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WIC Food Packages: Time for a Change
needs of most rather than all infants. The committee’s recommendation to provide complementary foods beginning at age 6 months is consistent with the most recent dietary guidance on complementary feeding (AAP, 2005; WHO, 2002; Kramer and Kakuma, 2002, 2004) and common guidelines for clinical practice in the field of pediatrics (Hendricks et al., 2001; Morris and Klein, 2000; AAP, 2001c; Rudolph and Rudolph, 2003).18
To make possible the gradual introduction of a variety of fruits and vegetables, the committee recommends the deletion of fruit juice and the addition of commercial baby food fruits and vegetables and fresh bananas to Food Package II for infants ages 6 months and older. The allowed foods span the range of textures appropriate for infants at different stages of development. To provide iron and zinc in forms with high bioavailability to meet the needs of fully breast-fed infants, the committee recommends the addition of commercial baby food meats for fully breast-fed infants beginning at age 6 months (Food Package II-BF). The package for fully breast-fed infants also provides additional baby food fruits and vegetables; the rationale is to provide additional nutritional value to improve the parity with other infant packages, to provide sufficient fruits and vegetables to mix with baby food meats to increase the palatability of strained meats for older infants, and to encourage prolonged breastfeeding by adding to the convenience and monetary value of the food packages of the fully breastfeeding mother/infant pair.
The recommendations for the milk fat content are consistent with AAP recommendations of whole milk for children who are one year of age and fat-reduced milk for older children (AAP, 2004). The exclusion of dried fruit from the processed fruit and vegetable options for children (see Table 4-3) is intended to reduce the risk of choking posed by that form of fruit (AAP, 2004).
Addressing Obesity Concerns
Overweight and obesity in children and adults largely outranks undernutrition as a significant public health concern (DHHS/PHS, 1988; NRC, 1989a; IOM, 1991, 2004a; Kessler, 1995; Koplan and Dietz, 1999; Mokdad et al., 1999, 2000, 2004, 2005; DHHS, 2001). Moreover, prevalences of overweight and obesity are especially high in subpopulations that are overrepresented in the WIC population (Flegal et al., 2002, Kumanyika et al., 1999; Paeratakul et al., 2002; Wardle et al., 2002).
Some parents may choose to feed their infants complementary foods before the age of 6 months, but the committee did not find a developmental or nutritional rationale to provide complementary foods in the WIC food package before age 6 months.