two identified studies were conducted in the United States. The studies are important because of their primary focus on modalities that may be instrumental in supporting behavior change related to complementary feeding, namely interactive texting, and the distribution of video content to be viewed in the home.

Study Population5

One study (three publications) was conducted in Puerto Rican and Hawaiian WIC populations (SMS WIC). The study population included mothers, about half of which had at least some college education. The population for the second study included foreign-born Latina women

___________________

5 Citation references for each study can be found in Table 4-4.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-13 Included Studies and Publications Within the WIC Setting

Study Name Publications Publication Title
SMS WIC (Short Messaging Service) Macchi et al. (2022) Effect of a short messaging service (SMS) intervention delivered to caregivers on energy, nutrients, and food groups intake in infant participants of the WIC program
Gibby et al. (2019) Acceptability of a text message-based intervention for obesity prevention in infants from Hawai’i and Puerto Rico WIC
Palacios et al. (2018) Effect of a multisite trial using SMS on infant feeding practices and weight gain in low-income minorities
Scheinmann et al. (2010) Evaluating a bilingual video to improve infant feeding knowledge and behavior among immigrant Latina mothers

participating in WIC in New York City (Scheinmann et al., 2010). In both studies, most of the women were not working and lived with a parent or spouse, and half of the women had not graduated from high school. The sample size across the two studies ranged from 202 to 439 participants.

Intervention and Study Goals

The intervention in one study (SMS WIC) involved interactive text messages sent to caregivers participating in WIC in Puerto Rico or Hawai’i. Study goals included (1) understanding the impact of texting on energy, nutrient, and food group intake (Macchi et al., 2022; Palacios et al., 2018) and infant feeding practices (Palacios et al., 2018); (2) demonstrating the acceptability of interactive text messaging among WIC participants (Gibby et al., 2019). The second study described the impact of an educational English/Spanish infant feeding video, distributed for home viewing at one WIC center in New York City, on encouraging breastfeeding, delaying the introduction of complementary foods until 6 months of age, and increasing maternal knowledge of appropriate infant feeding practices (Scheinmann et al., 2010).

Theoretical Frameworks

One study was based on the transtheoretical model of health and behavior change (SMS WIC). The other study did not describe the theoretical model upon which it was based (Scheinmann et al., 2010). These frameworks are described in Chapter 3.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Tools and Outcomes

The interactive texting study used questionnaires previously evaluated for validity to assess infant dietary intake (Macchi et al., 2022), the age of introduction of solids and juices, feeding methods, caregiver responses, and the feeding environment (Palacios et al. 2018); infant weight and length (Palacios et al., 2018); and quantitative and qualitative measures of the acceptability of the intervention (Gibby et al., 2019). The other study used infant feeding knowledge and behavior surveys adapted from the Bright Futures Nutrition series (Story et al., 2002) and telephone interviews to assess the impact of the video intervention on the age of introduction of various foods (Scheinmann et al., 2010).

Key Findings and Implications

Interactive texting was a highly accepted method of receiving education among women with low-income served by WIC (English and Spanish-speakers). Although most participants receiving the intervention text messages reported that the messages were useful and led them to make changes in the way they fed their infants (Gibby et al., 2019), impacts on measured behavior changes were mixed. At the 4-month follow-up, the intervention group had significantly higher intakes of total grains, protein, calcium, and zinc, compared with the control group, but no differences were seen in other food groups (Macchi et al., 2022), and there were no significant improvements in feeding practices or in weight status or rate of weight gain with the text message intervention (Palacios et al., 2018). This study stood out for its potential to influence what to feed and how to feed via a widely accessible and low-cost modality (SMS WIC).

The video intervention led to an increase in knowledge 6 months post intervention and positive changes in behavior, including later age of introduction of complementary foods (Scheinmann et al., 2010). The WIC studies are important in their primary focus on modalities that may be instrumental in supporting behavior change related to complementary feeding, namely interactive texting, and the distribution of video content to be viewed in the home.

Home Visiting

Of the interventions the committee reviewed that were carried out during home visits, 12 studies met the inclusion criteria, and the results of these studies were reported in 18 publications (see Table 4-14).6 Six of

___________________

6 Citation references for each study can be found in Table 4-4.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-14 Included Studies and Publications Within the Home Visiting Setting

Study Name Publications
INSIGHT (Intervention Nurses Start Infants Growing on Healthy Trajectories) Harris et al. (2020)
Hohman et al. (2020)
Savage et al. (2018)
Hohman et al. (2017)
Savage et al. (2016)
Sleep SAAF Hernandez et al. (2022)
Baby’s First Bites Van Vliet et al. (2022)
Family Spirit Nurture Rosenstock et al. (2021)
Delta Healthy Sprouts Tussing-Humphreys et al. (2019)
LoRe et al. (2019)
Early Childhood Obesity Prevention Program Cloutier et al. (2018)
BLISS Morison et al. (2018)
Williams Erickson et al. (2018)
Taylor et al. (2017)
POI Fangupo et al. (2015)
Remy et al. (2013)
Wen et al. (2011)
Watt et al. (2009)
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×
Publication Title
Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: The INSIGHT RCT
The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting intervention for firstborns affects dietary intake of second-born infants
INSIGHT responsive parenting intervention and infant feeding practices: Randomized clinical trial
INSIGHT responsive parenting intervention is associated with healthier patterns of dietary exposures in infants
Effect of the INSIGHT responsive parenting intervention on rapid infant weight gain and overweight status at age 1 year: A randomized clinical trial
Sleep SAAF responsive parenting intervention improves mothers’ feeding practices: A randomized controlled trial among African American mother–infant dyads
The Baby’s First Bites RCT: Evaluating a vegetable-exposure and a sensitive-feeding intervention in terms of child health outcomes and maternal feeding behavior during toddlerhood
Effect of a home-visiting intervention to reduce early childhood obesity among Native American children: A randomized clinical trial
Enhanced vs. standard parents as teacher curriculum on factors related to infant feeding among African American women
Parent-directed intervention in promoting knowledge of pediatric nutrition and healthy lifestyle among low-SES families with toddlers: A randomized controlled trial
Outcomes of an early childhood obesity prevention program in a low-income community: A pilot, randomized trial
Impact of a modified version of baby-led weaning on dietary variety and food preferences in infants
Impact of a modified version of baby-led weaning on infant food and nutrient intakes: The BLISS randomized controlled trial
Effect of a baby-led approach to complementary feeding on infant growth and overweight: A randomized clinical trial
Impact of an early-life intervention on the nutrition behaviors of 2-year-old children: A randomized controlled trial
Repeated exposure of infants at complementary feeding to a vegetable puŕee increases acceptance as effectively as flavor–flavor learning and more effectively than flavor–nutrient learning
Effectiveness of an early intervention on infant feeding practices and “tummy time”
Effectiveness of a social support intervention on infant feeding practices: Randomized controlled trial
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

the identified studies were conducted in the United States (INSIGHT; Family Spirit Nurture; Delta Healthy Sprouts; LoRe et al., 2019; Early Childhood Obesity Prevention Program; Hernandez et al., 2022). Three of these U.S. studies were conducted in the context of home visiting models meeting U.S. Department of Health and Human Services (HHS) criteria to be designated as evidence-based (see Chapter 3): Parents as Teachers (Delta Healthy Sprouts; Early Childhood Obesity Prevention Program;) and Family Spirit Nuture (Rosenstock et al., 2021). Of the six studies conducted outside of the United States, two were completed in New Zealand (POI; BLISS), and one each in the Netherlands (Baby’s First Bites), France (Remy et al., 2013), United Kingdom (Watt et al., 2009), and Australia (Wen et al., 2011).

Study Population

Five of the studies included caregivers who were predominantly White or of European heritage and who had relatively high income and/or education levels (POI; INSIGHT; Baby’s First Bites; BLISS; Wen et al., 2011). Five U.S. studies included predominantly Black (Sleep SAAF; Delta Healthy Sprouts; LoRe et al., 2019), Hispanic (Early Childhood Obesity Prevention Program), or Navajo (Family Spirit Nurture) individuals; these study populations had a high proportion of economically disadvantaged caregivers. One study specifically recruited from low-income neighborhoods in the United Kingdom (Watt et al., 2009). The sample size ranged from 47 to 802, with many studies having greater than 100 participants.

Intervention and Study Goals

Ten studies tested interventions in which nutrition-focused education, counseling, and/or skill-building and goal-setting activities and resources (e.g., recipes) were delivered to caregivers one-on-one in the home setting and compared with a standard of care (e.g., usual home visiting curriculum or health care in the study area) or a similar education or counseling intervention on a non-nutrition related topic. The studies differed based on who delivered the education or counseling and the frequency and duration of those visits. The interventions were delivered by trained home visitors (Early Childhood Obesity Prevention Program), paraprofessionals (Family Spirit Nurture) or parent volunteers (Delta Healthy Sprouts; Watt et al., 2009) in four studies; by trained research staff in four studies (POI; Sleep SAAF; BLISS; LoRe et al., 2019); and by nurses in two studies (INSIGHT; Wen et al., 2011). Three studies specifically noted that the interventionists and participants had similar cultural backgrounds (Sleep SAAF; Family Spirit Nurture; Delta Healthy Sprouts).

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Among the studies for which the number of intervention home visits was reported that number varied widely from 2 to 12 with a median of five visits (POI; INSIGHT; Sleep SAAF; BLISS; LoRe et al., 2019; Watt et al., 2009; Wen et al., 2011). The duration of the visits was infrequently reported but ranged from 45 to 120 minutes when specified (Early Childhood Obesity Prevention Program; Sleep SAAF; Family Spirit Nurture; Delta Healthy Sprouts). Two studies compared repeated exposures to vegetables to other infant feeding approaches (flavor–flavor learning, flavor–nutrient learning, or responsive parenting) (Baby’s First Bites; Remy et al., 2013); for these studies, the intervention was implemented in the home by parents who had been trained by research staff, and the data collection was done via home visits.

The studies’ goals involved a variety of outcomes related to what to feed and how to feed infants. Five studies were intended to increase responsive feeding practices, such as not pressuring the child to eat and not using food to soothe or reward the child (Fangupo et al., 2015; Hernandez et al., 2022; Rosenstock et al., 2021; Savage et al., 2018; Wen et al., 2011). Five studies aimed to encourage the use of recommended bottle or cup feeding practices (Fangupo et al., 2015; Hernandez et al., 2022; Savage et al., 2018; Tussing-Humphreys et al., 2019; Wen et al., 2011). Four studies were designed to affect the quantity or variety of fruits or vegetables, or both, consumed by the child (Fangupo et al., 2015; Morison et al., 2018; Remy et al., 2013; Van Vliet et al., 2022).

Four studies were intended to decrease child access to SSBs or snacks with added sugar or sodium (Cloutier et al., 2018; Fangupo et al., 2015; LoRe et al., 2019; Rosenstock et al., 2021; Tussing-Humphreys et al., 2019). Two studies focused broadly on improving child diet quality (Hohman et al., 2017, 2020; Williams Erickson et al., 2018) or on improving caregiver infant and young child feeding knowledge, attitudes, and behaviors (LoRe et al., 2019; Tussing-Humphreys et al., 2019). Five studies had goals related to early childhood obesity prevention (Cloutier et al., 2018; Rosenstock et al., 2021; Savage et al., 2016; Taylor et al., 2017; Tussing-Humphreys et al., 2019).

Theoretical Frameworks

Seven studies reported their interventions to have been based on a theoretical framework (see Chapter 3 for description of frameworks). These frameworks included the Stages of Change model (Baby’s First Bites), social cognitive theory (Family Spirit Nurture; Delta Healthy Sprouts), the transtheoretical model of behavior change (LoRe et al., 2019; Delta Healthy Sprouts), the responsive parenting framework (INSIGHT), social support theory (Watt et al., 2009), the Chronic Care Model (Early

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Childhood Obesity Prevention Program), and G.R. Patterson’s family systems ecological development theory (Family Spirit Nurture). The remaining studies did not directly refer to a theoretical model (POI; BLISS; Sleep SAAF; Remy et al., 2013).

Tools and Outcomes

The studies used a variety of tools to measure outcomes related to what and how to feed infants and young children (see Appendix E). Parent knowledge and behaviors related to infant and young child feeding or perceptions of infant behaviors were assessed using questionnaires or questions developed for the study (Cloutier et al., 2018; Fangupo et al., 2015; LoRe et al., 2019; Morison et al., 2018; Savage et al., 2018; Taylor et al., 2017; Watt et al., 2009; Williams Erickson et al., 2018), or based on published questionnaires (Cloutier et al., 2018; Fangupo et al., 2015; Harris et al., 2020; Hernandez et al., 2022; Remy et al., 2013; Savage et al., 2018; Taylor et al., 2017; Van Vliet et al., 2022) or questions (Wen et al., 2011). Multiple-pass 24-hour dietary recalls (Tussing-Humphreys et al., 2019; Van Vliet et al., 2022; Watt et al., 2009), FFQ (Fangupo et al., 2015; Hohman et al., 2017, 2020; Savage et al., 2018), 3-day weighed diet records (Morison et al., 2018; Williams Erickson et al., 2018), or pre-post weighing of foods consumed (Remy et al., 2013; Van Vliet et al., 2022) were completed with caregivers to evaluate infant and young children dietary intake. One study conducted an eating-in-the-absence-of-hunger experiment with toddlers (Van Vliet et al., 2022) and videotaped observations of maternal feeding behaviors (Van Vliet et al., 2022).

Key Findings and Implications

Among the outcomes examined, caregivers’ self-reported use of responsive feeding practices (Fangupo et al., 2015; Harris et al., 2020; Hernandez et al., 2022; Rosenstock et al., 2021; Savage et al., 2018; Van Vliet et al., 2022; Wen et al., 2011) was the outcome most consistently affected by home visiting interventions, especially those designed to reduce pressure on a child to eat. Home visiting interventions also significantly increased caregivers’ self-reported use of recommended bottle or cup feeding practices (Savage et al., 2018; Watt et al., 2009; Wen et al., 2011), improved reported (Watt et al., 2009) or measured (Remy et al., 2013) child intake of specific fruits or vegetables, increased caregiver knowledge of recommended infant and young child feeding practices (LoRe et al., 2019), improved dietary patterns (relatively more fruits and vegetables and less juice and SSB) for formula-fed infants (Hohman et al., 2017), and decreased child-reported intake of SSB (Rosenstock et al., 2021).

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Two studies documented that some of the improved outcomes persisted post-intervention (Morison et al., 2018; Rosenstock et al., 2021), and one study demonstrated a positive effect on the variety and frequency of vegetable consumption for the next child in the family, independent of any additional intervention (Hohman et al., 2020).

Most studies had null findings for some of the infant and young child feeding-related outcomes that they examined and some inconsistencies in effects across timepoints. Six studies reported no impact on most of the outcomes examined related to what or how to feed children (Fangupo et al., 2015; Hernandez et al., 2022; Morison et al., 2018; Taylor et al., 2017; Tussing-Humphreys et al., 2019; van Vliet et al., 2022; Watt et al., 2009; Williams Erickson et al., 2018). One additional study found no impact on any nutrition-related outcomes with the intention-to-treat analysis (Cloutier et al., 2018) but found that completers of the intervention were more likely to delay introduction of juice than non-completers.

Two studies within this sector stood out for their potential to influence what to feed and how to feed (see Chapter 5): the Family Spirit Nurture and INSIGHT trials.

Other Settings

The committee also reviewed interventions occurring in settings other than health care, ECE, CE, WIC, or home visiting. The settings of the interventions included research laboratories and/or virtual modalities. The committee reviewed 23 studies (28 publications) in other settings (see Table 4-15); five of the studies resulted in two publications each (Barends et al., 2013, 2014; Beinert et al., 2017; Helle et al., 2019a,b; Øverby et al., 2017; Røed et al., 2020, 2021; Verrall and Gray-Donald, 2005; Verrall et al., 2006). The geographic locations of these studies are presented in Table 4-16. The studies within the “Other” group could be classified into three study categories (see Table 4-17).

Study Population

Repeated Exposure Studies

Many of the studies that targeted repeated exposure to new foods did not report extensively on the sociodemographic characteristics of the sample, but when they did the study population was primarily highly-educated parents (e.g., with a college degree) (Beinert et al., 2017; Coulthard et al., 2014; Hetherington et al., 2015; Johansson et al., 2019; Johnson et al., 2021; Kalhoff et al., 2021; Mennella et al., 2017; Øverby et al., 2017; Owen et al., 2018; Rapson et al., 2022; Tournier et al., 2021). All but three studies

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 4-15 Included Studies and Publications Within Other Settings

Study Name Publications Publication Title
Harris et al. (2022) Effects of sugary drink countermarketing videos on caregivers’ attitudes and intentions to serve fruit drinks and toddler milks to young children
Rapson et al. (2022) Starting complementary feeding with vegetables only increases vegetable acceptance at 9 months: A randomized controlled trial
Cauble et al. (2021) A prenatal group based phone counseling intervention to improve breastfeeding rates and complementary feeding: A randomized, controlled pilot and feasibility trial
Johnson et al. (2021) Infant and toddler responses to bitter-tasting novel vegetables: Findings from the Good Tastes Study
Kalhoff et al. (2021) Feeding frozen complementary foods promotes food acceptance in infants: The randomized intervention trial Baby Gourmet
Ra (2021) Evaluation of a mobile-based maternal feeding education program for overweight prevention in infants
Food4-toddlers Røed et al. (2021) Effect of a parent-focused eHealth intervention on children’s fruit, vegetable, and discretionary food intake (Food4toddlers): Randomized controlled trial
Røed et al. (2020) Process evaluation of an eHealth intervention (Food4toddlers) to improve toddlers’ diet: Randomized controlled trial
Tournier et al. (2021) Fostering infant food texture acceptance: A pilot intervention promoting food texture introduction between 8 and 15 months
Wen et al. (2020) Effects of telephone and short message service support on infant feeding practices, “tummy time,” and screen time at 6 and 12 months of child age: A 3-group randomized clinical trial
Early Food for Future Health Helle et al. (2019b) Evaluation of an eHealth intervention aiming to promote healthy food habits from infancy: the Norwegian randomized controlled trial Early Food for Future Health
Helle et al. (2019a) Examining the effects of an eHealth intervention from infant age 6 to 12 months on child eating behaviors and maternal feeding practices 1 year after cessation: The Norwegian randomized controlled trial Early Food for Future Health
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 Name Publications Publication Title
OTIS Johansson et al. (2019) Protein-reduced complementary foods based on Nordic ingredients combined with systematic introduction of taste portions increase intake of fruits and vegetables in 9-month-old infants: A randomized controlled trial
Owen et al. (2018) Peas, please! Food familiarization through picture books helps parents introduce vegetables into preschoolers’ diets
Beinert et al. (2017) No long-term effect of a 2-day intervention on how to prepare homemade food, on toddlers’ skepticism for new food and intake of fruits and vegetables and sweet beverages: A randomized, controlled trial
Øverby et al. (2017) Effect of dietary interventions during weaning period on parental practice and lipoproteins and vitamin D status in 2-year-old children
Mennella et al. (2017) Learning to like vegetables during breastfeeding: A randomized clinical trial of lactating mothers and infants
Hetherington et al. (2015) A step-by-step introduction to vegetables at the beginning of complementary feeding. The effects of early and repeated exposure
Coulthard et al. (2014) Exposure to vegetable variety in infants weaned at different ages
Barends et al. (2014) Effects of starting weaning exclusively with vegetables on vegetable intake at the age of 12 and 23 months
Barends et al. (2013) Effects of repeated exposure to either vegetables or fruits on infants’ vegetable and fruit acceptance at the beginning of weaning
Maier et al. (2008) Breastfeeding and experience with variety early in weaning increase infants’ acceptance of new foods for up to 2 months
Mennella et al. (2008) Variety is the spice of life: Strategies for promoting fruit and vegetable acceptance during infancy
Forestell and Mennella (2007) Early determinants of fruit and vegetable acceptance
Koehler et al. (2007) Measuring the effects of nutritional counseling on total infant diet in a randomized controlled intervention trial
Krebs et al. (2006) Meat as a first complementary food for breastfed infants: Feasibility and impact on zinc intake and status
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 Name Publications Publication Title
Verrall et al. (2006) Community-based communication strategies to promote infant iron nutrition in northern Canada
Verrall and Gray-Donald (2005) Impact of a food-based approach to improve iron nutrition of at-risk infants in northern Canada

TABLE 4-16 Geographic Location of Other Setting Identified Studies

Country Number of Studies Number of Publications
United States 7 7
United Kingdom 3 3
Canada 1 2
Netherlands 1 2
Germany 2 2
Sweden 1 1
Norway 4 6
France; Germany and France; Australia; South Korea; New Zealand 1 (each) 1 (each)

NOTE: Appendix E has further information on studies in other settings.

TABLE 4-17 Number of Publications Within Each Study Category

Category Number of Studies Number of Publications (references)
Repeated exposure of infants to new foods 15 17a
Counter-marketing messages on unhealthy beverages targeting parents of young children 1 1b
Comprehensive nutritional interventions delivered to parents virtually 7 10c

SOURCE:

a Barends et al., 2013, 2014; Beinert et al., 2017; Coulthard et al., 2014; Forestell and Mennella, 2007; Hetherington et al., 2015; Johansson et al., 2019; Johnson et al., 2021; Kalhoff et al., 2021; Krebs et al., 2006; Maier et al., 2008; Mennella et al., 2008, 2017; Øverby et al., 2017; Owen et al., 2018; Rapson et al., 2022; Tournier et al., 2021.

b Harris et al., 2022

c Cauble et al., 2021; Helle et al., 2019a,b; Koehler et al, 2007; Ra, 2021; Røed et al., 2020, 2021; Verrall and Gray-Donald, 2005; Verrall et al., 2006; Wen et al., 2020.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

involved infants 4‒8 months old being introduced to complementary foods; the remaining three studies focused on children into their second year of life (Barends et al., 2013, 2014; Johnson et al., 2021; Owen et al., 2018). All but one study focused on exposing the children to new foods; one study focused on exposing breastfeeding mothers to vegetable juices to test the impact on infants of flavor exposure in human milk (Mennella et al., 2017). Two studies compared the impacts of exposure to novel foods between breastfed and formula-fed infants (Forestell and Mennella, 2007; Maier et al., 2008). At baseline, sample sizes across studies ranged from 45 to 250.

Marketing Message Study

The single marketing message study was conducted with 600 U.S. caregivers of children aged 9–36 months. Approximately one-third were people with low incomes, one-third were Black, and one-quarter were Hispanic (Harris et al., 2022).

Comprehensive Intervention Studies

All seven of the more comprehensive interventions were conducted with primarily mothers and all but one focused on infants in the first year of life; one study (Røed et al., 2020, 2021) was conducted in children averaging 10 months old at baseline and 24 months old at the final follow-up. A Canadian study was conducted with an indigenous population with an average of 9 years of education (Verrall and Gray-Donald, 2005; Verrall et al., 2006). The remaining studies included mostly highly educated women with at least a college degree. In the study by Cauble et al. (2021), 95 percent of the sample was White. Race/ethnicity was not reported in the remaining five studies. At baseline, sample sizes across studies ranged from 29 to 1,498.

Intervention and Study Goals

Repeated Exposure Studies

The goals of most of the studies that targeted repeated exposure to new foods when introducing solids were to enable children to develop taste preferences for and eat more vegetables (Barends et al., 2013, 2014; Beinert et al., 2017; Coulthard et al., 2014; Forestell and Mennella, 2007; Hetherington et al., 2015; Johansson et al., 2019; Johnson et al., 2021; Kalhoff et al., 2021; Maier et al., 2008; Mennella et al., 2008, 2017; Øverby et al., 2017; Owen et al., 2018; Rapson et al., 2022). Several compared exposures to vegetables and fruit (Forestell and Mennella, 2007; Johansson et

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

al., 2019; Mennella et al., 2008; Owen et al., 2018). Some studies focused on a single vegetable, while others exposed children to a variety of vegetables. One study focused on introducing more textured foods (Tournier et al., 2021). Another emphasized introducing more homemade rather than commercially prepared foods (e.g., jarred baby foods), with a focus on a variety of vegetables and fruit, iron-rich foods, and drinking water instead of sugary drinks (Beinert et al., 2017; Øverby et al., 2017). Another compared introducing meat (pureed beef) or iron-fortified infant cereal in exclusively human milk fed infants who can be at risk of iron-deficiency anemia (Krebs et al., 2006).

Almost all studies used a RCT design (Barends et al., 2013, 2014; Beinert et al., 2017; Coulthard et al., 2014; Forestell and Mennella, 2007; Hetherington et al., 2015; Johansson et al., 2019; Kalhoff et al., 2021; Krebs et al., 2006; Mennella et al., 2008, 2017; Øverby et al., 2017; Owen et al., 2018; Rapson et al., 2022; Tournier et al., 2021). Maier et al. (2008) compared multiple experimental groups, and Johnson et al. (2021) used a crossover design, exposing all study children to a bitter vegetable with and without added salt or sugar.

The duration of exposure to the novel foods ranged across studies and included 1 day (Johnson et al., 2021), 1‒2 weeks (Coulthard et al., 2014; Forestell and Mennella, 2007; Owen et al., 2018), approximately 1 month (Barends et al., 2013, 2014; Hetherington et al., 2015; Johansson et al., 2019; Maier et al., 2008; Rapson et al., 2022), and 2‒7 months (Kalhoff et al., 2021; Krebs et al., 2006; Mennella et al., 2017; Tournier et al., 2021). Many studies also included follow-up measures after the exposure period ended, ranging from approximately 3 months (Johansson et al., 2019; Kalhoff et al., 2021; Mennella et al., 2017; Owen et al., 2018; Rapson et al., 2022) to 12‒24 months (Barends et al., 2014; Beinert et al., 2017; Hetherington et al., 2015; Øverby et al., 2017). Studies provided the novel foods or recipes for the foods (Johansson et al., 2019) or information to parents to expose their children to the selected foods. Some studies included parent support via Facebook (Johansson et al., 2019), written information (Barends et al., 2013, 2014), counseling (Hetherington et al., 2015), or videos (Rapson et al., 2022). Beinert et al. (2017) and Øverby et al. (2017) provided parents with a 2-day course on homemade food preparation. Tournier et al. (2021) provided individual counseling on what to feed but did not provide the foods. Owen et al. (2018) asked parents to read a book to their child about fruits or vegetables.

Marketing Message Study

The goal of the RCT by Harris et al. (2022) was to test the immediate effects of watching two brief (<60 seconds) counter-marketing videos on

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

fruit drinks and toddler milks on parent attitudes toward and intentions to serve SSBs such as fruit drinks and toddler milks.

Comprehensive Intervention Studies

The goal of the more comprehensive intervention studies included testing the impacts of a variety of delivery strategies on multiple outcomes. All used some form of “virtual” interaction (e.g., radio, phone calls, texts, emails, website); Verrall and Gray-Donald (2005) and Verrall et al. (2006) also conducted in-person cooking classes. All but one of the more comprehensive interventions used an RCT design; however, the study by Cauble et al. (2021) was described as a randomized controlled pilot and feasibility study. The studies by Verrall and Gray-Donald (2005) and Verrall et al. (2006), were prospective studies implemented in one community without a control or comparison community.

Verrall and Gray-Donald (2005) and Verrall et al. (2006) disseminated information booklets, conducted cooking classes, and ran community-based radio segments on intake of iron-rich foods over a 6-month period. Koehler et al. (2007) tested the impact of researcher-delivered dietary counseling to mothers of infants from 2 to 10 months of age via a phone hotline available 3 times per week, with and without additional written information and individualized phone counseling. Helle et al. (2019a,b) use a website to test monthly online video clips on age-appropriate feeding topics coupled with cooking films and recipes delivered over a 6-month period beginning when children were 3–5 months old. Video topics included appropriate food types and textures, development of taste preferences, varied and adequate intake of fruit and vegetables, as well as responsive feeding practices. Røed et al. (2020, 2021) evaluated the impact of a website and emails on parental feeding practices and the child food environment and dietary intake over a 6-month period beginning when infants were 7‒12 months old. The website included a total of 22 lessons to encourage healthy foods, such as fruits and vegetables, and discourage discretionary foods and beverages; recipes; and a discussion forum. Wen et al. (2020) tested the impact of informational booklets mailed to mothers coupled with either nurse-led telephone or text messages on infant feeding practices, tummy time, and screen time while infants were 1–10 months old. Cauble et al. (2021) tested six weekly 1-hour group-based phone counseling sessions delivered by a registered dietitian and a certified lactation consultant. The sessions began in late pregnancy and included information on human milk feeding, as well as types and amounts of solid foods to feed. Ra (2021) developed a website that included information on human milk feeding as well as responding to hunger and satiation cues and not providing SSB and high-calorie snacks and encouraged mothers to access the content at least every 2 days from 38 weeks gestation until the child was 6 months of age.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Theoretical Frameworks

Only one of the repeated exposure studies mentioned a theoretical framework: learning theory (Hetherington et al., 2015). The marketing message study (Harris et al., 2022) and three of the seven more comprehensive interventions (Cauble et al., 2021; Koehler et al., 2007; Ra, 2021) did not specify a theoretical underpinning. The other interventions were based on one or more theories, including social cognitive theory (Helle et al., 2019a,b; Røed et al., 2021), attachment theory (Helle et al., 2019a,b), anticipatory guidance framework (Helle et al., 2019a,b), health belief model (Wen et al., 2020), model of planned promotion for population health (Røed et al., 2021), and cognitive behavioral theories (Verrall et al., 2006).

Tools and Outcomes

Repeated Exposure Studies

Most repeated exposure studies compared the weight of the novel foods consumed (Barends et al., 2013, 2014; Forestell and Mennella, 2007; Hetherington et al., 2015; Kalhoff et al., 2021; Maier et al., 2008; Mennella et al., 2008; Rapson et al., 2022). Some of the studies used measures of child liking (e.g., facial expressions of enjoyment or distaste during feeding) (Barends et al., 2013, 2014; Coulthard et al., 2014; Forestell and Mennella, 2007; Johnson et al., 2021; Maier et al., 2008; Mennella et al., 2017; Tournier et al., 2021), rate of eating (Mennella et al., 2017), and parent self-report of intake at home using food records or FFQ (Barends et al., 2013, 2014; Beinert et al., 2017; Coulthard et al., 2014; Hetherington et al., 2015; Johansson et al., 2019; Krebs et al., 2006; Øverby et al., 2017; Owen et al., 2018; Rapson et al., 2022; Tournier et al., 2021).

Marketing Message Study

The study by Harris et al. (2022) used surveys to assess parent attitudes toward and intentions to serve fruit drinks and toddler milks after watching the counter-marketing video compared to control videos.

Comprehensive Intervention Studies

Dietary intake was measured by FFQ in two studies (Helle et al., 2019a,b; Røed et al., 2020, 2021). In the study by Koehler et al. (2007), the foods consumed by infants were assessed by maternal report. Parent knowledge and behaviors related to infant and young child feeding or

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

perceptions of infant behaviors were assessed using questionnaires (Helle et al., 2019a,b; Ra, 2021; Wen et al., 2020). In the studies by by Verrall and Gray-Donald (2005) and Verrall et al. (2006), maternal knowledge of iron-rich foods (based on questionnaire), child intake of iron-rich complementary foods (based on 24-hour recall), and community sales of infant-fortified cereals and other complementary foods rich in iron were measured. Many of the studies also assessed uptake or satisfaction of the intervention (Cauble et al., 2021; Helle et al., 2019a,b; Røed et al., 2020; Wen et al., 2020).

Key Findings and Implications

Repeated exposure to vegetables when introducing solids may be effective in helping young children eat vegetables, at least over a relatively short term (e.g., several months); however, impacts on dietary intakes appear to diminish over time (Hetherington et al., 2015). Findings from one study suggest that reinforcing the feeding exposure with an educational component (e.g., reading children books about vegetables) may also improve intakes among young children (Owen et al., 2018). More long-term studies, including exposure of children to under-consumed foods after the introduction of complementary feeding are needed.

A single viewing of a video on unhealthy beverages can change parent attitudes over the short term, but the degree of counter-marketing required for attitudes to persist and translate into changes in parental behavior and child dietary intake is unknown.

Findings from the more comprehensive interventions suggest that technology-based interventions, including use of phone calls, texting, and websites, show promise in being potentially scalable and having positive impacts on what and how to feed young children, at least in the first year of life, and with relatively well-educated mothers. Few studies, however, assessed longer-term impacts, and the few that did so found diminished effects, suggesting the need for a life-course approach with ongoing interventions across various stages of childhood. Future comprehensive intervention trials among diverse groups of parents (both mothers and fathers) are needed.

One study within this sector stood out for its potential to influence both what to feed and how to feed (see Chapter 5). The Early Food for Future Health Study (Helle et al., 2019a,b) may provide one model for a web-based intervention that shows promise of impacting what to feed and how to feed behaviors.

SUMMARY

This chapter described key features of the 58 studies from 83 publications identified by the committee during the scoping review. While more

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

than half of the studies took place in health care or other settings, the committee also examined studies that took place in ECE, CE, home visit, and WIC settings. Just over one-third of the publications reviewed by the committee took place in the United States, with another one-third taking place in Europe. Intervention modality varied by study, with most studies taking place live or using noninteractive remote technology. Studies targeted a range of what to feed and how to feed outcomes focused on both the caregiver and the child. Caregiver what to feed outcomes included increasing the provision of nutrient-dense foods and beverages, increasing the variety of foods, and reducing the provision of foods with added sugars, salt, and saturated and trans fats, while child outcomes related to consuming a high-quality diet with appropriate amounts and variety of nutrient-dense foods and beverages. Studies addressing how to feed outcomes largely addressed caregivers using responsive feeding practices and repeated exposures to unfamiliar foods. Fewer studies addressed child outcomes; the most popular topics were acceptance of a variety of nutrient-dense foods and beverages and timely transition to self-feeding. More than one-third of publications also addressed obesity prevention.

In addition to reviewing the included studies by setting, the committee identified select studies and study elements that are broadly informative for developing scalable new initiatives to address infant and young child complementary feeding. The next chapter describes these studies and study elements in detail.

REFERENCES

Ahern, S. M., S. J. Caton, P. Blundell, and M. M. Hetherington. 2014. The root of the problem: Increasing root vegetable intake in preschool children by repeated exposure and flavour flavour learning. Appetite 80:154–160.

Barends, C., J. de Vries, J. Mojet, and C. de Graaf. 2013. Effects of repeated exposure to either vegetables or fruits on infant’s vegetable and fruit acceptance at the beginning of weaning. Food Quality and Preference 29(2):157–165.

Barends, C., J. H. M. de Vries, J. Mojet, and C. de Graaf. 2014. Effects of starting weaning exclusively with vegetables on vegetable intake at the age of 12 and 23 months. Appetite 81:193–199.

Beinert, C., S. Hernes, M. Haugen, and N. C. Øverby. 2017. No long-term effect of a 2-days intervention on how to prepare homemade food, on toddlers’ skepticism for new food and intake of fruits and vegetables and sweet beverages: A randomized, controlled trial. BMC Research Notes 10(1):607.

Cameron, A. J., K. Ball, K. D. Hesketh, S. A. McNaughton, J. Salmon, D. A. Crawford, S. Lioret, and K. J. Campbell. 2014. Variation in outcomes of the Melbourne Infant Feeding, Activity, and Nutrition trial (InFANT) program according to maternal education and age. Preventive Medicine 58:58–63.

Campbell, K., K. Hesketh, D. Crawford, J. Salmon, K. Ball, and Z. McCallum. 2008. The Infant Feeding Activity and Nutrition Trial (INFANT) an early intervention to prevent childhood obesity: Cluster-randomised controlled trial. BMC Public Health 8:103.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Campbell, K. J., S. Lioret, S. A. McNaughton, D. A. Crawford, J. Salmon, K. Ball, Z. McCallum, B. E. Gerner, A. C. Spence, A. J. Cameron, J. A. Hnatiuk, O. C. Ukoumunne, L. Gold, G. Abbott, and K. D. Hesketh. 2013. A parent-focused intervention to reduce infant obesity risk behaviors: A randomized trial. Pediatrics 131(4):652–660.

Caton, S. J., S. M. Ahern, E. Remy, S. Nicklaus, P. Blundell, and M. M. Hetherington. 2013. Repetition counts: Repeated exposure increases intake of a novel vegetable in UK preschool children compared to flavour–flavour and flavour–nutrient learning. British Journal of Nutrition 109(1):2089–2097.

Cauble, J. S., A. Herman, J. Wick, J. Goetz, C. M. Daley, D. K. Sullivan, and H. R. Hull. 2021. A prenatal group based phone counseling intervention to improve breastfeeding rates and complementary feeding: A randomized, controlled pilot and feasibility trial. BMC Pregnancy and Childbirth 21(1):521.

Clark, A., J. Anderson, E. Adams, S. Baker, and K. Barrett. 2009. Assessing an infant feeding web site as a nutrition education tool for child care providers. Journal of Nutrition Education and Behavior 41(1):41–46.

Cloutier, M. M., J. F. Wiley, C. L. Kuo, T. Cornelius, Z. Wang, and A. A. Gorin. 2018. Outcomes of an early childhood obesity prevention program in a low-income community: A pilot, randomized trial. Pediatric Obesity 13(1):677–685.

Coulthard, H., G. Harris, and A. Fogel. 2014. Exposure to vegetable variety in infants weaned at different ages. Appetite 78:89–94.

Daniels, L. A., A. Magarey, D. Battistutta, J. M. Nicholson, A. Farrell, G. Davidson, and G. Cleghorn. 2009. The NOURISH randomised control trial: Positive feeding practices and food preferences in early childhood—A primary prevention program for childhood obesity. BMC Public Health 9:387.

Daniels, L. A., K. M. Mallan, D. Battistutta, J. M. Nicholson, R. Perry, and A. Magarey. 2012. Evaluation of an intervention to promote protective infant feeding practices to prevent childhood obesity: Outcomes of the NOURISH RCT at 14 months of age and 6 months post the first of two intervention modules. International Journal of Obesity 36(1):1292–1298.

Daniels, L. A., K. M. Mallan, J. M. Nicholson, D. Battistutta, and A. Magarey. 2013. Outcomes of an early feeding practices intervention to prevent childhood obesity. Pediatrics 132(1):e109–e118.

Daniels, L. A., K. M. Mallan, D. Battistutta, J. M. Nicholson, J. E. Meedeniya, J. K. Bayer, and A. Magarey. 2014. Child eating behavior outcomes of an early feeding intervention to reduce risk indicators for child obesity: The NOURISH RCT. Obesity (Silver Spring, Md.) 22(5):E104–E111.

Daniels, L. A., K. M. Mallan, J. M. Nicholson, K. Thorpe, S. Nambiar, C. E. Mauch, and A. Magarey. 2015. An early feeding practices intervention for obesity prevention. Pediatrics 136(1):e40–e49.

de Franchis, R., L. Bozza, P. Canale, M. Chiacchio, P. Cortese, A. D’avino, M. De Giovanni, M. Dello Iacovo, A. D’onofrio, A. Federico, N. Gasparini, F. Iaccarino, G. Romano, R. Spadaro, M. Tedesco, G. Vitiello, A. Antignani, S. Auricchio, V. Valentino, F. De Filippis, D. Ercolini, and D. Bruzzese. 2022. The effect of weaning with adult food typical of the Mediterranean diet on taste development and eating habits of children: A randomized trial. Nutrients 14(12):2486.

Dodd, J. M., D. Turnbull, A. J. McPhee, A. R. Deussen, R. M. Grivell, L. N. Yelland, C. A. Crowther, G. Wittert, J. A. Owens, and J. S. Robinson. 2014. Antenatal lifestyle advice for women who are overweight or obese: Limit randomised trial. BMJ 348:g1285.

Dodd, J. M., J. Louise, A. R. Deussen, A. J. McPhee, J. A. Owens, and J. S. Robinson. 2018. Prenatal diet and child growth at 18 months. Pediatrics 142(3):e20180035.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Fangupo, L. J., A.-L. M. Heath, S. M. Williams, M. R. Somerville, J. A. Lawrence, A. R. Gray, B. J. Taylor, V. C. Mills, E. O. Watson, B. C. Galland, R. M. Sayers, M. B. Hanna, and R. W. Taylor. 2015. Impact of an early-life intervention on the nutrition behaviors of 2-y-old children: A randomized controlled trial. The American Journal of Clinical Nutrition 102(3):704–712.

Fiks, A. G., R. S. Gruver, C. T. Bishop-Gilyard, J. Shults, S. Virudachalam, A. W. Suh, M. Gerdes, G. K. Kalra, P. A. DeRusso, A. Lieberman, D. Weng, M. A. Elovitz, R. I. Berkowitz, and T. J. Power. 2017. A social media peer group for mothers to prevent obesity from infancy: The Grow2Gether randomized trial. Childhood Obesity 13(5):356–368.

Fildes, A., C. Lopes, P. Moreira, G. Moschonis, A. Oliveira, C. Mavrogianni, Y. Manios, R. Beeken, J. Wardle, and L. Cooke. 2015. An exploratory trial of parental advice for increasing vegetable acceptance in infancy. British Journal of Nutrition 114(2):328–336.

Forestell, C. A., and J. A. Mennella. 2007. Early determinants of fruit and vegetable acceptance. Pediatrics 120(6):1247–1254.

French, G. M., L. Nicholson, T. Skybo, E. G. Klein, P. M. Schwirian, L. Murray-Johnson, A. Sternstein, I. Eneli, B. Boettner, and J. A. Groner. 2012. An evaluation of mother-centered anticipatory guidance to reduce obesogenic infant feeding behaviors. Pediatrics 130(3):e507–e517.

Gibby, C. L. K., C. Palacios, M. Campos, R. E. Graulau, and J. Banna. 2019. Acceptability of a text message-based intervention for obesity prevention in infants from Hawai’i and Puerto Rico WIC. BMC Pregnancy and Childbirth 19(1):291.

Globus, I., Y. Latzer, O. Pshetatzki, C. Shani Levi, R. Shaoul, I. Elad, and G. S. Rozen. 2019. Effects of early parent training on mother–infant feeding interactions. Journal of Developmental and Behavioral Pediatrics 40(2):131–138.

Harris, H. A., S. Anzman-Frasca, M. E. Marini, I. M. Paul, L. L. Birch, and J. S. Savage. 2020. Effect of a responsive parenting intervention on child emotional overeating is mediated by reduced maternal use of food to soothe: The INSIGHT RCT. Pediatric Obesity 15(1):e12645.

Harris, J. L., L. Phaneuf, and F. Fleming-Milici. 2022. Effects of sugary drink countermarketing videos on caregivers’ attitudes and intentions to serve fruit drinks and toddler milks to young children. American Journal of Public Health 112(S):S807–S816.

Helle, C., E. R. Hillesund, A. K. Wills, and N. C. Øverby. 2019a. Evaluation of an eHealth intervention aiming to promote healthy food habits from infancy—The Norwegian randomized controlled trial Early Food for Future Health. International Journal of Behavioral Nutrition and Physical Activity 16(1):1.

Helle, C., E. R. Hillesund, A. K. Wills, and N. C. Øverby. 2019b. Examining the effects of an eHealth intervention from infant age 6 to 12 months on child eating behaviors and maternal feeding practices one year after cessation: The Norwegian randomized controlled trial Early Food for Future Health. PLOS ONE 14(8):e0220437.

Hernandez, E., J. A. Lavner, A. M. Moore, B. K. Stansfield, S. R. H. Beach, J. J. Smith, and J. S. Savage. 2022. Sleep SAAF responsive parenting intervention improves mothers’ feeding practices: A randomized controlled trial among African American mother–infant dyads. International Journal of Behavioral Nutrition and Physical Activity 19(1):129.

Hesketh, K. D., J. Salmon, S. A. McNaughton, D. Crawford, G. Abbott, A. J. Cameron, S. Lioret, L. Gold, K. L. Downing, and K. J. Campbell. 2020. Long-term outcomes (2 and 3.5 years post-intervention) of the INFANT early childhood intervention to improve health behaviors and reduce obesity: Cluster randomised controlled trial follow-up. International Journal of Behavioral Nutrition and Physical Activity 17(1):95.

Hetherington, M. M., C. Schwartz, J. Madrelle, F. Croden, C. Nekitsing, C. M. J. L. Vereijken, and H. Weenen. 2015. A step-by-step introduction to vegetables at the beginning of complementary feeding. The effects of early and repeated exposure. Appetite 84:280–290.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Hoffmann, J., J. Günther, L. Stecher, M. Spies, K. Geyer, R. Raab, D. Meyer, K. Rauh, and H. Hauner. 2021. Infant growth during the first year of life following a pregnancy lifestyle intervention in routine care—Findings from the cluster-randomised GeliS trial. Pediatric Obesity 16(2):e12705.

Hohman, E. E., I. M. Paul, L. L. Birch, and J. S. Savage. 2017. INSIGHT responsive parenting intervention is associated with healthier patterns of dietary exposures in infants. Obesity 25(1):185–191.

Hohman, E. E., J. S. Savage, L. L. Birch, and I. M. Paul. 2020. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting intervention for firstborns affects dietary intake of secondborn infants. Journal of Nutrition 150(8):2139–2146.

Horodynski, M. A., and M. Stommel. 2005. Nutrition education aimed at toddlers: An intervention study. Pediatric Nursing 31(5):364–372.

Johansson, U., I. Öhlund, O. Hernell, B. Lönnerdal, L. Lindberg, and T. Lind. 2019. Protein-reduced complementary foods based on Nordic ingredients combined with systematic introduction of taste portions increase intake of fruits and vegetables in 9 month old infants: A randomised controlled trial. Nutrients 11(6):1255.

Johnson, S. L., K. J. Moding, K. J. Grimm, A. E. Flesher, A. J. Bakke, and J. E. Hayes. 2021. Infant and toddler responses to bitter-tasting novel vegetables: Findings from the Good Tastes Study. Journal of Nutrition 151(1):3240–3252.

Kalhoff, H., I. V. Schmidt, I. Heindl, J. Kunert, and M. Kersting. 2021. Feeding frozen complementary foods promotes food acceptance in infants: The randomized intervention trial Baby Gourmet. Nutrition Research 87:49–56.

Koehler, S., W. Sichert-Hellert, and M. Kersting. 2007. Measuring the effects of nutritional counseling on total infant diet in a randomized controlled intervention trial. Journal of Pediatric Gastroenterology and Nutrition 45(1):106–113.

Krebs, N. F., J. E. Westcott, N. Butler, C. Robinson, M. Bell, and K. M. Hambidge. 2006. Meat as a first complementary food for breastfed infants: Feasibility and impact on zinc intake and status. Journal of Pediatric Gastroenterology and Nutrition 42(2):207–214.

Kucharczuk, A. J., T. L. Oliver, and E. B. Dowdell. 2022. Social media’s influence on adolescents’ food choices: A mixed studies systematic literature review. Appetite 168:105765.

Laws, R., P. Love, K. D. Hesketh, H. Koorts, E. Denney-Wilson, M. Moodie, V. Brown, K. L. Ong, J. Browne, S. Marshall, S. Lioret, L. Orellana, and K. J. Campbell. 2021. Protocol for an effectiveness-implementation hybrid trial to evaluate scale up of an evidence-based intervention addressing lifestyle behaviours from the start of life: Infant. Frontiers in Endocrinology (Lausanne) 12:717468.

LoRe, D., C. Y. Y. Leung, L. Brenner, and D. L. Suskind. 2019. Parent-directed intervention in promoting knowledge of pediatric nutrition and healthy lifestyle among low-SES families with toddlers: A randomized controlled trial. Child: Care, Health and Development 45(4):518–522.

Macchi, A. K., J. Banna, S. Moreira, M. Campos, and C. Palacios. 2022. Effect of a short messaging service (SMS) intervention delivered to caregivers on energy, nutrients, and food groups intake in infant participants of the WIC program. Frontiers in Public Health 10:986330.

Magarey, A., C. Mauch, K. Mallan, R. Perry, R. Elovaris, J. Meedeniya, R. Byrne, and L. Daniels. 2016. Child dietary and eating behavior outcomes up to 3.5 years after an early feeding intervention: The NOURISH RCT. Obesity 24(7):1537–1545.

Maguire, J. L., C. S. Birken, S. Jacobson, M. Peer, C. Taylor, A. Khambalia, M. Mekky, K. E. Thorpe, and P. Parkin. 2010. Office-based intervention to reduce bottle use among toddlers: TARGet Kids! pragmatic, randomized trial. Pediatrics 126(2):e343–e350.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Maier, A. S., C. Chabanet, B. Schaal, P. D. Leathwood, and S. N. Issanchou. 2008. Breastfeeding and experience with variety early in weaning increase infants’ acceptance of new foods for up to two months. Clinical Nutrition 27(6):849–857.

Marshall, N. E., B. Abrams, L. A. Barbour, P. Catalano, P. Christian, J. E. Friedman, W. W. Hay, T. L. Hernandez, N. F. Krebs, E. Oken, J. Q. Purnell, J. M. Roberts, H. Soltani, J. Wallace, and K. L. Thornburg. 2022. The importance of nutrition in pregnancy and lactation: Lifelong consequences. American Journal of Obstetrics and Gynecology 226(5):607–632.

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.

Mennella, J. A., S. Nicklaus, A. L. Jagolino, and L. M. Yourshaw. 2008. Variety is the spice of life: Strategies for promoting fruit and vegetable acceptance during infancy. Physiology & Behavior 94(1):29–38.

Mennella, J. A., L. M. Daniels, and A. R. Reiter. 2017. Learning to like vegetables during breastfeeding: A randomized clinical trial of lactating mothers and infants. American Journal of Clinical Nutrition 106(1):67–76.

Messito, M. J., M. W. Katzow, A. L. Mendelsohn, and R. S. Gross. 2020. Starting early program impacts on feeding at infant 10 months age: A randomized controlled trial. Childhood Obesity 16(S):S4–S13.

Morandi, A., M. Tommasi, F. Soffiati, F. Destro, L. Fontana, F. Grando, G. Simonetti, C. Bucolo, E. Alberti, L. Baraldi, A. Chiriacò, N. Ferrarese, G. Frignani, M. Pasqualini, V. Rossi, C. Siciliano, A. M. Zuccolo, G. Matticchio, V. Vettori, D. Danieli, L. Guarda, M. Iuliano, F. Raimo, S. Sirpresi, E. Trevisan, S. Vinco, and C. Maffeis. 2019. Prevention of obesity in toddlers (PROBIT): A randomised clinical trial of responsive feeding promotion from birth to 24 months. International Journal of Obesity 43(1):1961–1966.

Morison, B. J., A. L. M. Heath, J. J. Haszard, K. Hein, E. A. Fleming, L. Daniels, E. W. Erickson, L. J. Fangupo, B. J. Wheeler, B. J. Taylor, and R. W. Taylor. 2018. Impact of a modified version of baby-led weaning on dietary variety and food preferences in infants. Nutrients 10(8):1092.

Øverby, N. C., S. Hernes, and M. Haugen. 2017. Effect of dietary interventions during weaning period on parental practice and lipoproteins and vitamin D status in two-year-old children. Food & Nutrition Research 61(1):1350127.

Owen, L. H., O. B. Kennedy, C. Hill, and C. Houston-Price. 2018. Peas, please! Food familiarization through picture books helps parents introduce vegetables into preschoolers’ diets. Appetite 128:32–43.

Palacios, C., M. Campos, C. Gibby, M. Meléndez, J. E. Lee, and J. Banna. 2018. Effect of a multi-site trial using short message service (SMS) on infant feeding practices and weight gain in low-income minorities. Journal of the American College of Nutrition 37(7):605–613.

Ra, J. S. 2021. Evaluation of a mobile-based maternal feeding education program for overweight prevention in infants. Asian Nursing Research 15(2):136–143.

Rapson, J. P., P. R. Von Hurst, M. M. Hetherington, H. Mazahery, and C. A. Conlon. 2022. Starting complementary feeding with vegetables only increases vegetable acceptance at 9 months: A randomized controlled trial. American Journal of Clinical Nutrition 116(1):111–121.

Remy, E., S. Issanchou, C. Chabanet, and S. Nicklaus. 2013. Repeated exposure of infants at complementary feeding to a vegetable puŕee increases acceptance as effectively as flavor–flavor learning and more effectively than flavor–nutrient learning. Journal of Nutrition 143(7):1194–1200.

Røed, M., F. N. Vik, E. R. Hillesund, W. Van Lippevelde, A. C. Medin, and N. C. Øverby. 2020. Process evaluation of an eHealth intervention (Food4toddlers) to improve toddlers’ diet: Randomized controlled trial. JMIR Human Factors 7(3):e18171.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

Røed, M., A. C. Medin, F. N. Vik, E. R. Hillesund, W. Van Lippevelde, K. Campbell, and N. C. Øverby. 2021. Effect of a parent-focused eHealth intervention on children’s fruit, vegetable, and discretionary food intake (Food4toddlers): Randomized controlled trial. Journal of Medical Internet Research 23(2):e18311.

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.

Roset-Salla, M., J. Ramon-Cabot, J. Salabarnada-Torras, G. Pera, and A. Dalmau. 2016. Educational intervention to improve adherence to the Mediterranean diet among parents and their children aged 1–2 years. EniM clinical trial. Public Health Nutrition 19(6):1131–1144.

Sanghavi, D. M. 2005. Taking well-child care into the 21st century: A novel, effective method for improving parent knowledge using computerized tutorials. Archives of Pediatrics & Adolescent Medicine 159(5):482–485.

Savage, J. S., L. L. Birch, M. Marini, S. Anzman-Frasca, and I. M. Paul. 2016. Effect of the INSIGHT responsive parenting intervention on rapid infant weight gain and overweight status at age 1 year: A randomized clinical trial. JAMA Pediatrics 170(8):742–749.

Savage, J. S., E. E. Hohman, M. E. Marini, A. Shelly, I. M. Paul, and L. L. Birch. 2018. INSIGHT responsive parenting intervention and infant feeding practices: Randomized clinical trial. International Journal of Behavioral Nutrition and Physical Activity 15(1):64.

Scheinmann, R., M. A. Chiasson, D. Hartel, and T. J. Rosenberg. 2010. Evaluating a bilingual video to improve infant feeding knowledge and behavior among immigrant Latina mothers. Journal of Community Health 35(5):464–470.

Schroeder, N., B. Rushovich, E. Bartlett, S. Sharma, J. Gittelsohn, and B. Caballero. 2015. Early obesity prevention: A randomized trial of a practice-based intervention in 0–24-month infants. Journal of Obesity 2015:795859.

Spence, A. C., S. A. McNaughton, S. Lioret, K. D. Hesketh, D. A. Crawford, and K. J. Campbell. 2013. A health promotion intervention can affect diet quality in early childhood. Journal of Nutrition 143(1):1672–1678.

Spence, A. C., K. J. Campbell, D. A. Crawford, S. A. McNaughton, and K. D. Hesketh. 2014. Mediators of improved child diet quality following a health promotion intervention: The Melbourne InFANT program. International Journal of Behavioral Nutrition and Physical Activity 11:137.

Story, M., K. Holt, and D. Sofka. 2002. Bright futures in practice: Nutrition. Arlington, VA: National Center for Education in Maternal and Child Health.

Taveras, E. M., K. Blackburn, M. W. Gillman, J. Haines, J. McDonald, S. Price, and E. Oken. 2011. First steps for mommy and me: A pilot intervention to improve nutrition and physical activity behaviors of postpartum mothers and their infants. Maternal and Child Health Journal 15(8):1217–1227.

Taylor, R. W., S. M. Williams, L. J. Fangupo, B. J. Wheeler, B. J. Taylor, L. Daniels, E. A. Fleming, J. McArthur, B. Morison, L. W. Erickson, R. S. Davies, S. Bacchus, S. L. Cameron, and A.-L. M. Heath. 2017. Effect of a baby-led approach to complementary feeding on infant growth and overweight: A randomized clinical trial. JAMA Pediatrics 171(9):838–846.

Tournier, C., C. Bernad, J. Madrelle, J. Delarue, G. Cuvelier, C. Schwartz, and S. Nicklaus. 2021. Fostering infant food texture acceptance: A pilot intervention promoting food texture introduction between 8 and 15 months. Appetite 158:104989.

Tussing-Humphreys, L., J. L. Thomson, M. Goodman, and A. Landry. 2019. Enhanced vs standard parents as teacher curriculum on factors related to infant feeding among African American women. Southern Medical Journal 112(1):512–519.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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.
×

van Grieken, A., E. Vlasblom, L. Wang, M. Beltman, M. M. Boere-Boonekamp, M. P. L’Hoir, and H. Raat. 2017. Personalized web-based advice in combination with well-child visits to prevent overweight in young children: Cluster randomized controlled trial. Journal of Medical Internet Research 19(7):e268.

Van Vliet, M. S., J. M. Schultink, G. Jager, J. H. M. De Vries, J. Mesman, C. De Graaf, C. M. J. L. Vereijken, H. Weenen, V. W. T. De Wild, V. E. G. Martens, H. Houniet, and S. M. C. Van Der Veek. 2022. The Baby’s First Bites RCT: Evaluating a vegetable-exposure and a sensitive-feeding intervention in terms of child health outcomes and maternal feeding behavior during toddlerhood. Journal of Nutrition 152(2):386–398.

Verbestel, V., V. De Coen, M. Van Winckel, I. Huybrechts, L. Maes, and I. De Bourdeaudhuij. 2014. Prevention of overweight in children younger than 2 years old: A pilot cluster-randomized controlled trial. Public Health Nutrition 17(6):1384–1392.

Verrall, T., and K. Gray-Donald. 2005. Impact of a food-based approach to improve iron nutrition of at-risk infants in northern Canada. Preventive Medicine 40(6):896–903.

Verrall, T., L. Napash, L. Leclerc, S. Mercure, and K. Gray-Donald. 2006. Community-based communication strategies to promote infant iron nutrition in northern Canada. International Journal of Circumpolar Health 65(1):65–78.

Vlasblom, E., A. van Grieken, M. Beltman, M. P. L’Hoir, H. Raat, and M. M. Boere-Boonekamp. 2020. Parenting support to prevent overweight during regular well-child visits in 0–3 year old children (BBOFT+ program), a cluster randomized trial on the effectiveness on child BMI and health behaviors and parenting. PLOS ONE 15(8):e0237564.

Watt, R. G., K. I. Tull, R. Hardy, M. Wiggins, Y. Kelly, B. Molloy, E. Dowler, J. Apps, and P. McGlone. 2009. Effectiveness of a social support intervention on infant feeding practices: Randomised controlled trial. Journal of Epidemiology and Community Health 63(2):156–162.

Wen, L. M., L. A. Baur, J. M. Simpson, C. Rissel, and V. M. Flood. 2011. Effectiveness of an early intervention on infant feeding practices and “tummy time”: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine 165(8):701–707.

Wen, L. M., C. Rissel, H. Xu, S. Taki, L. Buchanan, K. Bedford, P. Phongsavan, and L. A. Baur. 2020. Effects of telephone and short message service support on infant feeding practices, “tummy time,” and screen time at 6 and 12 months of child age: A 3-group randomized clinical trial. JAMA Pediatrics 174(7):657–664.

Williams Erickson, L., R. W. Taylor, J. J. Haszard, E. A. Fleming, L. Daniels, B. J. Morison, C. Leong, L. J. Fangupo, B. J. Wheeler, B. J. Taylor, L. Te Morenga, R. M. McLean, and A.-L. M. Heath. 2018. Impact of a modified version of baby-led weaning on infant food and nutrient intakes: The BLISS randomized controlled trial. Nutrients 10(6):740.

Zheng, M., K. D. Hesketh, S. A. McNaughton, J. Salmon, D. Crawford, A. J. Cameron, S. Lioret, and K. J. Campbell. 2022. Quantifying the overall impact of an early childhood multi-behavioural lifestyle intervention. Pediatric Obesity 17(3):e12861.

Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 67
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 68
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 69
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 70
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 71
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 72
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 73
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 74
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 75
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 76
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 77
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 78
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 79
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 80
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 81
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 82
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 83
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 84
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 85
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 86
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 87
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 88
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 89
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 90
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 91
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 92
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 93
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 94
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 95
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 96
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 97
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 98
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 99
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 100
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 101
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 102
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 103
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 104
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 105
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 106
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 107
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 108
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 109
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 110
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 111
Suggested Citation:"4 Overview of Interventions Identified in the Scoping Review." 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 112
Next: 5 Identified Informative Studies and Elements »
Complementary Feeding Interventions for Infants and Young Children Under Age 2: Scoping of Promising Interventions to Implement at the Community or State Level Get This Book
×
Buy Paperback | $30.00 Buy Ebook | $24.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

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.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!