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From page 1... ... However, not all authoritative bodies have used such approaches for developing infant feeding guidance, and for many feeding questions there is little or no sound evidence available to guide best practices, despite the fact that research on infant and young child feeding has expanded in recent decades. Summarizing the current landscape of feeding recommendations for infants and young children can reveal the level of consistency of existing guidance, shed light on the types of evidence that underpin each recommendation, and provide insight into the feasibility of harmonizing guidelines. Read the entire page →
From page 2... ... The committee's search for guideline documents that included recommendations on what and/or how to feed infants and children from birth to 24 months focused on resources from government agencies and from authoritative domestic and international organizations. Guideline documents were found by performing targeted website searches, further supplemented by using the Food and Agriculture Organization of the United Nations' catalog of food-based dietary guidelines, by leveraging expert input, and by searching databases (e.g., ECRI Institute Guideline Trust, CPG Infobase: Clinical Practice Guidelines, PubMed) Read the entire page →
From page 3... ... . TABLE S-1 Guideline Document- and Recommendation-Level Eligibility Criteria Level Inclusion Criteria Exclusion Criteria Guideline • The most current • Documents that exclusively provide document-level recommendations feeding recommendations for preterm eligibility criteria or guidelines from infants authoritative agencies • Clinical treatment guidelines for a and organizations specific disease or condition • Documents that • Guideline documents from, for, funded provided guidance by, or in collaboration with industry related to what or how • Documents that exclusively provide to feed human milk, guidance related to clinical management infant formula, other of lactation foods and beverages, • Position statements that only support and supplements to or describe the benefits of breastfeeding infants and children without providing additional younger than 24 recommendations about how to feed months of agea (e.g., duration, frequency) Read the entire page →
From page 4... ... d Recommendations were excluded if they were about preterm infants; clinical treatment of a specific disease or condition; clinical management of lactation; the benefits of breastfeeding; methods for preparing and storing foods, including breastmilk and formula; malnutrition or emergency situations; intake of breastfeeding mothers; or infant formula composition. e Many agencies, organizations, and groups used the LEAP trial to update feeding guidelines related to the primary prevention of peanut allergy. Read the entire page →
From page 5... ... The included guideline documents varied with respect to the document type (e.g., position statement, clinical practice reports) , level of collaboration across organizations, scope of topics covered, target audiences, overall methodologies, presentation of recommendations, and mapping of evidence to each recommendation. Read the entire page →
From page 6... ... 6 FEEDING INFANTS AND CHILDREN FROM BIRTH TO 24 MONTHS TABLE S-2 Summary of the Consistency of Recommendations on What to Feed Infants and Young Children, by Topic Area Topic Area Summary of Consistency Across Recommendations Exclusive • Generally consistent in terms of recommending exclusive breastfeeding breastfeeding for up to, about, or around 6 months of age Continuation of • Generally consistent in being in support of continuing breastfeeding breastfeeding for at least 12 months • Not consistent in terms of the specific age to which breastfeeding should be continued Supplementary • Consistent in indicating that breastfed infants should not be routinely formula feedings given supplementary formula feedings Duration of • Generally consistent in recommending that, for formula-fed infants, formula use commercial infant formula should be used until 12 months of age • Consistent in indicating that infant formula is not needed beyond 12 months of age Type of infant • Consistent in recommending cow milk–based infant formulas for formula formula-fed infants • Consistent in recommending that the use of soy-based formula be limited to special circumstances Toddler milks • Consistent in recommending against the general use of toddler milks and follow-on formulas Milk and milk- • Generally consistent in recommending against cow milk before 9 based products months of age • Not consistent regarding suitability of cow milk for infants 9–12 months of age • Not consistent in whether milk can be added to complementary foods before 12 months of age • Generally consistent in indicating that whole milk should be provided to children in the age range of 12–24 months • Consistent in indicating that the amount of cow milk should be limited for children 12–24 months of age • Some inconsistencies in the recommended limit for the amount of cow milk for children 12–24 months of age • Consistent in recommending against providing flavored milk to infants and young children Fluids: Water, • Consistent in discouraging the provision of water to breastfed infants juice, sugar- 0–6 months of age sweetened • Consistent in recommending provision of water to infants 6–12 beverages, and months of age and children older than 1 year other nonmilk • Generally consistent in stating that juice should not be provided in the beverages first 12 months of life Read the entire page →
From page 7... ... SUMMARY 7 TABLE S-2 Continued Topic Area Summary of Consistency Across Recommendations Fluids: Water, • Generally consistent in recommending that juice intake for toddlers juice, sugar- not exceed 4 ounces per day sweetened • Consistent in recommending against providing infants and young beverages, and children with sugar-sweetened beverages other nonmilk • Consistent in recommending against providing coffee, tea, and beverages caffeinated beverages to infants and young children (continued) • Generally consistent in recommending against providing plant-based beverages to infants or young childrena Substances to • Consistent in recommending that foods for infants and young children avoid or limitb should be prepared without added sugars • Consistent in recommending that if pre-prepared foods and snacks are offered to young children, they should contain no or limited added or total sugars • Consistent in recommending that if foods with sugars are consumed, they should be consumed at mealtimes instead of as snacks • Consistent in advising against dipping pacifiers or bottle teats in substances with sugars • Consistent in recommending that foods for infants and young children be prepared without adding salt • Consistent in recommending that if pre-prepared foods and snacks are offered to young children, they should contain no or limited salt Variety and • Consistent in recommending that a variety of foods and food groups, healthy, nutritious textures, and flavors can help meet nutritional requirements foods Fruits and • Consistent in recommending consumption of a variety of fruits and vegetables vegetables Vegetarian and • Consistent in stipulating the need for a carefully planned diet to meet vegan diet requirements for several key nutrients • Some inconsistencies in explicitly mentioning a need for fortified products or nutrient supplements for vegans • Generally consistent in mentioning plant-based beverages as an option for toddlers in the context of specific dietary preferences Foods associated • Consistent in recommending that introduction of potentially allergenic with food allergy foods should not be delayed and celiac disease • Not consistent in recommending when and how to introduce peanuts based on the infant's risk for peanut allergy • Generally consistent in recommending not delaying introduction of allergenic food beyond 6 months of age, including eggs Iron • Consistent in acknowledging the importance of iron-rich complementary foods • Not consistent in recommended age of introduction of iron-rich complementary foods • Consistent in recommending that formula-fed infants be given iron fortified infant formulas until at least 6 months of age continued Read the entire page →
From page 8... ... are summarized in Table S-3 in the "Safety of foods and feeding practices" section. c A recommendation in a 2010 guideline document predated the acceptance of delayed cord clamping in the United States, which changed iron supplementation recommendations for infants. Read the entire page →
From page 9... ... TABLE S-3 Summary of the Consistency of Recommendations on How to Feed Infants and Young Children, by Topic Area Topic Area Summary of Consistency Across Recommendations Bottle use and • Generally consistent in recommending against certain foods and fluids propping being added to bottles • Generally consistent in recommending that bottle use be discontinued at about 12 months of age • Generally consistent in recommending that infants not go to bed or to sleep with a bottle • Consistent in recommending against bottle propping Cup use • Generally consistent in recommending that infants should transition to cups at 6–12 months of age • Generally consistent in recommending that milk should be served to toddlers in a cup Safety of foods • Consistent in recommending that milk, milk products, and juice given to and feeding children should be pasteurized practices • Consistent in recommending against giving honey to children under 1 year of age due to risk of botulism • Generally consistent in recommending against consumption of raw or undercooked eggs • Consistent in advising about choking hazards, although examples provided varied across guideline documents • Consistent in recommending that infants and young children be supervised while eating Introduction of • Generally consistent in recommending that complementary foods not be complementary introduced before 4 months of age nor delayed to after 6 months of age foods • Not consistent in whether the recommended age of introduction is an age range (4–6 months) or is focused on introduction at (approximately) Read the entire page →
From page 10... ... • Not consistent indicates recommendations providing different guidance on a topic. COMMUNICATION AND DISSEMINATION OF FEEDING RECOMMENDATIONS The feeding guideline documents reviewed by the committee generally did not describe complex, multisector implementation strategies. Read the entire page →
From page 11... ... The Child and Adult Care Food Program and the Special Supplemental Nutrition Program for Women, Infants, and Children are two key federal programs in the United States that integrate feeding recommendations into practice. Although the committee did not find an eligible guideline document from or for these pro grams, it did identify recent key resources that translated feeding recommendations, national policy, and federal regulations into programmatic guidance. Read the entire page →
From page 12... ... In fact, the need to customize guidance for particular target audiences and contexts means that some of the wording of recommendations may vary, especially in the dissemination and communication products. Harmonizing the Development of Future Feeding Guidelines Across the collection of guideline documents reviewed, the committee identified a range of methodological approaches taken to develop feeding recommendations. Read the entire page →
From page 13... ... Thus, the committee recommends that agencies, organizations, and groups developing guideline documents related to feeding infants and young children should consider the principles of dissemination and implementation science as a means to enhance the reach and impact of the feeding recommendations that are developed. Read the entire page →
From page 14... ... 14 FEEDING INFANTS AND CHILDREN FROM BIRTH TO 24 MONTHS CONCLUDING REMARKS In spite of all of the differences in the ways that guideline documents were developed, it is encouraging that there was consistency for the majority of recommendations across a variety of authoritative organizations. For the future, it is important to harmonize the process across organizations and to use more rigorous methods for developing, communicating, and disseminating recommendations for feeding infants and children from birth to 24 months of age. Read the entire page →

From page 1...

... However, not all authoritative bodies have used such approaches for developing infant feeding guidance, and for many feeding questions there is little or no sound evidence available to guide best practices, despite the fact that research on infant and young child feeding has expanded in recent decades. Summarizing the current landscape of feeding recommendations for infants and young children can reveal the level of consistency of existing guidance, shed light on the types of evidence that underpin each recommendation, and provide insight into the feasibility of harmonizing guidelines.

Read the entire page →

From page 2...

... The committee's search for guideline documents that included recommendations on what and/or how to feed infants and children from birth to 24 months focused on resources from government agencies and from authoritative domestic and international organizations. Guideline documents were found by performing targeted website searches, further supplemented by using the Food and Agriculture Organization of the United Nations' catalog of food-based dietary guidelines, by leveraging expert input, and by searching databases (e.g., ECRI Institute Guideline Trust, CPG Infobase: Clinical Practice Guidelines, PubMed)

Read the entire page →

From page 3...

... . TABLE S-1 Guideline Document- and Recommendation-Level Eligibility Criteria Level Inclusion Criteria Exclusion Criteria Guideline • The most current • Documents that exclusively provide document-level recommendations feeding recommendations for preterm eligibility criteria or guidelines from infants authoritative agencies • Clinical treatment guidelines for a and organizations specific disease or condition • Documents that • Guideline documents from, for, funded provided guidance by, or in collaboration with industry related to what or how • Documents that exclusively provide to feed human milk, guidance related to clinical management infant formula, other of lactation foods and beverages, • Position statements that only support and supplements to or describe the benefits of breastfeeding infants and children without providing additional younger than 24 recommendations about how to feed months of agea (e.g., duration, frequency)

Read the entire page →

From page 4...

... d Recommendations were excluded if they were about preterm infants; clinical treatment of a specific disease or condition; clinical management of lactation; the benefits of breastfeeding; methods for preparing and storing foods, including breastmilk and formula; malnutrition or emergency situations; intake of breastfeeding mothers; or infant formula composition. e Many agencies, organizations, and groups used the LEAP trial to update feeding guidelines related to the primary prevention of peanut allergy.

Read the entire page →

From page 5...

... The included guideline documents varied with respect to the document type (e.g., position statement, clinical practice reports) , level of collaboration across organizations, scope of topics covered, target audiences, overall methodologies, presentation of recommendations, and mapping of evidence to each recommendation.

Read the entire page →

From page 6...

... 6 FEEDING INFANTS AND CHILDREN FROM BIRTH TO 24 MONTHS TABLE S-2 Summary of the Consistency of Recommendations on What to Feed Infants and Young Children, by Topic Area Topic Area Summary of Consistency Across Recommendations Exclusive • Generally consistent in terms of recommending exclusive breastfeeding breastfeeding for up to, about, or around 6 months of age Continuation of • Generally consistent in being in support of continuing breastfeeding breastfeeding for at least 12 months • Not consistent in terms of the specific age to which breastfeeding should be continued Supplementary • Consistent in indicating that breastfed infants should not be routinely formula feedings given supplementary formula feedings Duration of • Generally consistent in recommending that, for formula-fed infants, formula use commercial infant formula should be used until 12 months of age • Consistent in indicating that infant formula is not needed beyond 12 months of age Type of infant • Consistent in recommending cow milk–based infant formulas for formula formula-fed infants • Consistent in recommending that the use of soy-based formula be limited to special circumstances Toddler milks • Consistent in recommending against the general use of toddler milks and follow-on formulas Milk and milk- • Generally consistent in recommending against cow milk before 9 based products months of age • Not consistent regarding suitability of cow milk for infants 9–12 months of age • Not consistent in whether milk can be added to complementary foods before 12 months of age • Generally consistent in indicating that whole milk should be provided to children in the age range of 12–24 months • Consistent in indicating that the amount of cow milk should be limited for children 12–24 months of age • Some inconsistencies in the recommended limit for the amount of cow milk for children 12–24 months of age • Consistent in recommending against providing flavored milk to infants and young children Fluids: Water, • Consistent in discouraging the provision of water to breastfed infants juice, sugar- 0–6 months of age sweetened • Consistent in recommending provision of water to infants 6–12 beverages, and months of age and children older than 1 year other nonmilk • Generally consistent in stating that juice should not be provided in the beverages first 12 months of life

Read the entire page →

From page 7...

... SUMMARY 7 TABLE S-2 Continued Topic Area Summary of Consistency Across Recommendations Fluids: Water, • Generally consistent in recommending that juice intake for toddlers juice, sugar- not exceed 4 ounces per day sweetened • Consistent in recommending against providing infants and young beverages, and children with sugar-sweetened beverages other nonmilk • Consistent in recommending against providing coffee, tea, and beverages caffeinated beverages to infants and young children (continued) • Generally consistent in recommending against providing plant-based beverages to infants or young childrena Substances to • Consistent in recommending that foods for infants and young children avoid or limitb should be prepared without added sugars • Consistent in recommending that if pre-prepared foods and snacks are offered to young children, they should contain no or limited added or total sugars • Consistent in recommending that if foods with sugars are consumed, they should be consumed at mealtimes instead of as snacks • Consistent in advising against dipping pacifiers or bottle teats in substances with sugars • Consistent in recommending that foods for infants and young children be prepared without adding salt • Consistent in recommending that if pre-prepared foods and snacks are offered to young children, they should contain no or limited salt Variety and • Consistent in recommending that a variety of foods and food groups, healthy, nutritious textures, and flavors can help meet nutritional requirements foods Fruits and • Consistent in recommending consumption of a variety of fruits and vegetables vegetables Vegetarian and • Consistent in stipulating the need for a carefully planned diet to meet vegan diet requirements for several key nutrients • Some inconsistencies in explicitly mentioning a need for fortified products or nutrient supplements for vegans • Generally consistent in mentioning plant-based beverages as an option for toddlers in the context of specific dietary preferences Foods associated • Consistent in recommending that introduction of potentially allergenic with food allergy foods should not be delayed and celiac disease • Not consistent in recommending when and how to introduce peanuts based on the infant's risk for peanut allergy • Generally consistent in recommending not delaying introduction of allergenic food beyond 6 months of age, including eggs Iron • Consistent in acknowledging the importance of iron-rich complementary foods • Not consistent in recommended age of introduction of iron-rich complementary foods • Consistent in recommending that formula-fed infants be given iron fortified infant formulas until at least 6 months of age continued

Read the entire page →

From page 8...

... are summarized in Table S-3 in the "Safety of foods and feeding practices" section. c A recommendation in a 2010 guideline document predated the acceptance of delayed cord clamping in the United States, which changed iron supplementation recommendations for infants.

Read the entire page →

From page 9...

... TABLE S-3 Summary of the Consistency of Recommendations on How to Feed Infants and Young Children, by Topic Area Topic Area Summary of Consistency Across Recommendations Bottle use and • Generally consistent in recommending against certain foods and fluids propping being added to bottles • Generally consistent in recommending that bottle use be discontinued at about 12 months of age • Generally consistent in recommending that infants not go to bed or to sleep with a bottle • Consistent in recommending against bottle propping Cup use • Generally consistent in recommending that infants should transition to cups at 6–12 months of age • Generally consistent in recommending that milk should be served to toddlers in a cup Safety of foods • Consistent in recommending that milk, milk products, and juice given to and feeding children should be pasteurized practices • Consistent in recommending against giving honey to children under 1 year of age due to risk of botulism • Generally consistent in recommending against consumption of raw or undercooked eggs • Consistent in advising about choking hazards, although examples provided varied across guideline documents • Consistent in recommending that infants and young children be supervised while eating Introduction of • Generally consistent in recommending that complementary foods not be complementary introduced before 4 months of age nor delayed to after 6 months of age foods • Not consistent in whether the recommended age of introduction is an age range (4–6 months) or is focused on introduction at (approximately)

Read the entire page →

From page 10...

... • Not consistent indicates recommendations providing different guidance on a topic. COMMUNICATION AND DISSEMINATION OF FEEDING RECOMMENDATIONS The feeding guideline documents reviewed by the committee generally did not describe complex, multisector implementation strategies.

Read the entire page →

From page 11...

... The Child and Adult Care Food Program and the Special Supplemental Nutrition Program for Women, Infants, and Children are two key federal programs in the United States that integrate feeding recommendations into practice. Although the committee did not find an eligible guideline document from or for these pro grams, it did identify recent key resources that translated feeding recommendations, national policy, and federal regulations into programmatic guidance.

Read the entire page →

From page 12...

... In fact, the need to customize guidance for particular target audiences and contexts means that some of the wording of recommendations may vary, especially in the dissemination and communication products. Harmonizing the Development of Future Feeding Guidelines Across the collection of guideline documents reviewed, the committee identified a range of methodological approaches taken to develop feeding recommendations.

Read the entire page →

From page 13...

... Thus, the committee recommends that agencies, organizations, and groups developing guideline documents related to feeding infants and young children should consider the principles of dissemination and implementation science as a means to enhance the reach and impact of the feeding recommendations that are developed.

Read the entire page →

From page 14...

... 14 FEEDING INFANTS AND CHILDREN FROM BIRTH TO 24 MONTHS CONCLUDING REMARKS In spite of all of the differences in the ways that guideline documents were developed, it is encouraging that there was consistency for the majority of recommendations across a variety of authoritative organizations. For the future, it is important to harmonize the process across organizations and to use more rigorous methods for developing, communicating, and disseminating recommendations for feeding infants and children from birth to 24 months of age.

Read the entire page →

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Summary Pages 1-14

Summary
Pages 1-14