With childhood obesity being a major health issue, getting off to the right start with a healthy diet is critical. Surprisingly, there are few studies, based on nationally representative samples, to guide nutrition advice given to parents of young children. In 2002, the Feeding Infants and Toddlers Study (FITS) was conducted for the first time to gather data on dietary patterns of children, ages 4 to 24 months. In 2008, a second cross-sectional, national FITS survey collected information on the diets of more than 3200 children, ages 0 to 47 months. An article, which appeared in the December 2010 Journal of the American Dietetic Association, describes the changes in dietary patterns among children, ages 4 to 24 months between 2002 and 2008.

In both years, the researchers found participants for the phone interviews through a database of new parents derived from prenatal and postnatal records and proprietory sources, like baby store/product mailing lists and parenting magazines. Using 2-dimensional food models and aids, the parents provided 24-hour recalls of their child’s intake both at home and away from home.  In some cases, the day care providers were also contacted. The response rate was lower in 2008 (60%) than in 2002 (73%), reflecting trends for declining participation of the public in phone interviews.  In the analyses, the samples were weighted to reflect the US population for those age groups and years.  While the National Health and Examination Survey (NHANES) also collects dietary data from a national sample, FITS includes more infants and toddlers than NHANES and provides information to breast milk intake that is not available in NHANES.

So, what can we glean from FITS about the diets of the youngest members of our society? From 2002 to 2008, some positive changes are apparent:

• More infants are being breastfed longer. In 2008, 43% were currently breastfeeding at 4-5.9 months, compared to only 26% in 2002 (p <0.01). Overall, 49% were still being breastfed at 6 months and 24% at 12 months in 2008 (the Healthy People 2010 goal is 50% and 25%, respectively).
• Along with getting more breast milk, fewer infants are starting complementary foods before 6 months. Of note, the percentage getting any type of dessert, sweets, or sweetened beverage is significantly lower at all ages from 4 to 20 months in 2008, compared to 2002. Salty snacks consumption has also declined in infants.
• Although there are few significant differences in percentages eating any vegetable or fruit at least once daily, fewer infants (under 12 months) consumed french fries or juice. the American Academy of Pediatrics does not recommend introducing juice in infants under 6 months of age.

However, there are also a few trends of potential concern. Intake of some iron-rich complementary foods has declined. Among older infants (9-11.9 months), intake of baby food meats, beef, and infant cereals was lower in 2008 than in 2002. Moreover, nearly 17% of infants in that age group consumed regular cow’s milk at least once a day. The American Academy of Pediatrics recently emphasized the need for iron-rich complementary foods (like infant cereals and red meat) in the diets of older infants. Regular whole cow’s milk is not recommended before 12 months.

Conclusions and Implications: Although FITS reflects some positive and a few negative trends, the reasons for the changes are still unclear. The sample characteristics are somewhat different between 2002 and 2008 (more Hispanic, fewer working, and more college-educated women in 2008 than in 2002) so more analysis is needed within subgroups. Following young children over time would also help determine how these changes in dietary patterns influence early child growth and health.

Source: Siega-Riz AM, Deming DM, Rediy KC, Fox MK, Concon E, Briefel RR. Food consumption patterns of infants and toddlers:where are we now? J Am Diet Assoc 2010; Supple 3:  S38-S51.