WIC infant feeding practices study summary of findings

              90 O0 7Y~*^
USDA
/l^fl > 7T/J Y
' I I
Food snd
Nutrition
Satvto*
OfloaofAnatyaia
•nd Evaluation
Novembw 1987
Contract No.
53-3196-3-003
_^\
WIC Infant Feeding
Practices Study
Summary of Findings
^-<wr G, r
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P
USDA
United States
Department of
Agriculture
Food and
Nutrition
Service
Office of Analysis
and Evaluation
November 1997
Contract No.
53-3198-3-003
WIC Infant Feeding
Practices Study
Summary of Findings
Authors:
Nazli Baydar
Margaret McCann
Rick Williams
Eric Vesper
Patricia McKinney
Submitted by:
Battelle
Centers for Public Health
Research and Evaluation
4000 NE 41st Street
P.O. Box 5395
Seattle, WA 98105-0395
Project Director: Patsy Henderson
Submitted to:
Office of Analysis and Evaluation
USDA Food and Nutrition Service
3101 Park Center Drive, Room 208
Alexandria, VA 22302
Project Officer: Patricia McKinney
This study was conducted under Contract No. 53-3198-003 with the Food and Nutrition Service, United States
Department of Agriculture. Points of view or opinions stated in this report do not necessarily represent the official
position of the Food and Nutrition Service.
$
WIC Infant Feeding Practices Study
Table of Contents
Background 2
WIC Mothers'Choice between Breastfeeding
and Formula Feeding 4
Breastfeeding Duration.Attitudes and Practices 7
Formula Feeding Practices 11
Supplemental Food Initiation and Feeding Practices 12
Summary ot Finding* 1
WIC Infant Feeding Practices Study
Background
rife A* i.
The Special Supplemental Nutrition Program forWomen, Infants,
and Children (WIC) gives Federal grants to States to administer the
WIC Program which provides supplemental foods, health care refer-rals,
and nutrition education.These benefits are available for low-income
pregnant women, breastfeeding and non-breastfeeding post-partum
women, and to infants and children under the age of five who
are found to be at nutritional risk.
Once the applicants are determined to be eligible to participate
in WIC, they receive benefits based upon their category of eligibility.
The amount of time participants may receive benefits (i.e., the certifi-cation
period) may range from 6 months to a year. During a certifica-tion
period,WIC participants receive vouchers that allow them to
obtain a monthly food package designed to supplement their diets. In
addition,WIC local agencies are required to offer all adult participants
and caretakers of infants and children participants at least two nutri-tion
education contacts during each certification period. For the
infants who are certified for one year,WIC local agencies are required
to offer two nutrition education contacts during each six-month
period. However, participants can not be denied WIC benefits if they
do not attend or participate in nutrition education activities.
The WIC Program encourages mothers to breastfeed their babies.A
greater variety and quantity of food is offered to breastfeeding partici-pants
than to non-breastfeeding, postpartum participants. In addition,
breastfeeding mothers who elect not to receive infant formula
through WIC for their infants receive an enhanced food package that
was added to the WIC food packages in 1992. * WIC breastfeeding
women may receive benefits for up to one year while non-breastfeeding
women are eligible for only six months postpartum.
WIC breastfeeding women are always considered to be at a higher
level of nutritional risk than non-breastfeeding postpartum women.
This publication is based on theWIC Infant Feeding Practices
Study (WIC-IFPS) sponsored by the Food and Nutrition Service (FNS)
of the United States Department of Agriculture The WIC-IFPS is a one-year
longitudinal study, which describes the infant feeding practices
over the first year of life among a nationally representative sample of
approximately 900 mothers who participated inWIC while they
2 Summary ol Findings
WIC Infant Feeding Practices Study
were pregnant.The mothers or caretakers of the infants were inter-viewed
on a monthly basis in the first 7 months of these infants' lives,
with additional interviews conducted when the infants were 9 and
12 months old.The interviews were conducted between August 1994
and December 1995.All data reported in this publication are based
on the reports of the mothers' recall including information on moth-ers'participation
in variousWIC Program activities.The WIC-IFPS is
designed to describe the changes in infant feeding practices over the
first year of an infant's life and examine the factors that shape moth-ers'
infant feeding decisions. Frequent contacts permitted the moth-ers
to provide a detailed description of their feeding attitudes, beliefs,
and practices.
Summary of Finding 3
WIC Infant Feeding Practices Study
WIC Mothers' Choice between
Breastfeeding and Formula Feeding
JU S
■ More than one-half of WIC
mothers Initiate breastfeeding. At
the time of hospital discharge, less
than one-half of all WIC mothers
were still breastfeeding (Figure 1).
The WIC Program defines breastfeeding
as "the practice of feeding a mother's
breast milk to her infant(s) on the
average of at least once a day." Using this
definition, 56 percent ofWIC mothers
initiate breastfeeding. At hospital
discharge, 45 percent of all WIC moth-ers
were breastfeeding. Of these, about
30 percent were exclusively
breastfeeding and 15 percent were
breast- and formula-feeding.The Healthy
People 2000 goal for breastfeeding
initiation is "to increase to at least 75
percent, the proportion of mothers who
breastfeed their babies in the early
postpartum period." If the "early post-partum
period" is interpreted as the
time of hospital discharge, the compa-rable
percent forWIC mothers is 45
percent.
■ Mothers of different racial or
ethnic background differ substan-tially
in their likelihood of initiat-ing
breastfeeding (Figure 2).
Four race and ethnicity groups of
mothers were examined: white, African
American, Hispanic and other.This latter
category consists of the mothers who
identified themselves as Asian, Pacific
Islander,American Indian,Alaskan
Native, or declined providing informa-tion
about their racial and ethnic origin.
Among racial and ethnic groups,
Hispanic mothers are the most likely to
initiate breastfeeding (84%), followed by
Figure 1. Breastfeeding Initiation Rate for WIC Mother*
Is Below the Goals Set by Healthy People 2000.
100%
8
80%
60%
° 40%
20%
0% T r
Healthy People 2000 Goals Ever At Hospital Discharge
Figure 2. Mothers' Breastfeeding Initiation Rates Differ
by Race and Ethnicity.
100%
4 Summary of Finding*
WIC Infant Feeding Practices Study
white mothers (53%) and African
American mothers (34%).
Other characteristics of mothers are
associated with the likelihood of
breastfeeding. Other things being equal,
mothers who are younger, mothers who
are born in the United States, mothers
who do not live with the father of their
infant, mothers who have low levels of
education, and mothers who have other
children are less likely to choose to
breastfeed than mothers who are older,
born outside the United States, live with
the father of their infant, have high
levels of education, and have no other
children. Mothers are also more likely to
breastfeed if they receive advice to
breastfeed from their own mother or
other relatives, and if they breastfed
their previous children.
■ Breastfeeding advice or support
from professional sources is an
important factor in the initiation of
breastfeeding (Figure 3).
Thirty-nine percent of the mothers
recall receiving advice from their
physicians to breastfeed and even more
mothers report receiving information
about breastfeeding from WIC (64%).
Almost all mothers who receive advice
to breastfeed from their physicians also
receive inforn ation from WIC about
breastfeeding. Slightly more than one-half
of the mothers (58%) receive
information about breastfeeding from a
professional source other than WIC.
The mothers who receive advice
from their physicians to breastfeed are
more likely to breastfeed than those
who do not receive such advice.
Figure 3. Mothers Who Receive Information About Breastfeeding From
WIC and Advice From Their Phyeiciane Have Higher
Breastfeeding Initiation Rates.
100%
80%
60%
40%
20%
0% T 1 r
Healthy Pnopto WIC Information and Information No Information and
2000 Goal Advice Irom the Physician from WIC No Advice
Similarly, the mothers who receive
information about breastfeeding from a
professional source other than WIC are
more likely to breastfeed than those
who do not receive such information.
Among the mothers who do not receive
breastfeeding advice from their physi-cians,
receiving information about
breastfeeding from WIC is associated
with a 62 percent increase in the
likelihood of initiation of breastfeeding.
Only 30 percent of the WIC mothers
report that they know about the special
WIC breastfeeding food package that
mothers < get if they elect not to
receive infant formula from WIC.
Mothers who report that they know
about this special WIC food package are
almost twice as likely to breastfeed than
mothers v o report that they do not
know about it.
■ Mothers experience a variety of
circumstances in the hospital that
are unsupportive of the establish-ment
of breastfeeding.
Something other than breastmilk as the
first feeding, delayed timing of first
breastfeeding, lack of rooming-in
arrangements and hospital gift packages
that contain formula, bottle, or a pacifier,
are examples of neonatal circumstances
that may be unsupportive of the
establishment of breastfeeding. Only
twenty-nine percent ofWIC mothers
give their infants breastmilk as the first
feeding. Sixty percent ofWIC infants
receive formula as the first feeding and
10 percent receive either sugar water or
plain water. The type of first feeding
differs by the race and ethnicity of the
mother. Only 12 percent ofAfrican
American mothers breastfeed at the first
Summary of Findings 5
WIC Infant Feeding Practices Study
feeding (Figure 4).Among the mothers
who ever initiate breastfeeding, 19
percent do so within one hour after
birth.
Seventy-two percent ofWIC infants
sleep away from their mothers at least
for one night during their hospital stay.
Ninety-three percent ofWIC mothers
receive a gift package from the hospital.
The gift packages of almost all WIC
mothers contain items that are detri-mental
to the establishment of
breastfeeding, such as formula, a bottle,
or a pacifier.Among the mothers who
receive a gift package, 86 percent get
some formula in that package.
Many WIC mothers who start
breastfeeding in the hospital report
experiencing some nursing problems
(Figure 5) such as sore nipples (46%),
not having enough milk (39%), or milk
coming in late (24%). Altogether, three-quarters
of breastfeeding mothers
experience one or more nursing
problems while they are still in the
hospital. However, 33 percent of the
mothers who experience nursing
problems in the hospital receive no
help from the hospital staff. For ex-ample,
thinking that one does not have
enough milk for the infant is one of the
major predictors of stopping
breastfeeding.Yet, 25 percent ofWIC
mothers who think that they do not
have enough milk while in the hospital
receive no nursing help from the
hospital staff.
Figure 4. First Feeding Differs by Race and Ethnicity of the Mother.
100%
80%
60%
40%
20%
White African American Hispanic Other
Feeding
Formula
Feeding
BreatmHk
Figure 5. The Perception of Not Having Enough Milk is the Second Most
Common Nursing Problem Reported by WIC Mothers.
100%
Baby
Choked
8 Sumrr+ry of Finding*
WIC Infant Feeding Practices Study
Breastfeeding Duration,
Attitudes and Practices
i i £k$
■ One-half of the breastfeeding WIC
mothers stop breastfeeding by the
end of the second month.
The breastfeeding duration goal in the
Healthy People 2000 report is that at
least 50 percent of infants are to be
breastfed until 5-6 months of age.Thirty-one
percent ofWIC mothers who
initiated breastfeeding, and only 16
percent of all WIC mothers continue
breastfeeding until their infant is 5
months old.
By 13 days of age, one-quarter of the
infants whose mothers initiated
breastfeeding are weaned from the
breast. One-half of the breastfeeding
WIC mothers stop breastfeeding by the
end of the second month (57 days).
Among the WIC mothers who initiate
breastfeeding, some subgroups
breastfeed for longer durations than
others. African American and white
mothers are less likely than others to
breastfeed until their infant is 5 months
old (Figure 6). Mothers who are young
and who have low levels of education
are likely to stop breastfeeding earlier
than other mothers. For example, one-half
of breastfeeding mothers who are
not yet 20 years old stop breastfeeding
by 19 days after the birth. Mothers who
were born outside the United States,
and mothers who have more than a
high school education stop
breastfeeding later than other mothers.
For example, one-half of the
breastfeeding WIC mothers who were
born abroad continue breastfeeding 96
days or longer after the birth of the
infant.
Figure 6. Percent of Mothers Breastfeeding Until Their Infant is
5 Months Old Differs by Race and Ethnicity.
100%
Total White African
American
Hispanic Other
■ Large proportions of WIC infants
who are breastfed, also receive
formula. Furthermore, formula
supplementation of breastfeeding
WIC infants starts very early In life.
At any given month during the first year
of life, only about one-half or fewer of
breastfeedingWIC mothers breastfeed
without supplementing with formula. At
one month of age, only 13 percent of all
WIC infants are breastfed without
formula, another 20 percent are fed
breastmilk and formula, and almost two-thirds
are fed formula only.
Formula supplementation starts very
soon after birth. One-fourth of
breastfeedingWIC infants are given
formula during the first five days of life
and one-half are given formula during
the first 16 days of life.
Some subgroups ofWIC mothers are
more likely than other subgroups to
supplement breastmilk with formula.
For example,African American mothers
and young mothers are more likely to
supplement breastmilk with formula.
One-half ofAfrican American mothers
who breastfeed, supplement their
breastmilk with formula by the time
their infants are 12 days old.
Breastfeeding mothers who have others
care for their infants are more than
twice as likely to give formula to their
infants than the breastfeeding mothers
who care for their infants themselves.
Summary of Findings 7
WIC Infant Feeding Practices Study
■ Breastfeeding WIC mothers who
supplement with formula are
almost 2.5 times more likely to stop
breastfeeding than those who do
not supplement with formula
(Figure 7).
The difference in breastfeeding duration
between the mothers who supplement
with formula and those who do not
supplement, is large.WIC mothers who
do not supplement breastmilk with
formula are more likely to breastfeed
their infants for longer durations than
those who do supplement their
breastmilk with formula.Almost one-half
of the mothers who do not supplement
breastmilk with formula are predicted
to continue breastfeeding for 5 months,
compared with only 16 percent of the
mothers who supplement with formula
(Figure 7).
■ Mothers who believe that
breastfeeding Is beneficial are less
likely to supplement breastfeeding
with formula and are also less
likely to stop breastfeeding than the
mothers who do not believe that
breastfeeding is beneficial.
Breastfeeding mothers differ from non-breastfeeding
mothers in their attitudes
and beliefs about breastfeeding. Non-breastfeeding
mothers are significantly
less likely to express positive attitudes
towards most issues concerning
breastfeeding, and are generally more
likely to say that they are "not sure"
about various statements about conse-quences
of breastfeeding. Attitudes and
beliefs about breastfeeding also vary
considerably by race and ethnicity.
Figure 7. Formula Supplementation Predicts a Shorter Duration
of Breastfeeding.
100%
(0 £ 80%
5 3 60%
40%
CD ™
of
3
C
£ 20%
0%
47%
16%
1 i 1
Not Supplementing Supplementing with Fonnuta
African American mothers report the
most concern about barriers to
breastfeeding, and Hispanic mothers
report the most awareness of the
benefits of breastfeeding.
Attitudes and beliefs about breast-feeding
are linked to breastfeeding
practices and breastfeeding duration.
Mothers who report more positive
attitudes towards breastfeeding are less
likely to supplement breastfeeding with
formula and less likely to stop
breastfeeding. In fact, the differences in
breastfeeding duration of white,African
American, and Hispanic mothers are
almost entirely due to the reported
differences in beliefs and attitudes
towards breastfeeding.
■ Mothers who believe that they do
not have sufficient milk, or that
there Is something wrong with
their milk are more likely to
supplement breastfeeding with
formula and are more likely to stop
breastfeeding than mothers who do
not report such problems with their
milk (Figure 8).
The percentages of breastfeeding moth-ers
who report nursing problems de-crease
over time. In the first month, 34
percent of the mothers think that they do
not have enough milk and 10 percent
think that something is wrong with the
milk. During the first month following
the birth, thinking that one does not have
enough breastmilk is the second most
common nursing problem reported by
the WIC mothers, following sore nipples.
Mothers who report that they have
problems with their breastmilk constitute
a group that is likely to stop
breastfeeding.These mothers are over 60
percent more likely to supplement their
breastmilk with formula, and about 50
percent more likely to stop breastfeeding
than those who report no problems with
their breastmilk. If the mothers who
perceive problems with their breastmilk
do start supplementing breastmilk with
8 Summary of Finding*
WIC Infant r Jing Practices Study
formula, the chances that they will stop
breastfeeding is quadrupled as com-pared
with the mothers who do not
think that they have problems with
their milk and who are not supplement-ing
with formula.
■ Mothers who report participating
in WIC Program activities that
support breastfeeding have longer
durations of breastfeeding.
Thirty-eight percent of breastfeeding
mothers knew about the special WIC
breastfeeding food package for mothers
who do not accept formula for their
infants frcm WIC. Breastfeeding mothers
who reported that they knew about the
special WIC breastfeeding food package
were 27 percent less likely to stop
breastfeeding than comparable mothers
who did not know about this food
package.
The mothers were also asked
whether they received information
about breastfeeding from WIC and
whether they received advice from WIC
staff to breastfeed. Almost three-quarters
of breastfeeding mothers said that they
received information from WIC about
breastfeeding and almost two-thirds said
that they were told by WIC staff to
breastfeed.
Among the three WIC Program
activities that support breastfeeding
(special food package, breastfeeding
information, and breastfeeding advice),
mothers who receive each additional
program activity are further likely to
breastfeed for a longer time (Figure 9).
The mothers who receive all three WIC
Program activities are the least likely to
stop breastfeeding.
Figure 8. Mothers Who Have Problems with Breas tmilk and Supplement
With Formula Are Very Likely to Stop Breastfeeding by One Month.
100%
80%
0 0
60%
a I
CD CO
II If
40%
20%
No Problems and
No Supplementation
Problems and
No Supplementation
Problems and
Supplementation
Figure 9. Mothers Who Receive Multiple Breastfeeding Support Activities
From WIC Are More Likely to Continue Breastfeeding.
100%
80%
II 60%
mm
m c
40%
I 20%
0%
41%
NoAcWvttiw 1 Activity 2 Activities 3Acttv*««
Summary of Findings 9
WIC Infant Feeding Practices Study
■ WIC mothers breastfeed less
often than is recommended to
ensure sufficient milk production.
Breastfeeding WIC infants are breastfed
almost 7 times a day in Month 1.
Mothers who breastfeed exclusively are
advised to nurse about eight to twelve
times a day in the first two weeks of life,
in order to stimulate breast milk produc-tion.
Although the reported frequency
of breastfeeds is not as high as advised,
it is high enough to suggest that
breastmilk is a major component of the
diet for those WIC infants who continue
to breastfeed.
Formula supplementation is the
strongest and most direct predictor of
the frequency of breastfeeds.WIC
mothers who supplement with formula
breastfeed 1.3 less times per day.The
role of formula supplementation in
predicting the frequency of breastfeeds
indicates that WIC mothers may be
substituting breastfeeds with formula
feeds (supplemental formula use) rather
than providing formula in addition to
the breastmilk at each feeding (compl'
mentary formula use).
■ Women who receive advice from
their physicians to breastfeed,
breastfeed more often.
Breastfeeding WIC mothers who
received advice from their physicians to
breastfeed do so 1.7 more times per day,
on average, than otherwise comparable
Figure 10. Most Breastfeeding WIC Mothers Feed Their Infants
When They Cry or Seem Hungry.
100%
e 80%
o5
9
m
o
c
eo%
40%
I 20%
When Cried or Seemed Hungry Set Schedule
I Month 1 I Month 2 1 Month 3
mothers who did not receive such
advice. Physicians' advice, therefore, is
not only associated with initiating
breastfeeding but also associated with
more frequent breastfeeds.
■ Most WIC infants are breastfed
when they appear hungry, rather
than on a fixed schedule (Figure
10).
At one month of age, almost two-thirds
of the WIC infants are breastfed when
they cry or appear hungry, as advised by
the FNS. Less than one-quarter of the
infants are breastfed on a set schedule
and the remaining infants are led
sometimes on a set schedule and
sometimes when they cry or appear
hungry.
■ One-third of breastfeeding
mothers express milk during the
first two months.
Many of the breastfeedingWIC mothers
report that they express milk from their
breasts (one-third in the first and
second month and one-fourth in the
third month). Most mothers who
express breastmilk, do so using a
manual breast pump. Less than one-quarter
(21%) of the mothers who were
using manual or electric breast pumps
in Month 3 reported receiving their
breast pumps from WIC.
10 Summary of Findings
WIC Infant Feeding Practices Study
Formula Feeding Practices
< / k,
■ More than 90 percent of formula-fed
WIC infants receive iron -
fortified formula.
Most WIC infants who receive formula
are given iron-fortified formula.Among
the formula-fed infants, the percentage
who receive iron-fortified formula
increases from 91 percent at about one
month of age to about 95 percent at six
months of age. Furthermore, at Month 1
all formula-fed WIC infants, whose
mothers received advice on how to feed
formula from a doctor, nurse or other
health care practitioner other than WIC
staff, were given iron-fortified formula as
opposed to 90 percent of infants whose
mothers obtained information about
how to feed formula from lay sources or
from formula labels.
■ Less than ten percent of WIC
mothers report that they mix
formula with extra water to make it
last longer.
A small percentage (8%) ofWIC moth-ers
report overdiluting the formula.
However, mothers whose infants have a
higher birth weight are more likely to
report that they overdilute formula.
■ About 25 percent ofWIC mothers
add other foods or liquids into the
bottle with the formula by the time
their infants are three months old
(Figure 11).
Figure 11. About 25 Percent of the Mothers Add Other Foods or Liquids to the
Bottle With the Formula by the Time Their Infants Are 3 Months Old.
100%
80%
1
IS 60%
It ,9 fe 40%
m "6
a. < 20%
0%
36%
Total While African Hispanic
American
Other
The percentage ofWIC mothers who
add other foods or liquids into the
bottle with the formula increases from
11 percent in Month 1 to 24 percent in
Month 3- Some groups of mothers are
especially likely to add other foods or
liquids into the bottle. African American
mothers are more likely than mothers
from other racial or ethnic groups to
add other foods or liquids into the
bottle. Similarly, mothers younger than
20 years old are more likely than older
mothers to add other foods or liquids
into the bottle. More than one in three
African American WIC mothers (36%),
and about one in five white (22%) or
Hispanic (18%) mothers add other foods
or liquids into the bottle with the
formula at Month 3- Receiving advice
from WIC staff or from health care
providers other than WIC staff about
how to feed or prepare formula is not
associated with a lower likelihood of
adding other foods or liquids into the
bottle.
Summary of Findings 11
1 WIC Infant Feeding Practices Study
Supplemental Food Initiation
and Feeding Practices
■ Large proportions of WIC Infants
are given cereal, fruits, and veg-etables
before they become four
months old (Figure 12).
WIC infants receive supplemental foods
much earlier than the recommended
age of 4-6 months. More than 60
percent ofWIC infants are given cereal
before they reach four months of age,
42 percent ofWIC infants are given
fruits, and 29 percent ofWIC infants are
given vegetables before that age. Few
infants, however, are given meats,
starchy foods other than cereal, dairy
foods, or high protein foods other than
meats before they are 4 months old The
early introduction of sweet or snack
foods may be a more significant prob-lem
with 21 percent ofWIC infants
receiving sweet or snack foods (most
likely honey or jam) before they are 4
months old.
There are substantial race and
ethnicity differences in the age of
initiation of supplemental foods.
Hispanic WIC mothers postpone giving
cereal to their infants but start giving
high protein foods other than meats
(e.g. beans and legumes) somewhat
earlier than other mothers.White
mothers start giving cereals to their
infants earlier than any other race or
ethnic group, followed by African
American mothers.
■ Cereal is often the first supple-mental
food introduced to the diets
ofWIC infants (Figure 13).
For over four fifths ofWIC infants (83%),
cereal is the first supplemental food.
Fruits and vegetables are introduced
Figure 12. Many WIC Infants Are Given Supplemental Foods
Before They Are 4 Months Old.
100%
Carsal Fruits Vegetables Meats Starchy Oaky High Protein Sweat or
FooosOther FoodsOther Snack
Than Oreal Than Maats Foods
Figure 13. WIC Mothers Initiate Feeding Cereal First.
100%
CsraaV E3*"» \1oHmUm | |
12 Summary of Finding*
WIC Infant Feeding Practices Study
Figure 14. WIC Infants Who Receive Child Care Are Mora Likely to be
Given Cereal and Fruits.
100%
second, followed by meats. Fruits and
vegetables arc often introduced at about
the same time. Meat is often introduced
as the third or fourth group of supple-mental
food. Only 3 percent of the
mothers introduce meat into the infant's
diet as the first supplemental food.
Mother's race and ethnicity is
significantly associated with the order
in which different supplemental food
groups are introduced into WIC infants'
diets. For example, cereal is the first
supplemental food to be initiated for 90
percent of white and 94 percent of
African American infants, although it is
the first supplemental food for only 65
percent of Hispanic infants. Fifty
percent of Hispanic mothers introduce
fruits into their infant's diet either as the
first supplemental food or about at the
same time as they introduce cereal. In
contrast, very few African American
mothers (16%) introduce fruits as the
first supplemental food.The introduc-tion
of meat follows fruits and veg-etables
among the mothers of all racial
and ethnic groups.
■ WIC infants who arc cared for by
someone other than their mothers
are more likely than infants who
are cared for by their mothers to
receive cereals and fruits inappro-priately
early (Figure 14).
WIC infants who have someone other
than their mothers care for them are
about 50 percent more likely to receive
cereal and 30 percent more likely to
receive fruits before they reach 4
months of age.As indicated above,
infants receiving care from someone
C«fMl Fruit*
Cared For
bytheUother
□ Cared For by Someone
Other Than the Mother
other than their mother are also more
likely to have fewer breastfeeds every
day, and more likely to have breastfeeds
supplemented with formula at very
young ages.These findings, taken
together, indicate a pattern of nutrition
during infancy that is outside of the
recommended guidelines.
■ WIC infants who are getting
formula exclusively or in addition
to breastmilk are more likely than
exclusively breastfed infants to
receive cereal, fruits, and vegetables
Inappropriately early (Figure 15).
Formula-fed WIC infants are highly likely
to receive the three basic groups of
supplemental foods inappropriately
early. These infants are twice as likely to
receive cereal inappropriately early,
almost three times as likely to receive
fruits inappropriately early, and more
than three and a half times as likely to
receive vegetables inappropriately early.
The introduction of fruits and veg-etables
inappropriately early may be
because of inappropriately early
introduction of the infant cereal (which
is often the first supplemental food that
is given).
Mothers who feed formula may be
more likely to give their infants some
supplemental foods too early because of
several reasons.The mothers who feed
formula may view the bottle as an easier
means to feed other foods to their
infants than a spoon.A spoon is the
recommended means of feeding all
supplemental foods including cereal.
Only 18 percent of formula-feedingWIC
infants who receive supplemental foods
in Month 2 have ever eaten these foods
from a spoon. Second, formula-feeding
mothers may add cereal to the bottle to
promote longer sleep. Mothers who
started feeding cereal were asked why
they did this. Many of these mothers
said that they did this to get the infant
to sleep through the night or because
the infant seemed to want "too much"
Summary of Findings 13
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