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5 Existing Recommendations on How to Feed
Pages 127-154

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From page 127...
... • A summary of consistency across recommendations on how to feed infants and young children is presented in a table at the end of this chapter. This chapter reviews the recommendations related to how to feed infants and young children that were included in the guideline documents that met the committee's inclusion criteria (see Chapter 2)
From page 128...
... Box 5-1 presents the terminology the committee uses throughout this chapter to describe the levels of consistency. BOTTLE USE AND PROPPING Ten guideline documents included recommendations related to bottle use or propping (see Appendix B, Table B-19)
From page 129...
... and the New Zealand Ministry of Health each participated in two different guideline documents. Accordingly, the identified guideline documents reflect 12 different organizations from Australia, Canada, Europe, New Zealand, the United Kingdom, and the United States.1 Foods and Fluids to Provide or Avoid in Bottle Use Six guideline documents included recommendations on foods and fluids to provide or avoid in bottle use.
From page 130...
... could not be mapped to its evidence. Age Restriction for Bottle Use Four guideline documents included recommendations on age restrictions for bottle use.
From page 131...
... guideline document, in turn, cited the New Zealand Dental Association's 2008 guideline document as evidence for its recommendation. Type of Bottle and Bottle-Feeding Behaviors Four guideline documents included recommendations related to bottlefeeding behaviors.
From page 132...
... Bottle Propping Three guideline documents included recommendations on bottle propping (Health Canada et al., 2015; NHMRC, 2012; Pérez-Escamilla et al., 2017 [RWJF-HER]
From page 133...
... Accordingly, the identified guideline documents reflect 14 different organizations from Australia, Canada, Europe, New Zealand, the United Kingdom, and the United States.6 Age for Cup Use Six guideline documents included recommendations on the age for cup use. All indicated that the appropriate age range for introducing cup use was between 6 and 12 months.
From page 134...
... could not be mapped to its evidence. Fluids to Provide or Avoid in Cup Use Eight guideline documents included recommendations that addressed the fluids to provide or avoid when feeding from a cup.
From page 135...
... General Considerations for Cup Use Two guideline documents included recommendations related to general cup use. A collaborative guideline document from Canada encouraged the use of an open cup, with assistance (Health Canada et al., 2014)
From page 136...
... Finally, the recommendation from the other RWJF-HER guideline document mapped to FoodSafety.gov. Safety of Honey Consumption8 Three guideline documents included recommendations related to the safety of honey consumption.
From page 137...
... Consumption of Raw or Undercooked Foods Five guideline documents included recommendations related to infant and young child consumption of raw or undercooked foods. One guideline document recommended avoiding raw or undercooked meat, poultry, and fish (Health Canada et al., 2014)
From page 138...
... Prevention of Choking Eleven guideline documents included recommendations related to the prevention of choking. Several recommendations advise not offering food items that are a choking hazard to infants and young children.
From page 139...
... guideline document include • Foods that are difficult to bite or chew (e.g., raw apple, raw celery, hard dried fruit, corn chips, rice crackers) , • Small round foods (e.g., berries, cherry tomatoes, raisins/sultanas, peas, watermelon seeds)
From page 140...
... guideline document was embedded in a broader recommendation that mapped to a systematic review; the portion specifically related to choking hazards, however, could not be mapped to its evidence. The Australian government guideline document (NHMRC, 2012)
From page 141...
... Supervision During Eating Eight guideline documents included recommendations related to supervision of infants and young children while they are eating. Some guideline documents recommended that infants and young children never be left unattended while they are eating (NICE, 2008; SACN, 2018; SACN and COT, 2018)
From page 142...
... , recognizing that there may need to be adapta 10 Organizations reflected in the guideline documents include AAP, Breastfeeding Commit tee for Canada, COT, CPS, Dietitians of Canada, EFSA, ESPGHAN, Health Canada, New Zealand Ministry of Health, NHMRC, PAHO, RCPCH, RWJF-HER, SACN, SIAIP, SIGENP, and WHO.
From page 143...
... Recommended Foods to Introduce First Ten guideline documents included recommendations about which foods to introduce first. All mentioned iron-rich foods (such as puréed or mashed meats)
From page 144...
... Gradual Introduction of New Foods and Order of Introduction Seven guideline documents included recommendations on the gradual introduction of new foods and order of introduction. Five recommended that diversification of the diet and introduction of new foods should occur gradually (Grueger et al., 2013; Ministry of Health, 2012; PAHO/WHO, 2003; SACN, 2018; WHO, 2005)
From page 145...
... mapped to systematic reviews, either alone or in combination with a narrative review. FOOD CONSISTENCY AND TEXTURE Ten guideline documents included recommendations on food consistency and texture during infancy and early childhood (see Appendix B, Table B-23)
From page 146...
... As such, the identified guideline documents reflect eight organizations from Canada and the United States, along with PAHO and WHO.14 Consistent Meal Schedule During the Complementary Feeding Period Four guideline documents included recommendations on meal schedule and complementary foods. Three guideline documents recommended that a regular meal schedule be established (Gidding et al., 2005 [AHA]
From page 147...
... ;15 this recommendation includes breast milk substitutes, if used. A guideline document from PAHO/WHO stated, For the average healthy breastfed infant, meals of complementary foods should be provided 2–3 times per day at 6–8 months of age and 3–4 times per day at 9–11 and 12–24 months of age.
From page 148...
... mapped to "theoretical estimates of the number of feedings required, calculated from energy requirements and gastric capacity."20 HUNGER AND SATIETY CUES Seven guideline documents included recommendations related to hunger and satiety cues (see Appendix B, Table B-25)
From page 149...
... Consistency The guideline documents were generally consistent in emphasizing the importance of hunger and satiety cues in infant and child feeding. There was also consistency across organizations in support of the importance of 21  Organizations reflected in the guideline documents include AHA, Breastfeeding Commit tee for Canada, CPS, Dietitians of Canada, ESPGHAN, Health Canada, PAHO, RWJF-HER, SIAIP, SIGENP, and WHO.
From page 150...
... ; WHO participated in two of the guideline documents. As such, the identified guideline documents reflect 13 different organizations from Australia, Canada, Italy, the United Kingdom, and the United States, along with PAHO and WHO.22 Feeding Environment Seven guideline documents included recommendations related to the feeding environment.
From page 151...
... Repeated Exposure Five guideline documents included recommendations related to repeated exposure. All stated the importance of repeated exposure to help children accept new foods (Gidding et al., 2005 [AHA]
From page 152...
... Evidence Base Across the six guideline documents, the committee identified eight statements of recommendation. Most mapped to narrative reviews, background documents, and technical documents.
From page 153...
... 6 months • Consistent in recommending that the first foods offered to infants be iron rich or iron fortified • Consistent in recommending gradual introduction of new foods Food • Consistent in recommending that food consistency and texture be consistency tailored to the developmental needs of the child and texture • Consistent in recommending that consistencies and textures of foods offered should change as the child gets older Meal • Generally consistent in recommending that a consistent meal schedule be frequency established • Generally consistent in recommending that young children need several eating occasions, both meals and snacks, over the course of the day Hunger and • Generally consistent in emphasizing the importance of using hunger and satiety cues satiety cues to guide infant and child feeding Responsive • Generally consistent in recommending that the feeding environment be feeding pleasant and include nurturing behaviors (e.g., verbalization, eye-to-eye contact, not forcing the child to eat) • Consistent in recommending that repeated exposure is needed for children to accept new foods • Generally consistent in recommending that self-feeding and self regulation be encouraged in infants and toddlers NOTE: The committee uses the following phrases to describe consistency of recommendations: • Consistent indicates alignment across the recommendations.


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