Updates on Guidelines for Feeding Infants and Toddlers Rickelle Richards, PhD, MPH, RDN, CD Brigham Young University

Learning Objectives At the end of the session, attendees will be able to Describe the feed-on-demand principle and its relationship with feeding young infants. Identify the nuts and bolts of introducing solid foods including the when, what, and how. Summarize common feeding concerns during the toddler years. Evaluate case scenarios of toddlers‘ feeding practices and apply responsive feeding guidelines to the scenarios.

Middle Infancy Later Infancy Newborn Toddler

Principle: Feed on Demand Baby’s First Food… Principle: Feed on Demand

Baby’s First Solid Foods… Developmental Readiness Start with fruits, veggies, grains, or meat? Timing & spacing of new foods; check for allergies American Academy of Pediatrics Grains Recs New “purposeful feeding of peanut” guideline

Transitioning to Later Infancy… From purees to table food Choking hazards Introducing the cup Responsive feeding

What is responsive feeding?

Feeding Toddlers… Developmental Manifestations Sense of independence Food jags Neophobia/picky eating Concerns about too much milk/juice/SSBs Scheduled snacks vital Family meals Responsive feeding practices

Case scenario #1 Billy is a 24-month-old boy. He throws food on the floor, plays with it, pushes the spoon away when his mom feeds him, laughs at his older brothers (ages 4 and 7), and generally does not seem interested in eating. It takes him over an hour to eat each meal and snack, and it is not a pleasant experience for Billy or his mother. What advice could be given to the mother, based on responsive feeding guidelines?

Case scenario #2 Lucy is 22 months old. Lucy’s mother and grandmother allow her to walk around the house with apple juice in a sippy cup while they are preparing dinner. She also “demands” snacks such as crackers, slices of cheese, and cookies, which her mother often gives her out of frustration. When they attempt to put Lucy in her booster chair at the table, she fights with them and yells, “NO chair!” Mother and grandmother often eat quickly in front of the television while feeding Lucy from their plates while she also watches TV. Lucy’s mother and grandmother are frustrated and are concerned that he is not eating enough for dinner.  What advice could be given to the mother, based on responsive feeding guidelines?

References Perez-Escamilla R, Segura-Perez S, Lott M, on behalf of the RWJF HER Expert Panel on Best Practices for Promoting Healthy Nutrition, Feeding Patterns, and Weight Status for Infants and Toddlers from Birth to 24 Months. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Durham, NC: Healthy Eating Research, 2017. Available at http://healthyeatingresearch.org Togias A, Cooper SF, Acebal ML, Assa'ad A, Baker JR Jr, Beck LA, Block J, Byrd-Bredbenner C, Chan ES, Eichenfield LF, Fleischer DM, Fuchs GJ 3rd, Furuta GT, Greenhawt MJ, Gupta RS, Habich M, Jones SM, Keaton K, Muraro A, Plaut M, Rosenwasser LJ, Rotrosen D, Sampson HA, Schneider LC, Sicherer SH, Sidbury R, Spergel J, Stukus DR, Venter C, Boyce JA. Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. Ann Allergy Asthma Immunol. 2017 Feb;118(2):166-173.e7. doi: 10.1016/j.anai.2016.10.004. Epub 2017 Jan 5. PubMed PMID: 28065802. Brown J. Nutrition through the Life Cycle. 2017. 6th ed. Cengage Publishing; Boston. MA