Complementary Feeding Interventions for Infants and Young Children Under Age 2 Scoping of Promising Interventions to Implement at the Community or State Level (2023) / Chapter Skim
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7 Implications and Considerations for Design of Interventions to Improve Infant and Young Child Feeding Behavior in the United States
7 Implications and Considerations for Design of Interventions to Improve Infant and Young Child Feeding Behavior in the United States
Pages 153-190
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The expansion and harmonization of existing supports for complementary feeding in the United States across settings would facilitate families with young children receiving consistent messages 153
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, which are populations of high relevance for public health interventions. The 10 health care setting studies conducted outside the United States and Canada often enrolled participants outside of pediatric clinics (e.g., parent groups, home visits)
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. Beneficial effects on what to feed and on how to feed were noted both from interventions delivered by physicians and from interventions delivered by other health care personnel, suggesting that further studies focused on interventions delivered by registered dietitians, psychologists, social workers or other health professionals might facilitate future implementation.
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Furthermore, augmentation of services by community health workers or peer counselors would greatly enhance the feasibility of population-wide nutrition education in the health care setting (Burt and Sisselman-Borgia, 2020)
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More research can help to improve understanding of how to best support the involvement of home-based care providers with repeated exposure as well as other complementary feeding interventions. The Child and Adult Care Food Program (CACFP)
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. This existing infrastructure could help with translating complementary feeding interventions into ECE settings, since community and parent engagement are essential.
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. The committee concludes that the existing infrastructure of both CACFP and EHS could be enhanced to improve translation of complementary feeding interventions in ECE settings.
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Intentional partnerships between cooperative extension academics and educators and settings focused on complementary feeding of children under age 2 years could improve nutrition education and training options for caregivers, early childhood educators, and paraprofessionals such as community health workers, and could have a significant impact on complementary feeding interventions. 1 See https://eatingsmartbeingactive.colostate.edu/eating-smart-%e2%80%a2-being active/about/description (accessed June 27, 2023)
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met the eligibility criteria for inclusion in this scoping review of promising interventions around complementary feeding, the WIC program, through the provision of healthy first foods paired with human milk feeding support and nutrition education, is itself already a highly impactful complementary feeding intervention for infants and young children under age 2 years. There is extensive published literature on WIC and program impacts, including a recent systematic review of maternal and child health outcomes associated with program participation (Caulfield et al., 2022)
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Thus, exploring appropriate funding approaches to expand the reach of WIC nutrition education and human milk feeding support to families with incomes above the 185 percent of the federal policy level income threshold has great potential for optimizing complementary feeding for all families in the United States. Home Visiting As noted in Chapter 3, U.S.
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. Unlike the other settings discussed thus far, the biggest barrier to leveraging home visiting to deliver infant and young child feeding interventions is its limited reach within the U.S.
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The committee concludes that home visiting programs could feasibly implement many of the interventions identified as efficacious in this scoping review. There is the opportunity for home visiting programs to expand their involvement in the delivery of complementary feeding interventions in the United States To facilitate this, multiple settings (e.g., health care, ECE, CE, WIC)
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There are clear opportunities to enhance the focus on complementary feeding in each setting through the expansion of funding to support the workforce necessary for such efforts and the integration of nutrition into existing initiatives. COLLECTION AND APPLICATION OF STANDARDIZED INFANT AND YOUNG CHILD FEEDING OUTCOMES The collection of a harmonized set of process and impact outcomes across the settings described in this report would have several practical implications.
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. The current report presents evidence that complementary feeding interventions increased child consumption of fruits and vegetables, improved caregiver responsive feeding behaviors, and decreased child consumption of SSBs and snacks high in added sugar or salt.
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Although the research studies on complementary feeding interventions reviewed in this report used many different approaches, the predominant approach was caregiver self-report via questionnaires. While it may be feasible for program personnel to collect self-reported information via questionnaire, many research questionnaires may be too long and complex to use as part of standard operations.
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REACHING UNDERSERVED POPULATIONS It is a priority of the sponsor and the committee that any complementary feeding intervention or strategy maximize the potential for equitable reach to diverse populations, which is why the sponsor requested the committee to describe ways that interventions could reach underserved populations and improve equity. The previous chapters have detailed studies that provide promising interventions around complementary feeding in early childhood.
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. A crucial step in future work to implement complementary feeding interventions will be to ensure that the strategies that have been shown to work effectively in more highly resourced populations can be implemented in less-resourced ones.
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At the center of the work on complementary feeding, and also a focus of the previous chapters, is the evidence surrounding the important behaviors related to what to feed and how to feed. Interventions that fail to consider the diverse social determinants that influence what and how to feed -- ranging from diversity in basic access to healthy, affordable food options to cultural norms and practices around feeding -- are unlikely to be successful at achieving optimal outcomes across diverse populations.
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. The committee concludes that the successful implementation of complementary feeding interventions in underserved populations will require partnership, collaboration, and community engagement with the target populations throughout the research, implementation, and scale-up processes.
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The committee concludes that for the anticipatory guidance, nutrition education, and brief targeted feeding interventions reviewed in this report to be most effective, they should also assess and address food insecurity. Food Marketing Food marketing is ubiquitous in the United States.
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Notably, while the United States has a school meals program that includes nutrition standards to ensure healthy meals and some nutrition education occurs in U.S. schools (NCES, n.d.)
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In the United States, it is possible to envision an INFANT-like program delivered through WIC, CE (SNAP-Ed or EFNEP) , child care centers (including EHS)
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. Since Family Spirit is delivered in primarily rural and reservation-based communities that have experienced historical and present-day marginalization, the scaling of this community-co-designed, culturally sensitive infant and young child feeding intervention could have important health equity implications.
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In chapter 6, the committee describes factors for consideration in scaling infant and young child feeding interventions. As the INFANT program has shown, translational trials and implementation monitoring and evaluation are crucial when going to scale.
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It discussed the collection and application of standardized infant and young child feeding outcomes and ways to reach underserved populations with complementary feeding interventions. Additional considerations, including food insecurity, food marketing, and nutrition literacy were also addressed.
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2021. The child and adult care food program and home-based child care providers: Expanding participation.
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2011. Impact of internet vs traditional Special Supplemental Nutrition Program for Women, Infants, and Children nutrition education on fruit and vegetable intake.
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2009. Assessing an infant feed ing web site as a nutrition education tool for child care providers.
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2019. Beverage policy implementation by Child and Adult Care Food Program participation and program type: A statewide examination in Georgia.
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2018. Participa tion in the Child and Adult Care Food Program is associated with healthier nutrition environments at family child care homes in Mississippi.
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2020. Child care sites participating in the federal Child and Adult Care Food Program provide more nutritious foods and beverages.
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2020. Impact of changes to the Child and Adult Care Food Program on children's dietary intake in family child care homes.
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2022. Child and Adult Care Food Program participation benefits, barriers and facilitators for independent child care centers in California.
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n.d. Child care licensing laws for nutrition, active play and screen time -- Snapshot: Maryland.
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2012. Participation in the Child and Adult Care Food Program is associated with more nutritious foods and beverages in child care.
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2022a. Child and Adult Care Food Program.
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2020. Participation in the Child and Adult Care Food Program is associated with fewer barri ers to serving healthier foods in early care and education.
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