Infant Feeding and Feeding Transitions During the First Year of Life

Abstract

OBJECTIVE. Infancy is a time of rapid transition from a diet of virtually nothing but milk (either breast milk or infant formula) to a varied diet from nearly all food groups being consumed on a daily basis by most infants. Despite various recommendations about infant feeding, little is known about actual patterns of feeding among US infants. This article documents transitions in infant feeding patterns across the first year of life and determinants of key aspects of infant feeding.METHODS. Using data from the Infant Feeding Practices Study II, we analyzed responses to a 7-day food-recall chart that was administered every month. The sample size declined from 2907 at birth to 1782 at 12 months of age.RESULTS. Although 83% of survey respondents initiated breastfeeding, the percentage who breastfed declined rapidly to 50% at 6 months and to 24% at 12 months. Many of the women who breastfed also fed their infants formula; 52% reported that their infants received formula while in the hospital. At 4 months, 40% of the infants had consumed infant cereal, 17% had consumed fruit or vegetable products, and Ͻ1% had consumed meat. Compared with infants who were not fed solid foods at 4 months, those who were fed solid foods were more likely to have discontinued breastfeeding at 6 months (70% vs 34%) and to have been fed fatty or sugary foods at 12 months (75% vs 62%).CONCLUSIONS. Supplementing breast milk with infant formula while infants were still in the hospital was very common. Despite recommendations that complementary foods not be introduced to infants aged 4 months or younger, almost half of the infants in this study had consumed solid foods by the age of 4 months. This early introduction of complementary foods was associated with unhealthful subsequent feeding behaviors. Pediatrics 2008;122:S36-S42 T HE AMERICAN ACADEMY of Pediatrics (AAP) recommends that infants be breastfed exclusively for the first several months of life and that breastfeeding should continue through the first year of life. The AAP Committee on Nutrition recommends that infants begin consuming foods in addition to breast milk or formula after 4 months of age, preferably at 6 months of age. 1,2 Early foods should include a source of iron, either fortified infant cereal or meat, but foods high in fat or sugar (eg, sugar-sweetened beverages, French fries, and candy) should not be given to infants. 3 Within these constraints, infants should be introduced to a variety of foods as they transition to table foods. 4 Little is known about current patterns of feeding among US infants during their first year of life. The Feeding Infants and Toddlers Study, a cross-sectional study of US children aged 4 to 24 months conducted in 2002, documented infant and child food intake on the basis of one or two 24-hour recalls but did not collect detailed information on younger infants. 5 In the study described here, we attempted to fill this knowledge gap by assessing milk and formula consumption among a large sample of US infants, as well as changes in their d...

Sources of Supplemental Iron Among Breastfed Infants During the First Year of Life

“…Mothers should be encouraged to breastfeed exclusively for approximately the first 6 months of their infant's life and also should be informed about appropriate introduction of iron-rich foods to their infant at ϳ6 months of age. In the United States, iron-fortified infant cereal is often the first food other than breast milk or formula given to infants, and meat is generally introduced into their diet much later (see ref 14). Both infant cereal and meat, however, are good sources of iron and can be among the first complementary foods to which infants are introduced.…”

Fruit Juice in Infants, Children, and Adolescents: Current Recommendations

“…42 For mothers who cannot breastfeed or who choose not to breastfeed, a prepared infant formula can be used as a complete source of nutrition. No additional nutrients are needed.…”

Selected Complementary Feeding Practices and Their Association With Maternal Education

“…Because some mothers did not complete each survey until several weeks after it was mailed, and a few waited several months, we analyzed all data by the age of the infants when the questionnaires were actually completed, which was determined by a question that asked the mothers to provide the date they completed the questionnaire. Using the same procedures described by Grummer-Strawn et al, 9 we created the following age categories for analysis: 3 to 6 weeks (1 month), 7 to 10 weeks (2 months), 11 to 14 weeks (3 months), 15 to 18 weeks (4 months), 19 to 23 weeks (5 months), 24 to 28 weeks (6 months), 29 to 35 weeks (7 months), 36 to 42 weeks (9 months), 43 to 50 weeks (10.5 months), and 51 to 59 weeks (1 year). For example, if the mother completed the 4-month questionnaire when her infant was 22 weeks old, we included the data in the 5-month age group (19 -23 weeks) instead of the 4-month (15-18 weeks) age group.…”

“…The prevalence of other infant feeding practices among US mothers, including breastfeeding, the introduction of various foods, and feeding of sugary or fatty foods, is described by Grummer-Strawn et al elsewhere in this supplement. 9 …”