Although exclusive breastfeeding is recommended for infants up to 6 months of age (AAP, 2009), breastfeeding proportions in the United States range from 74 percent shortly after birth to 14 percent exclusively breastfeeding at 6 months (CDC, 2010). Breastfeeding prevalence is lower among women in low-income groups than for the general population: 71 percent for those at 100–184 percent of the poverty threshold compared to 78 percent for those at 185–349 percent of poverty (CDC, 2010). The first Feeding Infants and Toddlers Study (FITS), a comprehensive assessment of food and nutrient intakes of infants and toddlers, found that almost 30 percent of infants were fed complementary foods before the age of 4 months, when infants should be consuming only breast milk or formula (Briefel et al., 2004). The AAP, in its most recent recommendations, advises that the introduction of complementary foods be delayed until after 6 months of age (AAP, 2009) (also see Chapter 3, Table 3-1).
A study of participants in the Supplemental Nutrition Program for Women, Infants, and Children (WIC) (USDA/FCS, 1997) found, like the FITS study (Fox et al., 2004), that many 6–11-month-old infants had been introduced to foods earlier than recommended. Almost 25 percent of infants ages 9 through 11 months were fed cow’s milk (Briefel et al., 2004; USDA/FCS, 1997), which AAP (2009) recommends delaying until 1 year of age. Fruit juice intake exceeded AAP recommendations for about 60 percent of the children ages 1–2 years old in FITS (Skinner et al., 2004). Nonjuice fruit and vegetable consumption was low, with approximately 30 percent of infants and toddlers consuming no fruits or vegetables (Fox et al., 2004). The most common vegetable consumed by toddlers 15 months and older was fried potatoes (Fox et al., 2004).
Fox et al. (2006) reported that juice was second only to milk in the amount of energy contributed to the diets of children age 1 year. Among the other foods also reported to contribute significant percentages of the energy intake of children age 1 year were several that are high in solid fat and/or added sugars. These include sweetened beverages (4.7 percent of energy), cookies (3.2 percent), cakes and pies (1.7 percent), and chips and other salty snacks (1.3 percent), among others. Also, notably, more than 60 percent of 1-year-old children enrolled in WIC had usual sodium intakes above the Tolerable Upper Intake Level (UL) (IOM, 2006).