Food Packages I and II for Infants

Change in Age Specifications and Breastfeeding Categories

The committee made several important changes to the age specifications and breastfeeding categories for infants. Each merits priority for pilot testing and randomized, controlled trials.

The committee recommends that Food Package I serve infants from birth through age 5 months and that Food Package II serve infants ages 6 months through 11 months. Currently, the shift from Food Package I to II occurs at age 4 months. The proposed Food Package I would provide only iron-fortified infant formula for partially breast-fed and fully formula-fed infants until an infant is 6 months old. This change is consistent with recent position statements from the American Academy of Pediatrics emphasizing that the introduction of complementary feedings before 6 months of age only substitutes foods that lack the protective components of human milk and that exclusive breastfeeding should be used as the reference or normative model for feeding infants.

To support the successful establishment of breastfeeding, the committee recommends offering only two feeding options initially—full breastfeeding or full formula feeding. That is, formula would not be provided routinely during the first month after birth for any infants whose mothers intend to breastfeed. In a few circumstances, a small amount of powdered formula may be provided during the first month after birth if needed as the mother/infant pair establish a pattern of breastfeeding. As currently is the case, the breastfeeding mother could ask to have the infant assigned to full formula feeding at any time.

Beginning the second month after birth, a third infant feeding option is available—partial breastfeeding. The committee proposes the following definition of a partially breast-fed infant for the purpose of assigning WIC food packages: the infant is breast-fed but also receives formula from the WIC program in an amount not to exceed approximately half the amount of formula allowed for a fully formula-fed infant. In contrast, the current approach provides the same amount of formula to partially breast-fed and fully formula-fed infants and could allow a mother who breastfeeds an average of once daily to qualify as a breastfeeding woman. Under the new proposal, breastfeeding mothers who request more than the amount of formula allowed for partially breast-fed infants could receive up to the maximum amount of formula for the fully formula-fed infant, but the mother no longer would be eligible for Food Package V for a partially breastfeeding mother. Because Package V is more desirable than the package for non-breastfeeding mothers, this change might encourage a higher

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