Feeding Infants and Children from Birth to 24 Months Summarizing Existing Guidance (2020) / Chapter Skim
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7 Conclusions and Future Directions
7 Conclusions and Future Directions
Pages 171-184
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From page 171... ...
Finally, the committee identifies gaps in the evidence related to feeding recommendations and communication and dissemination of feeding guidance. CONSISTENCY AMONG EXISTING FEEDING RECOMMENDATIONS AND TYPES OF EVIDENCE USED Across the 26 topic areas related to what to feed and how to feed, the committee sorted the recommendations in the 43 guideline documents into a variety of different themes.
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From page 172... ...
• the recommended duration of use of infant formula for nonbreastfed or For partially breastfed infants, most stated until 12 months of age but one guide line document gave an age range of 9–12 months. • Some guideline documents recommended delaying any cow milk until after 12 months, while others stated that cow milk could be introduced at 9–12 months or even as early as 6 months.
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From page 173... ...
Although some organizations conducted systematic reviews of the evidence for select topics, there is a relative paucity of published randomized controlled trials related to infant feeding, which limits the strength of the conclusions that can be drawn. Because of the challenges of conducting a formal systematic review, some organizations based their recommendations on "expert-informed" consensus, but this approach can result in different conclusions depending on which body of experts is involved in the process (Kredo et al., 2016)
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From page 174... ...
Collaboration on feeding guidelines, starting at the development phase and continuing through the dissemination phase, is likely to facilitate the harmonization of guidance, as described below. HARMONIZING THE DEVELOPMENT OF FUTURE FEEDING GUIDELINES The guideline documents reviewed reflected a mix of approaches, indicating substantial opportunity to improve and ideally harmonize the planning, development, communication, and dissemination of future feeding guidelines across organizations.
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Harmonization of the process for developing feeding guidelines does not necessarily imply that the specific feeding recommendations need to be exactly the same across countries, communities, and professional organizations. In fact, the need to customize guidance for particular target audiences and contexts means that the wording and presentation of recommendations may vary, especially in the communication and dissemination products.
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From page 176... ...
. There needs to be active acknowledgment and management of inevitable differences and tensions that arise, to maximize collaborative advantage and avoid collaborative inertia, or the tendency for collaborative activities to progress slowly (Vangen and Huxham, 2013)
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From page 177... ...
into guidelines in a timely way; and • Including the date of publication on all guideline documents and associated materials, and indicating if current guidance is meant to supersede previous guidance from the same organization. If multiple guideline documents are released from one source for different audiences detailing different aspects of the development process, it would be useful to explicitly outline within each document how they fit together and provide a link to access each of the individual documents (e.g., in an appendix)
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From page 178... ...
Health care providers need to know how to effectively communicate that there is uncertainty, guide consideration of risk versus benefit, and communicate their clinical judgment and experience to caregivers. Caregivers also need guidance on how to judge credible versus less credible sources of information, which recommendations are strongly supported by scientific evidence, and which practices allow more flexibility to incorporate family preferences and values without risking infant or child health.
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EVIDENCE GAPS Based on its review of the existing feeding guidelines for infants and young children, the committee identified key evidence gaps. These gaps are part of the reason for inconsistencies in feeding recommendations, and thus research to fill these gaps is necessary to facilitate harmonization of guidance development across organizations.
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From page 180... ...
Agreement among key stakeholders about the specifics of the feeding guidelines, includ ing how they will be disseminated, is critical to successful implementation. • ith the help of key stakeholders and partners, tailor implementation and W dissemination strategies to the target audience based on socioeconomic, cul tural, health care, and food systems characteristics in order to meet the needs of the target groups, including mothers and other caregivers (Chambers and Norton, 2016; Tumilowicz et al., 2019)
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From page 181... ...
, that may also warrant further research, but those are not included below because the committee did not find mention of them in the recommendations abstracted from the eligible guideline documents. • Recommended duration of exclusive breastfeeding and the age of introduction of complementary foods: Most recommendations stated "about" or "around" 6 months of age, but a few indi cated an age range of 4–6 months and one Robert Wood Johnson Foundation-Healthy Eating Research specified "when the child is developmentally ready, which usually happens between 4 and 6 months" (Pérez-Escamilla et al., 2017)
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From page 182... ...
• Recommended age of introduction of potentially allergenic foods: Recommendations were generally consistent for introduction of allergenic foods in the second 6 months of life and not delaying introduction beyond 12 months of age. The evidence for comple mentary feeding practices to prevent food allergy is strongest for peanuts; additional research is needed for other allergenic foods, particularly eggs (including the preparation of egg used, as in whole, egg white, egg yolk)
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From page 183... ...
Evidence Gaps Related to Communication and Dissemination of Feeding Guidelines The evidence gaps listed below were identified through the committee's review of communication and dissemination strategies provided in existing feeding guideline documents. • Identify the best ways to communicate to parents and other care givers, health care providers, early care and education providers, program administrators, and policy makers regarding levels of evidence to support different recommendations for feeding children under 2 years of age, and implications for implementation.
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From page 184... ...
CLOSING REMARKS In spite of all of the differences in the ways that guideline documents were developed, it is encouraging that there was consistency in many of the feeding recommendations across a variety of authoritative organizations. Moving forward, however, it is important to encourage more rigorous, systematic, and ideally harmonized methods for developing recommendations for feeding infants and children from birth to 24 months of age, and for disseminating and implementing the recommendations using the principles of D&I science.
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