Infant feeding and feeding transitions during the first year of life

Background: Exclusive breastfeeding for the first several months of life is recommended by professional organizations and there is consensus that complementary foods should not be introduced before 4 months of age. Little is known about the way complementary foods are used in the United States. Methods: The Infant Feeding Practices Study II (IFPS) is a longitudinal mail survey of pregnant and postpartum women that assessed details of infant feeding practices and their determinants, with nearly monthly follow-up from birth to 12 months. Data collection on this national cohort of 2005 births was completed in early 2007. We analyzed the feeding transitions in this cohort of about 2,200 mothers. Results: Breastfeeding initiation is high (84%) but declines rapidly to 67% at 2 months (7-<11 weeks) and 59% at 4 months (15-<19 weeks). Much of this breastfeeding is mixed with formula feeding as 54% of infants receive formula in the hospital. A substantial proportion of infants consume solid foods before 4 months—40% consume infant cereal and 17% consume fruit or vegetable products. Although meat is considered an important first food, less than 1% of infants consume meat by 4 months. Infants who never breastfed are more likely to receive cereal by 4 months compared with breastfed infants (62% vs. 36%), and more likely to receive fruits and vegetables (28% vs. 14%). Conclusions: Supplementation of breastfeeding in the hospital with infant formula is very common. Complementary foods are typically introduced before the recommended age, particularly among never breastfed infants.