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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3 Considerations
3 Considerations
Pages 37-66
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The subsequent section describes methodological considerations and scalability aspects considered for the informative examples. FACTORS CONSIDERED IN MAPPING ALL INTERVENTIONS The committee reviewed all trials testing interventions aimed at improving infant and young child feeding behavior and extracted information from each related to the study setting, intervention, and outcomes.
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programs that include nutrition and feeding for young children. In addition, the committee included in its review interventions that occurred in two aligned settings (Special Supplemental Nutrition Program for Women, Infants, and Children [WIC]
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: Interventions were categorized as occurring in an ECE setting if they occurred in an early learning and development setting in which children are cared for and taught by people other than their parents or primary caregivers with whom they live. Examples include Early Head Start, child care centers, and family child care homes (Morrissey, 2019)
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Large family child care home: provides care and education of 7 to 12 children, including the caregiver's/teacher's own children in the home of the caregiver/teacher, with one or more qualified adult assistants to meet child:staff ratio requirements; and
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. ECE programs can provide nutritious foods, promote physical activity, limit screen time, support human milk feeding, create opportunities for outdoor learning, and participate in the Child and Adult Care Food Program (CACFP)
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states that: While ECE programs are not necessarily designed to improve child health, a growing body of research indicates that they may lead to short and long-term improvements in health-related outcomes. University Cooperative Extension Programs CE is a nationally funded system overseen by the U.S.
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. Much as in the case with EFNEP, CE professionals oversee and supervise community educators to deliver evidence-based SNAP–Ed activities focused on promoting healthy eating, increasing physical activity, reducing sedentary behavior, and improving food safety and food security (Yetter and Tripp, 2020)
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, WIC staff and participants discuss issues such as developing healthy eating habits in infants and young children, responsive feeding strategies, reading food labels when shopping, and preparing healthy meals. There is an expansive published literature on WIC and its impacts, including a recent systematic review of maternal and child health outcomes associated with program participation (Caulfield et al., 2022)
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The services may include facilitating access to obstetric and pediatric health care services, parental education and coaching, emotional support, developmental and behavioral health screening and referrals, advice on selecting high quality child care and preschools, referrals to other community services, and education and support around human milk feeding, complementary feeding (both what and how to feed) , and mitigating food insecurity (Kåks and Målqvist, 2020; NHVRC, 2018; Salvy et al., 2017)
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, demonstrating the potential for home visiting programs to play an important role in promoting recommended infant feeding practices and behaviors. Of the home visiting models that have had impact studies conducted to examine their effectiveness specifically with Tribal populations, one home visiting model (Family Spirit Nuture)
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Interventions In reviewing interventions aimed at improving infant and young child feeding behavior, the committee considered each intervention's type, mode, duration, location, and theoretical frameworks, as well as the rigor of the study design evaluating it. Type of Intervention While scoping the literature, the committee reviewed interventions aimed at improving what to feed and/or how to feed infants and young children after the initiation of complementary feeding.
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Duration of the Intervention Interventions ranged in duration from a single, brief interaction to an intervention that lasted 2 years; some interventions included contact with a single individual and others included multiple study staff, medical professionals, nutrition educators, community workers, or other professionals or paraprofessionals. Interventions influencing infant and young child feeding behaviors occurred at a variety of time points prenatally and throughout the first 2 years of life.
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on a different topic or using different feeding or parenting strategies, or interventions with and without additional components. Outcomes Complementary feeding intervention studies focusing on infants and young children under age 2 years have evaluated a variety of outcomes.
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. Elaboration likelihood model: Attitude changes are influenced by the content of persuasive communication and the strength of judgments (DiClemente et al., 2002)
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This parenting style encompasses responsive feeding (Baumrind, 1991; Maccoby, 1983)
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When interventions are randomly assigned at the cluster level, the trial is considered "cluster-randomized." Generally, the strength of randomized controlled trials is the high likelihood of baseline comparability of the randomized groups (approximately equal distribution of known and unknown confounders) so that differences are likely attributable to an effect of the intervention or a result of random error, which can be quantified.
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from one or more food groups • Provision of foods with a variety of textures and flavors How to • Use of responsive feeding • Timely transitions to selffeed/eat practicesa feeding (e.g., self-feeding • Providing appropriate portion finger foods, using utensils sizes and plates/bowls at meals, • Repeated exposure to new drinking from a cup) b foods or flavors • Eating same foods at the table • Weaning from the bottle and with family other bottle-feeding practices • Food responsiveness/ • Family meals emotional overeating • Eating without TV or other • Enjoyment of food screens • Desire to drink • Caregiver/family modeling of • Satiation responsiveness, healthy eating slowness in eating • Mealtime conversations about • Emotional undereating healthy eating • Food fussiness • Meal and snack frequency and regularity • Involving child in meal preparation a Responsive feeding describes a feeding process with reciprocity between parent and child in order to encourage the child to develop the skills needed to maintain a healthy dietary intake independently.
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FACTORS CONSIDERED IN ASSESSING INFORMATIVE EXAMPLES The committee reviewed each identified intervention aimed at improving infant and young child feeding behavior, assessed the strengths and weaknesses of the studies evaluating these interventions, and considered the aspects important for effectiveness and scalability. Intervention Methodology This section describes the committee's approach to the evaluation of study methods for the purpose of assessing internal validity, defined as the extent to which the design, implementation, and analysis of the study results provide an accurate indication of the impact of the intervention on the outcomes considered.
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. Quality of Outcome Assessment Instruments If valid conclusions are to be drawn from a study, the instruments used to measure the outcomes (e.g., feeding behaviors, child development)
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For cluster-randomized trials, a larger number of clusters increases internal validity. Second, validity can be influenced by the proportion of participants completing follow-up.
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Susceptibility to Biases There are several types of bias that are common concerns for studies evaluating counseling and education interventions. Among such studies, for example, outcomes assessed by participant report may be vulnerable to reporting bias motivated by social desirability (Nederhof, 1985)
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. If the structure of the data (e.g., participants clustered within clinics or child care sites)
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. The key measures that the committee assessed for maintenance include reported post-study intervention effects at the individual or site level (e.g., impacts on individual or site level outcomes 6 months post-study)
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Scalability Based on Existing Infrastructure in the United States Finally, the intervention designs were compared with the existing health care, ECE, and CE infrastructure in the United States to further assess scalability. To determine whether the existing U.S.
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2023. American Academy of Pediatrics' schedule of well-child care visits: AAP, Bright Futures.
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2022. Maternal and child outcomes associated with the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
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2021. Perspective: Design and conduct of human nutrition randomized controlled trials.
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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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2020. A scoping review of social–behaviour change techniques applied in complementary feeding in terventions.
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2020. SNAP-Ed FY 2019 Supplemental Nutrition Assistance Program Education through the land grant university system: A retrospective review of land-grant uni versity SNAP-Ed programs and impacts.
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