Tools and Cutoff Points to Assess Inappropriate Infant Feeding in the WIC Setting

Almost all states use inappropriate infant feeding as a nutrition risk criterion for infants. In general, inappropriate intake is assessed by either a 24-hour recall or specially targeted questions about infant feeding practices. In a field test of the impact of the WIC program on the growth and development of children, Puma and colleagues (1991) documented the inadequacies of using 24-hour recalls for assessing the dietary intakes of infants. These investigators examined infant feeding by asking a set of questions on breastfeeding, the type of milk or formula being used, the type of solid foods being consumed, and when these foods were introduced into infant diets. Similarly, the 1988 NMIHS included a series of questions on infant feeding practices that could be used in the WIC program setting to assess infant feeding practices (Gordon and Nelson, 1995).

Recommendation for Inappropriate Infant Feeding

Risks from most inappropriate infant feeding practices described above are well documented. Acceptable methods are available for identifying these practices. The potential for benefit from participation in the WIC program is expected to be good based on theoretical and indirect empirical evidence. Therefore, the committee recommends use of selected inappropriate infant feeding practices as risk criteria for use by all states, as listed in Table 6-3.

Inappropriate Use of Nursing Bottle

Rampant dental caries affecting the primary teeth of infants and young children can result from the practice of allowing the child to fall asleep with a bottle filled with a fermentable liquid (fruit juice, milk, or other beverage with added sugar). This form of caries is known by several names, including nursing bottle caries, baby bottle tooth decay, and nursing bottle syndrome.

Prevalence of Inappropriate Use of Nursing Bottle

Data on the prevalence of baby bottle tooth decay are inadequate because young children do not usually receive routine dental care or examinations. Reports have indicated that 2.5 to 14 percent of U.S. preschool age children show evidence of extensive tooth decay (Derkson and Ponti, 1982; Johnsen,



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