Complementary Feeding Interventions for Infants and Young Children Under Age 2 Scoping of Promising Interventions to Implement at the Community or State Level (2023) / Chapter Skim
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Existing guidance on what to feed infants and young children includes introducing nutrient-dense, developmentally appropriate foods, including foods rich in iron, zinc, and vitamin D, and avoiding foods high in added sugars and sodium. The existing research on how to feed infants and young children recognizes that complementary feeding ideally occurs through ongoing and reciprocal interactions between the caregiver and the developing child.
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requested that the National Academies conduct a scoping review to identify promising complementary feeding interventions. The National Academies' Health and Medicine Division convened the Committee on Complementary Feeding Interventions for Infants and Young Children Under Age 2 whose members had expertise in epidemiology, public health nutrition, dietetics/community nutrition, infant and child feeding practices and nutritional requirements, federal food and nutrition programs (along with equity and access to these programs)
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At the direction of the study sponsor, the committee also included interventions that complemented existing federal programs targeting at-risk children under 2 years of age and their caregivers that may influence infant and young child feeding behaviors (e.g., WIC and home visiting programs) and interventions conducted in other settings that otherwise met the criteria for inclusion.
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For each of the informative study and informative intervention elements, the committee provided a brief description of the study and the insights that the study contributed toward the committee's conclusions. The committee also described factors needed to scale interventions to the community or state levels and noted the ability of the intervention to reach underserved populations,3 reduce inequities, and complement federal-level programs such as WIC and home visiting programs.
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in CE systems, 2 in WIC settings (4 publications) , 12 in home visiting programs (18 publications)
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All five studies involved child care centers or nurseries, ECE settings that typically involve multiple child care providers caring for multiple children in "classroom"-type settings.
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TABLE S-2 Number of Publications Targeting How to Feed by Outcome and Setting Caregiver Child Offering repeated Accepting Using Providing exposures to Modeling Providing a variety of responsive appropriate unfamiliar Appropriately healthy regular nutrient-dense Timely How to Feed feeding portion foods and providing eating meals and foods and transition to Using a Outcomes practices sizes flavors bottle and cup behavior snacks beverages self-feeding cup Health care 14 2 5 4 5 12 5 3 1 ECE 1 0 2 0 0 1 0 0 0 CE 0 0 0 0 1 0 0 0 0 Home visit 14 6 8 3 6 0 1 5 0 WIC 3 0 0 0 0 0 0 0 0 Other 7 1 6 1 0 1 12 5 0 TOTAL 39 9 21 8 12 14 18 13 1 7
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Both educational interventions that aimed to reach parents through child care centers achieved positive outcomes. University Cooperative Extension The committee reviewed one study (one publication)
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Studies differed based on who delivered the education or counseling and the frequency and duration of the visits. Key Findings The home visiting interventions had consistent significant impact on increasing caregivers' use of responsive feeding practices, especially related to reducing pressure on the child to eat.
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INFORMATIVE EXAMPLES The committee identified three informative studies and six informative intervention elements based on its expert judgment on the quality of methods, evidence of effectiveness, and potential for scalability. Informative Studies Among the informative studies, one was conducted in the health care setting, and two involved home visiting (see Box S-1)
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With a strong theoretical framework and description of visit fidelity, this trial provides important insights for future implementation of home visiting models. The final informative study was the Family Spirit Nurture RCT, which had a rigorous design, strong theoretical framework, attention to
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. TABLE S-3 Informative Intervention Element Studies and Takeaways Informative Intervention Study (Trial)
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11. Carefully monitor the coverage and quality of implementation, including client satisfaction, for all groups, including individuals with low incomes and mem bers of minority groups, to ensure equity.
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COMMITTEE CONCLUSIONS ON EFFECTIVE AND SCALABLE INTERVENTIONS Building on Existing Infrastructure and Ecosystems The committee concluded that the expansion and harmonization of existing supports for complementary feeding in the United States across settings would facilitate families with young children receiving consistent messages about complementary feeding and responsive feeding. Across health care, ECE, CE, WIC, and home visiting settings, there are distinct opportunities -- and challenges -- to harnessing existing programs and harmonizing strategies across these settings (see Box S-3)
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Monitoring and evaluation efforts that include identifying disparities in access to services, program impact, and outcomes measures by race/ethnicity, parental education level, and socioeconomic status could be used to drive program refinements that improve health equity. BOX S-3 Committee Conclusions on Existing Ecosystems and Infrastructure for Complementary Feeding Interventions Health Care -- Interventions involving the U.S.
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systems to collaborate to develop, distribute, and provide training on interactive what to feed and how to feed modules for U.S. home visiting programs, and for home visitors to effectively deliver complementary feeding interventions to families, as demonstrated by Intervention Nurses Start Infants Growing on Healthy Trajectories and Family Spirit Nurture.
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The Family Spirit Nurture home visiting intervention also holds promise as an intervention that could be readily scaled in the United States, pending the findings from the second RCT. Families with infants and young children can benefit from access to credible information on best feeding practices.
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The committee concludes that there were several interventions with promising elements that could be part of a multicomponent constellation of interventions delivered across settings and systems to address what and how to feed infants and young children. It is critically important that the settings and corresponding systems that were examined -- health care, ECE, CE, home visiting, and WIC -- be included in such an effort.
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