What are the current feeding practices of infants and toddlers?

Challenge

The U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) oversees the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a program that offers supplemental healthy foods and nutrition education to low-income postpartum and breastfeeding women, infants, and children (up to age 5) who are at nutritional risk. FNS needs up-to-date information on current child feeding practices and nutritional outcomes, especially in light of 2009 changes to WIC food packages and programs.

The WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2) was launched to examine the feeding practices employed by those who enroll in WIC around the time of their child’s birth. Study participants remain eligible for the study even if they do not continue with WIC. By capturing data on caregivers and their children over the first 9 years of the child’s life, the study informs a series of research questions regarding

• Feeding practices
• Association between WIC participation and those practices
• Health and nutrition-related outcomes of children currently or previously on WIC

Solution

The Westat team is led by experts in nutrition, epidemiology, child development, and health economics. We recruited a nationally representative sample of 4,000+ mothers at WIC sites to participate in the study.

We collected data from WIC state agencies and from WIC staff to contextualize how WIC sites are delivering services.

Trained telephone data collectors regularly interview study participants until the child’s 9th birthday. The first part of the interview includes detailed questions about what the child ate on a given day. The second part inquires about specific feeding practices, social and demographic characteristics, satisfaction with WIC services, child health and development, and more.

We also gather weight and length or height data, depending on the child’s age, from WIC administrative records and health care providers.

This study uses Blaise, a comprehensive commercial off-the-shelf (COTS) survey processing system. It provides integrated multimode support for computer-assisted survey data collection. This includes interviewer-assisted (e.g., computer-assisted personal interviewing [CAPI], computer-assisted telephone interviewing [CATI]) and self-response (e.g., computer-assisted web interviewing [CAWI]) modes across a wide variety of platforms (smartphone, tablet, desktop).

Results

Westat has prepared several of the final reports that present and interpret the longitudinal data in the only current national, longitudinal study of infant and toddler feeding practices in low-income families originally enrolled in WIC. Notable findings over the first few years of the study include

• Increased acceptance of breastfeeding
• Increased initiation and duration of breastfeeding
• Though racial disparities remain, the greatest gains in initiation were among African American mothers
• Better diet quality of children who remain on WIC longer than children who leave the program earlier in life

After controlling for multiple factors, there were no significant differences by race, but children with Hispanic caregivers had higher diet quality scores than children with non-Hispanic caregivers.

In brief, findings indicate that WIC helps ensure that all U.S. children have access to nutritious foods.

Findings from the WIC ITFPS-2 will be used to inform WIC program policy and the 2020 Dietary Guidelines for Americans for the 0- to 24-month age group.

Learn more from study reports

• WIC Infant and Toddler Feeding Practices Study 2: Infant Year Report
• WIC Infant and Toddler Feeding Practices Study 2: Second Year Report
• WIC Infant and Toddler Feeding Practices Study 2: Third Year Report
• WIC Infant and Toddler Feeding Practices Study 2: Fourth Year Report
• WIC Infant and Toddler Feeding Practices Study 2: Fifth Year Report

Learn more about the findings published in journals

• Prenatal and Postnatal Experiences Predict Breastfeeding Patterns in the WIC Infant and Toddler Feeding Practices Study-2
• The Relationship Between Breastfeeding and Initial Vegetable Introduction with Vegetable Consumption in a National Cohort of Children Ages 1–5 Years from Low-Income Households
• Duration of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participation Is Associated with Children’s Diet Quality at Age 3 Years
• Duration of WIC Participation and Early Feeding Practices Are Associated with Meeting the Added Sugars Recommendation at Age 3 Years
• Shifts in Sources of Food but Stable Nutritional Outcomes Among Children in the Early Months of the COVID-19 Pandemic
• The WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2) Through Age 5: What We’ve Learned, What Questions Remain, and How You Can Use This Longitudinal Dataset
• Duration of WIC Participation and Early Feeding Practices Are Associated with Meeting the Added Sugars Recommendation at Age 3 Years
• Longer WIC Participation Duration Is Associated with Higher Diet Quality at Age 5 Years