Transitions in feeding: Infant Feeding Practices Study II American Public Health Association Washington, DC November 5, 2007 Laurence M. Grummer-Strawn (CDC) Sara Fein (FDA) Kelley S. Scanlon (CDC)

Background – Recommendations on Infant Feeding Breastfeeding at least 12 months (AAP SOBr) Breastfeeding at least 12 months (AAP SOBr) Introduction of complementary foods at 4- 6 months (AAP CON) or at 6 months (AAP SOBr) Introduction of complementary foods at 4- 6 months (AAP CON) or at 6 months (AAP SOBr) Iron-rich foods (fortified cereal or meat) should be among the first foods (IOM, AAP CON) Iron-rich foods (fortified cereal or meat) should be among the first foods (IOM, AAP CON) Variety of complementary foods Variety of complementary foods Limitation of low nutrient-dense foods Limitation of low nutrient-dense foods

Key variables 7-day food frequency table of how many times each food/drink was fed 7-day food frequency table of how many times each food/drink was fed Reported in times per day or times per week Reported in times per day or times per week Asked at every postnatal questionnaire (Neonatal and months 2, 3, 4, 5, 6, 7, 9, 10.5, 12) Asked at every postnatal questionnaire (Neonatal and months 2, 3, 4, 5, 6, 7, 9, 10.5, 12)

Analysis Examination by age at date of questionnaire completion Examination by age at date of questionnaire completion –e.g. If 6-month questionnaire was completed at 36 weeks of age, it is included in the week age group If 2 questionnaires completed in the same age category, selected first completion If 2 questionnaires completed in the same age category, selected first completion

Complementary liquids given in the hospital

Complementary foods/drinks given in past 7 days at 3-7 weeks

Complementary foods/drinks given in past 7 days at weeks of age

Complementary foods/drinks given in past 7 days at weeks of age, by ever breastfed

Variety of foods 3 food groups 3 food groups –Baby cereal, other cereal –Fruits, vegetables –Meat, fish, eggs, combination dinners Examined consumption of each category at least once a day Examined consumption of each category at least once a day

Summary Considerable supplementation of breastfeeding w/ formula, starting in hospital Considerable supplementation of breastfeeding w/ formula, starting in hospital Cereal starts early, with roughly half introducing before 4 months Cereal starts early, with roughly half introducing before 4 months Meat is introduced much later – median at 7 months Meat is introduced much later – median at 7 months Variety is not consistently achieved until about 12 months Variety is not consistently achieved until about 12 months Cow’s milk introduced early Cow’s milk introduced early “Junk foods” common by 12 months “Junk foods” common by 12 months