One of the many questions new parents consistently have for pediatric providers is related to what and how to feed their infants and young children. Although this may seem a relatively straightforward question, there is a wide array of guidelines available to help inform decision making. Often this plethora of information can be confusing due to inconsistencies in advice.

A consensus group from the National Academies of Sciences, Engineering, and Medicine with support from the Centers for Disease Control and Prevention and the National Institutes of Health recently concluded a comprehensive review of 43 guideline documents from governmental and nongovernmental agencies, organizations and groups from the United States, other high-income countries and the World Health Organization. Topics under review included recommendations about what to feed infants and toddlers including: exclusive breastfeeding, continuation of breastfeeding, supplementary formula feeding, duration and type of infant formula, milk and milk-based products, nonmilk products such as water and juice, foods to avoid, healthy foods, foods associated with allergies, and vitamin and mineral supplements. Guidelines related how to best feed children including: bottle use and propping, cup use, food and feeding safety, meal frequency, hunger and satiety cues, and others. This report also included guidance for all organization to help align future recommendations including interagency collaboration and utilization of best practices for guideline development and dissemination (National Academies of Sciences, Engineering, and Medicine [NASEM], 2020).

The good news is for the majority of the guidelines reviewed there were consistent recommendations. Although some gaps or inconsistencies were noted, most guidelines recommended the following: exclusive breastfeeding for 6 months; encouragement of breastfeeding until 1 year; use of infant formula if needed as a substitute for breastfeeding for 12 months; introduction of potentially allergenic foods at 6 months or before 1 year; supplementation of Vitamin D for exclusively breastfed infants but advice against routine iron supplementation; preparation of foods without salt; and finally the need for added nutrients for vegetarian or vegan children (NASEM, 2020). Generally there was agreement that: infant and toddler feeding should always be under the supervision of an adult; weaning to a cup should be encouraged at 1 year; propping of bottles or use of bottles in bed is discouraged as is mixing cereal with milk products in a bottle; avoidance of frequent consumption of fluid or foods containing sugar; introduction of a wide range of appropriate solid foods at around 6 months of age; avoidance of any small pieces of food that could result in choking; offering healthy food choices; promoting finger foods to encourage self-feeding; and encouraging responsive feeding based on hunger and satiety cues (NASEM).

Evidence gaps were identified in the areas of: maternal and child effects of breastfeeding post 1 year; when to replace formula with cow milk with guidelines ranging from 6 to 12 months; whether to introduce iron supplementation at 6, 9, or 12 months; when best to introduce peanuts to potentially at-risk children; whether breastfed infants need vitamin D supplementation if the mother is adequately supplemented; and, strategies to identify and best treat infants under 6 months at high risk for iron deficiency. More research is also needed to identify approaches to identify iodine requirements in children under 2 years and nutritional adequacy for children who are vegetarian or vegan (NASEM, 2020).

Recommendations on dissemination of guidelines were offered. Although it is recognized that the majority of these guidelines are primarily focused on healthcare providers, parents, early childhood educators program administrators, and policy makers also need guidance. For parents and others, the level of detail found in existing guidelines is often too dense and needs further translation or new resources. The committee made recommendations on how agencies and organizations responsible for developing guidelines need to reconceptualize how to share this information with specific stakeholders. In the meantime, nurses and other pediatric providers can access this very comprehensive report and share consistent recommendations with parents.

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