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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

Summary1

Recommendations for feeding infants and young children have changed substantially over time owing to scientific advances, cultural influences, societal trends, and other factors. At the same time, stronger approaches to reviewing and synthesizing scientific evidence have evolved, such that there are now established protocols for developing evidence-based health recommendations. However, not all authoritative bodies have used such approaches for developing infant feeding guidance, and for many feeding questions there is little or no sound evidence available to guide best practices, despite the fact that research on infant and young child feeding has expanded in recent decades. Summarizing the current landscape of feeding recommendations for infants and young children can reveal the level of consistency of existing guidance, shed light on the types of evidence that underpin each recommendation, and provide insight into the feasibility of harmonizing guidelines.

THE COMMITTEE’S TASK AND APPROACH

With support from the Centers for Disease Control and Prevention and from the National Institutes of Health, the National Academies of Sciences, Engineering, and Medicine convened an ad hoc consensus committee that was asked to collect, compare, and summarize existing recommendations on what and how to feed infants and young children from birth to

___________________

1 This summary does not include references. Citations to support the text herein are provided in the body of the report.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

24 months of age (see Box S-1). The committee was also asked to make recommendations to stakeholders on strategies for communicating and disseminating feeding recommendations.

The committee’s search for guideline documents that included recommendations on what and/or how to feed infants and children from birth to 24 months focused on resources from government agencies and from authoritative domestic and international organizations. Guideline documents were found by performing targeted website searches, further supplemented by using the Food and Agriculture Organization of the United Nations’ catalog of food-based dietary guidelines, by leveraging expert input, and by searching databases (e.g., ECRI Institute Guideline Trust, CPG Infobase: Clinical Practice Guidelines, PubMed).

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

The identified documents and resources varied in span and scope, and they required a screening process to determine whether the guideline document contained feeding recommendations and, if so, which of the recommendations addressed the concepts of what or how to feed infants and young children. To that end, the committee established guideline document-level and recommendation-level eligibility criteria (see Table S-1).

TABLE S-1 Guideline Document- and Recommendation-Level Eligibility Criteria

Level Inclusion Criteria Exclusion Criteria
Guideline document-level eligibility criteria
  • The most current recommendations or guidelines from authoritative agencies and organizations
  • Documents that provided guidance related to what or how to feed human milk, infant formula, other foods and beverages, and supplements to infants and children younger than 24 months of agea
  • Includes guidance relevant to high-income countriesb
  • Includes general guidance for the healthy mother–infant dyad, without consideration of modifying adverse clinical health conditions
  • Readily available on the Internet
  • Documents that exclusively provide feeding recommendations for preterm infants
  • Clinical treatment guidelines for a specific disease or condition
  • Guideline documents from, for, funded by, or in collaboration with industry
  • Documents that exclusively provide guidance related to clinical management of lactation
  • Position statements that only support or describe the benefits of breastfeeding without providing additional recommendations about how to feed (e.g., duration, frequency)
  • Position statements that only recommend methods for preparing and storing foods, including breastmilk and formula
  • Guidance for establishing or operating donor milk banks
  • Documents providing guidance related to malnutrition or emergency situations
  • Guidance relevant to the intake of breastfeeding mothers
  • Documents about infant formula composition
  • Documents that have the primary purpose of being a communication or dissemination tool (e.g., training manual, pamphlets)
  • Documents published before 2000
  • Documents not available in English
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

TABLE S-1

Level Inclusion Criteria Exclusion Criteria
Recommendation-level eligibility criteria
  • Recommendations that provide guidance related to what and/or how to feed human milk, infant formula, other foods and beverages, or supplements to infants and children younger than 24 months of agec
  • Recommendations on topics listed in the document-level exclusion criteriad
  • Dietary Reference Intake or other dietary reference values for individual nutrients
  • Recommendations related to peanut allergy prevention that were prepared or published before the release of the LEAP triale

NOTE: LEAP = Learning Early About Peanut Allergy.

a Summaries of the state of science in an attempt to make recommendations, but which found inadequate evidence to do so, were considered eligible.

b Countries’ income levels classified using the fiscal year 2020 World Bank classification (https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups; accessed November 8, 2019).

c Recommendations may include the primary prevention of food allergies and other common conditions (e.g., diarrhea, constipation, dental caries). However, recommendations on the treatment of a condition were excluded.

d Recommendations were excluded if they were about preterm infants; clinical treatment of a specific disease or condition; clinical management of lactation; the benefits of breastfeeding; methods for preparing and storing foods, including breastmilk and formula; malnutrition or emergency situations; intake of breastfeeding mothers; or infant formula composition.

e Many agencies, organizations, and groups used the LEAP trial to update feeding guidelines related to the primary prevention of peanut allergy. Inclusion of peanut allergy–related recommendations predating the release of the LEAP trial results would unnecessarily introduce inconsistency and those earlier recommendations were therefore excluded.

The committee abstracted each eligible recommendation verbatim, along with the type of evidence that directly mapped to the recommendation and the associated strength-of-evidence rating, if available. Abstracted recommendations were sorted by topic area and thematically grouped within each topic. Within each theme, the committee reviewed the guidance provided in the verbatim recommendations to describe the level of consistency across guideline documents. The committee also summarized the type of evidence that mapped to each recommendation within a given theme.

For each guideline document, the committee noted any information that the organization included about communicating or disseminating the feeding recommendations. As the available guidance was limited in scope, the committee performed exploratory scans for examples of communication and dissemination materials from the resources and websites reviewed in its guideline document search.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

CONSISTENCY OF EXISTING FEEDING RECOMMENDATIONS

The committee identified 156 potentially relevant documents, webpages, and resources through its various search strategies. After applying the eligibility criteria, 43 guideline documents remained to be reviewed in more detail. Included guideline documents reflected the contributions of 26 different agencies, organizations, or groups from Australia, Canada, Europe, Italy, New Zealand, the United Kingdom, and the United States, along with global guidance from the World Health Organization. Nine of the guideline documents were collaborative efforts between two or more organizations.

The included guideline documents varied with respect to the document type (e.g., position statement, clinical practice reports), level of collaboration across organizations, scope of topics covered, target audiences, overall methodologies, presentation of recommendations, and mapping of evidence to each recommendation. Few guideline documents graded the evidence, and those that did often used different rating systems. This heterogeneity likely contributed to some of the noted inconsistencies found across recommendations.

Comparison of Guidance on What to Feed

The majority of abstracted recommendations provided guidance on what to feed (as opposed to how to feed) infants and young children from birth to 24 months. Eligible recommendations were found in all 43 guideline documents. The committee grouped the recommendations into 18 topic areas, with most topic areas having multiple themes. The committee’s comparison of recommendations on what to feed children from birth to 24 months of age is presented in Table S-2. The type of evidence mapping to each recommendation was varied. Most recommendations mapped to narrative reviews, with fewer mapping to systematic reviews. Some recommendations mapped to other types of evidence (e.g., government reports and websites, single scientific publication) and some could not be mapped to any specific evidence.

Comparison of Guidance on How to Feed

Approximately one-third of the abstracted recommendations provided guidance related to how to feed infants and young children from birth to 24 months of age. Eligible recommendations were found in 23 of the guideline documents. The committee grouped the recommendations into eight topic areas, with most topic areas having multiple themes. The committee’s comparison of recommendations on how to feed children from

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

TABLE S-2 Summary of the Consistency of Recommendations on What to Feed Infants and Young Children, by Topic Area

Topic Area Summary of Consistency Across Recommendations
Exclusive breastfeeding
  • Generally consistent in terms of recommending exclusive breastfeeding for up to, about, or around 6 months of age
Continuation of breastfeeding
  • Generally consistent in being in support of continuing breastfeeding for at least 12 months
  • Not consistent in terms of the specific age to which breastfeeding should be continued
Supplementary formula feedings
  • Consistent in indicating that breastfed infants should not be routinely given supplementary formula feedings
Duration of formula use
  • Generally consistent in recommending that, for formula-fed infants, commercial infant formula should be used until 12 months of age
  • Consistent in indicating that infant formula is not needed beyond 12 months of age
Type of infant formula
  • Consistent in recommending cow milk–based infant formulas for formula-fed infants
  • Consistent in recommending that the use of soy-based formula be limited to special circumstances
Toddler milks and follow-on formulas
  • Consistent in recommending against the general use of toddler milks
Milk and milk-based products
  • Generally consistent in recommending against cow milk before 9 months of age
  • Not consistent regarding suitability of cow milk for infants 9–12 months of age
  • Not consistent in whether milk can be added to complementary foods before 12 months of age
  • Generally consistent in indicating that whole milk should be provided to children in the age range of 12–24 months
  • Consistent in indicating that the amount of cow milk should be limited for children 12–24 months of age
  • Some inconsistencies in the recommended limit for the amount of cow milk for children 12–24 months of age
  • Consistent in recommending against providing flavored milk to infants and young children
Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages
  • Consistent in discouraging the provision of water to breastfed infants 0–6 months of age
  • Consistent in recommending provision of water to infants 6–12 months of age and children older than 1 year
  • Generally consistent in stating that juice should not be provided in the first 12 months of life
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

TABLE S-2

Topic Area Summary of Consistency Across Recommendations
Fluids: Water, juice, sugar-sweetened beverages, and other nonmilk beverages
  • Generally consistent in recommending that juice intake for toddlers not exceed 4 ounces per day
  • Consistent in recommending against providing infants and young children with sugar-sweetened beverages
  • Consistent in recommending against providing coffee, tea, and caffeinated beverages to infants and young children
  • Generally consistent in recommending against providing plant-based beverages to infants or young childrena
Substances to avoid or limitb
  • Consistent in recommending that foods for infants and young children should be prepared without added sugars
  • Consistent in recommending that if pre-prepared foods and snacks are offered to young children, they should contain no or limited added or total sugars
  • Consistent in recommending that if foods with sugars are consumed, they should be consumed at mealtimes instead of as snacks
  • Consistent in advising against dipping pacifiers or bottle teats in substances with sugars
  • Consistent in recommending that foods for infants and young children be prepared without adding salt
  • Consistent in recommending that if pre-prepared foods and snacks are offered to young children, they should contain no or limited salt
Variety and healthy, nutritious foods
  • Consistent in recommending that a variety of foods and food groups, textures, and flavors can help meet nutritional requirements
Fruits and vegetables
  • Consistent in recommending consumption of a variety of fruits and vegetables
Vegetarian and vegan diet
  • Consistent in stipulating the need for a carefully planned diet to meet requirements for several key nutrients
  • Some inconsistencies in explicitly mentioning a need for fortified products or nutrient supplements for vegans
  • Generally consistent in mentioning plant-based beverages as an option for toddlers in the context of specific dietary preferences
Foods associated with food allergy and celiac disease
  • Consistent in recommending that introduction of potentially allergenic foods should not be delayed
  • Not consistent in recommending when and how to introduce peanuts based on the infant’s risk for peanut allergy
  • Generally consistent in recommending not delaying introduction of allergenic food beyond 6 months of age, including eggs
Iron
  • Consistent in acknowledging the importance of iron-rich complementary foods
  • Not consistent in recommended age of introduction of iron-rich complementary foods
  • Consistent in recommending that formula-fed infants be given iron-fortified infant formulas until at least 6 months of age
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

TABLE S-2

Topic Area Summary of Consistency Across Recommendations
Iron
  • Some inconsistencies in duration of use of iron-fortified formulas for formula-fed infants, and suggested iron content of infant formulas
  • Generally consistent in advising against general use of iron supplementsc
  • Consistent in recommending the need for adequate intake of iron among infants fed vegetarian or vegan diets
Vitamin D
  • Generally consistent in recommending vitamin D supplementation among breastfed infants
  • Consistent in relating the need for vitamin D supplementation for formula-fed infants to the total amount of daily infant formula intake
  • Not consistent regarding the amount of infant formula intake that necessitates vitamin D supplementation
  • Consistent in recommending vitamin D supplementation for high-risk or vitamin D–deficient children 12–24 months of age
Iodine
  • Consistent in recommending against the use of iodine supplements
Other nutrient supplements
  • Generally consistent in stating that nutrient supplements are not needed for infants and young children consuming a healthy, varied dietd
  • Consistent in recommending that fluoride supplementation for infants and young children be contingent on the fluoride status of the water supply
Dietary fat
  • Consistent in noting the importance of diets with adequate fat content
  • Consistent in recommending against foods high in saturated and/or trans fats
  • Consistent in recommending plant oils

NOTE: The committee uses the following phrases to describe consistency of recommendations:

  • Consistent indicates alignment across the recommendations.
  • Generally consistent indicates that the recommendations tended to provide similar guidance, although there were some differences in details or wording.
  • Some inconsistencies indicates mixed recommendations, some of which align.
  • Not consistent indicates recommendations provided different guidance on a topic.

a This statement pertains to general use of plant-based beverages. A caveat is noted in the “Vegetarian and vegan diet” section.

b Recommendations regarding foods to avoid or limit based on food safety considerations (e.g., unpasteurized beverages, honey due to the risk of botulism) are summarized in Table S-3 in the “Safety of foods and feeding practices” section.

c A recommendation in a 2010 guideline document predated the acceptance of delayed cord clamping in the United States, which changed iron supplementation recommendations for infants. The statement of consistency reflects only the more recent guideline documents.

d This statement pertains to nutrient supplements generally. Consistency of recommendations related to supplementing specific nutrients are noted elsewhere in the table.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

birth to 24 months of age is presented in Table S-3. As was the case with recommendations on what to feed infants and young children, the type of evidence mapping to each recommendation varied, but the recommendations predominantly mapped to narrative reviews.

TABLE S-3 Summary of the Consistency of Recommendations on How to Feed Infants and Young Children, by Topic Area

Topic Area Summary of Consistency Across Recommendations
Bottle use and propping
  • Generally consistent in recommending against certain foods and fluids being added to bottles
  • Generally consistent in recommending that bottle use be discontinued at about 12 months of age
  • Generally consistent in recommending that infants not go to bed or to sleep with a bottle
  • Consistent in recommending against bottle propping
Cup use
  • Generally consistent in recommending that infants should transition to cups at 6–12 months of age
  • Generally consistent in recommending that milk should be served to toddlers in a cup
Safety of foods and feeding practices
  • Consistent in recommending that milk, milk products, and juice given to children should be pasteurized
  • Consistent in recommending against giving honey to children under 1 year of age due to risk of botulism
  • Generally consistent in recommending against consumption of raw or undercooked eggs
  • Consistent in advising about choking hazards, although examples provided varied across guideline documents
  • Consistent in recommending that infants and young children be supervised while eating
Introduction of complementary foods
  • Generally consistent in recommending that complementary foods not be introduced before 4 months of age nor delayed to after 6 months of age
  • Not consistent in whether the recommended age of introduction is an age range (4–6 months) or is focused on introduction at (approximately) 6 months
  • Consistent in recommending that the first foods offered to infants be iron rich or iron fortified
  • Consistent in recommending gradual introduction of new foods
Food consistency and texture
  • Consistent in recommending that food consistency and texture be tailored to the developmental needs of the child
  • Consistent in recommending that consistencies and textures of foods offered should change as the child gets older
Meal frequency
  • Generally consistent in recommending that a consistent meal schedule be established
  • Generally consistent in recommending that young children need several eating occasions, both meals and snacks, over the course of the day
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

TABLE S-3

Topic Area Summary of Consistency Across Recommendations
Hunger and satiety cues
  • Generally consistent in emphasizing the importance of using hunger and satiety cues to guide infant and child feeding
Responsive feeding
  • Generally consistent in recommending that the feeding environment be pleasant and include nurturing behaviors (e.g., verbalization, eye-to-eye contact, not forcing the child to eat)
  • Consistent in recommending that repeated exposure is needed for children to accept new foods
  • Generally consistent in recommending that self-feeding and self-regulation be encouraged in infants and toddlers

NOTE: The committee uses the following phrases to describe consistency of recommendations:

  • Consistent indicates alignment across the recommendations.
  • Generally consistent indicates that the recommendations tended to provide similar guidance, although there were some differences in details or wording.
  • Some inconsistencies indicates mixed recommendations, some of which align.
  • Not consistent indicates recommendations providing different guidance on a topic.

COMMUNICATION AND DISSEMINATION OF FEEDING RECOMMENDATIONS

The feeding guideline documents reviewed by the committee generally did not describe complex, multisector implementation strategies. Accordingly, the committee focused on information contained within the guideline documents related to changing knowledge, attitudes, and/or behaviors, and the channels by which to spread feeding guidance. Of the 43 eligible guideline documents the committee reviewed, 25 included a statement or section related to communicating or disseminating the feeding recommendations. Most of the guideline documents the committee reviewed were specifically developed for one or more target audiences, with a large majority aimed at health care providers (e.g., physicians, nurse practitioners, nurses, dentists, registered dietitian nutritionists, and other nutrition professionals). Other target audiences included parents and guardians, early care and education providers, program administrators, and policy makers. Communication and dissemination approaches were varied across these different target audiences:

  • Health care providers: The guideline documents primarily focused on the health care provider as a critical nexus for guiding caregiver practices. The guideline documents encouraged practitioners to promote awareness, changes in attitudes and knowledge, and adoption of recommendations, and to engage in advocacy.
  • Parents and guardians: Although the importance of providing parents and guardians with specific feeding guidance was acknowl-
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
  • edged, these groups were infrequently the target audience for the guideline documents reviewed. A host of online resources is available to parents and guardians, but these materials are sometimes inconsistent in directly mapping back to a guideline document.

  • Early care and education providers: Despite being integral players in infant and young child feeding, early care and education providers were often not the target audience of the guideline documents the committee reviewed. The committee notes that, in the United States, this stakeholder group has a key publication that provides national health and safety performance standards, referred to as Caring for Our Children. One of the standards included relates to nutrition and draws on feeding recommendations from authoritative organizations.
  • Program administrators: Program administrators were also not a primary target audience for most of the included guideline documents. The Child and Adult Care Food Program and the Special Supplemental Nutrition Program for Women, Infants, and Children are two key federal programs in the United States that integrate feeding recommendations into practice. Although the committee did not find an eligible guideline document from or for these programs, it did identify recent key resources that translated feeding recommendations, national policy, and federal regulations into programmatic guidance.
  • Policy makers: Some of the guideline documents reviewed included recommendations targeting policy makers. The level of detail provided for this target audience varied. For instance, one organization expressed strong support for national policies and legislation related to the feeding recommendations, whereas another guideline document provided explicit guidance to the government.

The guideline documents the committee reviewed were limited in their descriptions of best practices or approaches to communication and dissemination of the feeding recommendations. There is a need to better understand effective communication and dissemination techniques for each of the target audiences, with special consideration of issues of equity, especially in light of an increasing recognition of the association between social determinants of health and persistently observed health disparities, the changing landscape of mobile health devices and applications, and the role of social networks in influencing knowledge, attitudes, and behaviors.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

CONCLUSIONS AND FUTURE DIRECTIONS

Across the 26 topic areas related to what to feed and how to feed infants and young children, the committee found that many of the recommendations from the various organizations were consistent or generally consistent. When there was inconsistency, it often related to the specific ages or age ranges stated in the recommendation. Although the committee found considerable variability in the wording of recommendations, in many cases, the differences in wording were subtle.

Overall, recommendations often mapped to narrative reviews. Within most of the themes, at least one of the recommendations for that theme mapped to a systematic review. For some themes, the committee was unable to map a few of the recommendations to the evidence, and for others, the guideline document indicated that there was little or no evidence to support a recommendation. In almost all cases, the body of evidence for a given recommendation was not formally graded.

As many organizations had recommendations on the same topics, and many recommendations were generally consistent, there is substantial potential for harmonization using a collaborative approach. Collaboration on feeding guidelines, starting at the development phase and continuing through the dissemination phase, is likely to facilitate the harmonization of guidance. Harmonization of the process for developing feeding guidelines does not necessarily imply that the specific feeding recommendations need to be exactly the same across countries, communities, and professional organizations. In fact, the need to customize guidance for particular target audiences and contexts means that some of the wording of recommendations may vary, especially in the dissemination and communication products.

Harmonizing the Development of Future Feeding Guidelines

Across the collection of guideline documents reviewed, the committee identified a range of methodological approaches taken to develop feeding recommendations. This heterogeneity has implications for the consistency and quality of guideline documents, and it underscores the need to consider ways to harmonize the process. Based on its review and comparison of feeding recommendations, along with its collective expertise, the committee offers insight to help align and improve future guidelines.

Preparing to Develop the Guidelines

When developing feeding guidelines, there are several potential advantages of using a collaborative approach that involves multiple organizations

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

from the start of the process. If a formal systematic review of the evidence is to be conducted, this process can be centralized so that all of the organizations or a consortium of organizations make use of the resulting review, potentially enhancing both quality and efficiency. Collaboration between organizations can also facilitate development of uniform standards for quality guidelines, avoid duplication of effort in generating recommendations, and establish consensus across organizations. Including key stakeholders, communication experts, and representatives of the target audience at the beginning stages can help to ensure that the final product is appropriately designed and disseminated.

Developing the Guidelines

Published criteria on developing high-quality guidelines stipulate that a range of best practices related to the guideline development process, review, and dissemination be consistently considered during each step and specified in the guideline document. Within the guideline document, recommendations need to be identifiable, specific, unambiguous, and explicitly linked to supporting evidence.

Planning for Dissemination and Implementation of Guidelines

Timely and effective dissemination of evidence-based recommendations is critical to bridge the practice chasm and improve feeding practices and health and developmental outcomes for infants and young children. Effective strategies are needed to support communication and dissemination of feeding guidance, and to promote the systematic uptake of guidelines.

Incorporating principles of dissemination and implementation (D&I) science may speed up the translation and application of recommendations. By identifying key influences on the adoption, implementation, and sustainability of interventions, D&I science provides vital information about how, when, by whom, and under what circumstances evidence spreads, both within or by organizations, and affects the intended population. Documenting any adaptations that are made in response to the local context and target audience can guide future D&I efforts for feeding guidelines, taking equity principles into account.

Thus, the committee recommends that agencies, organizations, and groups developing guideline documents related to feeding infants and young children should consider the principles of dissemination and implementation science as a means to enhance the reach and impact of the feeding recommendations that are developed.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×

CONCLUDING REMARKS

In spite of all of the differences in the ways that guideline documents were developed, it is encouraging that there was consistency for the majority of recommendations across a variety of authoritative organizations. For the future, it is important to harmonize the process across organizations and to use more rigorous methods for developing, communicating, and disseminating recommendations for feeding infants and children from birth to 24 months of age.

Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 1
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
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Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 3
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 4
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 5
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 6
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 7
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 8
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 9
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 10
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 11
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 12
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 13
Suggested Citation:"Summary." National Academies of Sciences, Engineering, and Medicine. 2020. Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. Washington, DC: The National Academies Press. doi: 10.17226/25747.
×
Page 14
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Recommendations for feeding infants and young children have changed substantially over time owing to scientific advances, cultural influences, societal trends, and other factors. At the same time, stronger approaches to reviewing and synthesizing scientific evidence have evolved, such that there are now established protocols for developing evidence-based health recommendations. However, not all authoritative bodies have used such approaches for developing infant feeding guidance, and for many feeding questions there is little or no sound evidence available to guide best practices, despite the fact that research on infant and young child feeding has expanded in recent decades. Summarizing the current landscape of feeding recommendations for infants and young children can reveal the level of consistency of existing guidance, shed light on the types of evidence that underpin each recommendation, and provide insight into the feasibility of harmonizing guidelines.

Feeding Infants and Children from Birth to 24 Months collects, compares, and summarizes existing recommendations on what and how to feed infants and young children from birth to 24 months of age. This report makes recommendations to stakeholders on strategies for communicating and disseminating feeding recommendations.

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