Honoring Indigenous Milk Medicine Week: “Nourishing Our Futures”

 In celebration of Native Breastfeeding Week, which has evolved into Indigenous Milk Medicine Week, we are incredibly honored to feature the Project Director for the Navajo Breastfeeding Coalition/Dine Doula Collective, Amanda Singer, CLC. Singer’s clans are Naaneesht’ezhi Tachinii (The Charcoal-Streaked Division of the Red Running Into the Water Clan) born for Honaghaanii (One-Walks-Around clan). A Navajo woman originally from Coalmine, N.M., Singer currently lives in Fort Defiance, Ariz.

Like this year’s Indigenous Milk Medicine Week theme “Nourishing Our Futures” which celebrates and respects the power of human milk as medicine for Indigenous People, Singer has been working to heal and uplift her community for 15 years.

Photo by Raul Angel on Unsplash

Impassioned by her own birth and infant feeding experiences, while working as a WIC Peer Counselor, Singer realized the challenges she faced were not uncommon. Prior to becoming a counselor, Singer says she would sit at home wishing for more resources to be available to her, but when she started working within the system, she says she was better able to navigate it.

“I realized I could use my voice there to help my community,” she says. “Hearing their stories, that was what really fueled me.” 

She became a connector, referring families here and there, eventually reaching out to politicians to help change the overall culture of maternal child health support. She and her colleagues were active in advocating for legislation like that Navajo Nation Healthy Start Act of 2008.

Like Indra’s Net, as Singer heard more and more stories and delved deeper into her work,  that interconnectedness and interdependence continued to reflect and illuminate her next quest. 

There came a time though when she felt dulled by the bureaucratic red tape of working within a government entity, so with hesitation, she resigned from her position at WIC. 

When she found her way to the Navajo Breastfeeding Coalition, she says she felt herself stepping into her power.  

The coalition received a small grant from the Kellogg Foundation and collaborated with the Changing Woman Initiative to bring the Indigenous Doula Training to their area in 2019. 

Singer reports being rejuvenated by the energy of the young group of 40 participants. She was inspired by their “younger, motivated minds”. Ten of the participants have joined forces with Singer, growing the coalition. 

“In the early days [of my work], it was hard feeling like ‘How am I going to create change?’” Singer begins. “And then a miracle happened really, all of a sudden, I have these other like-minded individuals… I have my squad,” she says of connecting with this new wave of maternal child health advocates.  

Continuing to reflect back, Singer says, “Nothing has changed really.” 

Indigenous families continue to be challenged by the second highest maternal infant mortality rates among other health inequities.

Source: United States Breastfeeding Committee.

Authors Lucy Truschel and Cristina Novoa point out in their piece American Indian and Alaska Native Maternal and Infant Mortality: Challenges and Opportunities

 “…Accessing…care and support… can be difficult for urban American Indians, who still feel the legacy of the United States’ historic mistreatment of American Indian and Alaska Native (AI/AN) communities—genocide, forced migration, and cultural erasure.** Today, the AI/AN community feels this legacy most acutely in problems like high rates of poverty, housing challenges, job discrimination, and social isolation. Research shows that such stressors take a toll on pregnant women’s health and increases the risk of both maternal and infant mortality.”  

Until recently, Singer says, these challenges have been largely ignored. But because the pandemic has grossly amplified many of these issues, Indigenous people and the challenges they face are getting harder to ignore, she explains.  

What’s more, there’s the issue of entities professing support, but their mission often falls short, Singer says. 

For instance, the Indian Health Service (IHS) has implemented breastfeeding promotion and support programming like adopting the Baby-Friendly Hospital Initiative (BFHI). 

But Singer comments that hospitals tend to be more in tune with Western practices, and the institutions often fail to honor the preservation of traditional birth practices and ceremonies even though they advertise cultural preservation as one of their core commitments. 

“Isn’t birth where cultural preservation starts?” Singer wonders rhetorically. 

Fulfilling continuity of care is an issue too. There are very few home visiting programs available to families who live two to three hours away from the closest lactation support. 

During Indigenous Milk Medicine Week, Singer and colleagues will present Revitalizing Culture through Breastfeeding and Chestfeeding  which will go into further discussion of these absurdities. The presentation will  cover how cultural practices in breastfeeding have been interrupted by colonization and how we can contribute towards cultural revitalization in breastfeeding/ chestfeeding. Participants will be awarded 1.75 L-CERPs & 2 Contact Hours. 

Singer emphasizes the power of community-based organizations like the Navajo Breastfeeding Coalition as part of the web of support. 

“We adapt to what our community needs,” she explains. 

These community-based organizations can always use more funding. If you are interested in supporting the Navajo Breastfeeding Coalition’s mission, you can donate through their fiscal sponsor the New Mexico Foundation. Use the drop down menu to select “Dine Nation (Breastfeeding)”. 

Announcing the launch of the Continuity of Care (CoC) in Breastfeeding Support: a Blueprint for communities

World Breastfeeding Week 2021 is upon us! There is so much to celebrate this week and through the month of August with National Breastfeeding Month (NBM) while acknowledging all the work there’s left to do. Our Milky Way caught up with National Association of County and City Health Officials (NACCHO) Lead Program Analyst Harumi Reis-Reilly, MS, CNS, LDN CHES, IBCLC and Senior Program Assistant Erika Ennis, CLC, and we are pleased to help announce the launch of the Continuity of Care (CoC) in Breastfeeding Support: a Blueprint for communities. The blueprint is designed to support local-level organizations to strengthen their community lactation landscape to ensure that families are supported throughout their infant feeding journey. The Blueprint will launch during National Breastfeeding Month #NBM21 on August 24th.

Learn more in this extensive Q&A. 

Q: Back in 2018, NACCHO released Breastfeeding in the Community: Program Implementation Guide: Reducing Disparities in Breastfeeding through Peer and Professional Support which quickly became the most downloaded resource from the Community Health & Maternal Child Health e-newsletter reaching thousands of local health professionals. Now, NACCHO is about to release the Continuity of Care in Breastfeeding Support Blueprint in partnership with USBC. How has this work evolved and grown from a few years ago to today? 

A: We have been working on this diligently for the past two years with so many people across the country. This was truly a collaborative process, with collective intellectual inputs. 

The blueprint project has been developed with funding through a cooperative agreement with the Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity (DNPAO), and in partnership with the U.S. Breastfeeding Committee (USBC).  

It all started in September 2018, through the reconvening of the dormant Continuity of Care (CoC) Constellation. The CoC Constellation met monthly throughout 2019. The Constellation conducted two information gathering surveys to identify additional resources, stakeholders to finalize the development of the CoC concept. The Constellation was then divided into five subgroups that reflect the first 1,000 days and beyond. This process allowed the group to identify and welcome additional experts from each field and was divided into five subgroups based on participants’ expertise. The five subgroup themes were: 

  • Preconception & Prenatal period
  •  Birth and Discharge
  • First Few Weeks
  •  Return to Work/School
  • and Baby’s 4+ Months.

 The subgroups discussed the landscape of breastfeeding support and transitions of care for each of these lactation journey periods. They identified both barriers and facilitators to establish CoC and relevant resources, such as useful tools and successful examples from the field. These findings are translated into this Blueprint’s strategies and recommendations. During June and July 2020, all subgroup participants and additional experts (71 participants in the first meeting, 58 in the second meeting) participated in an interactive virtual workshop (originally planned as an in-person meeting, and canceled due to the COVID-19 pandemic) to identify specific roles of key stakeholders responsible for establishing breastfeeding support within a community. Additionally, participants provided input regarding resources needed by stakeholders to establish continuity of care.  Data were analyzed and categorized in themes, resulting in the seven core CoC recommendations. These recommendations and strategies were sent for final review and feedback to all who participated in any of the Blueprint development meetings, and a final feedback call was hosted. 


Q: World Breastfeeding Week’s 2021 theme is “A Shared Responsibility”. This jives perfectly well with the idea of Continuity of Care, where breastfeeding support becomes less of an individual burden and places responsibility on the networks and systems that families find themselves in. Will you please speak to this idea?

A: This year’s theme for both World Breastfeeding Week and National Breastfeeding Month #NBM21 (continuity of care theme “Every Step of the Way”) sets the perfect timing and atmosphere for the launch of the CoC blueprint. The blueprint reinforces the idea that we all have a role and a collective responsibility to make the healthy choice the easy, default and feasible one. If the policies, systems and environments where families live, work, play and raise children are not proactively supportive and conducive of chest/breastfeeding, and skilled lactation support are not easily accessible, families will discontinue chest/breastfeeding prematurely, even if they did not plan to do so. This is evidenced by data that shows that most parents in the United States do not reach their breastfeeding goals. The new blueprint will include an image of the chest/breastfeeding local health system to show the wide range of community stakeholders that need to be engaged to build this lactation safety net in the community, so families do not fall through the cracks and sub-optimally breastfeed.

Q: Will you please share a few examples of how stakeholders are answering the call to support healthy infant feeding? 

A: Our team has been closely following CDC’s Racial Ethnic Approaches to Community Health (REACH) recipients and providing technical assistance to their lactation support continuity of care implementations in their communities for the past three years. They have been doing such great work, even during the current pandemic and its restrictions. Here are some highlights to share:

The County of San Diego, Health and Human Services Agency, implemented a community-wide environment improvement strategy, by successfully launching a digital social marketing campaign to normalize breastfeeding. The goal was to promote the uptake of the county’s REACH-adapted “It’s Only Natural” campaign by supporting services organizations. Their integrated advertising campaign utilized zip code geofencing strategies and specifically targeted their audience by age, race, location, and income. Check out their video: Breastfeeding Video for San Diego County HHSA 

The University of Arkansas for Medical Services developed the UAMS Breastfeeding Series, a set of 12 microlearning videos that includes lactation education and address concerns for providers and families. 

The YMCA, Healthy Savannah, in Georgia engaged their community through an innovative breastfeeding photovoice project aimed to identify issues around breastfeeding continuity of care in their jurisdiction. The photovoice method was used as a way for Black/African-Americans mothers in the community to capture their own images and perspectives that represent barriers to breastfeeding. Check out their final project here.

When the pandemic started, the City of Miami Gardens collaborated with community partners to host virtual discussions, and onsite support, to ensure internet stability and privacy. They host several online events that included local participants, and attendees from other states and countries! In addition, they conducted train -the- trainer workshops to increase organizational capacity to promote, protect and support breastfeeding virtually.  To learn more check out one of their Facebook master class videos.


Q: How do you envision the infant feeding landscape changing as a result of the release of the blueprint? 

A: One important thing to note is that the Blueprint is specifically intended to influence the local lactation landscape only, with suggested evidence-based action steps that are in the sphere of influence of community-level organizations. There are definitely many actions that must be taken by state- and national-level organizations that directly or indirectly influence chest/breastfeeding continuity of care in the community, but those are not outlined in this blueprint. With that said, we envision that long-term, with full blueprint implementations by many communities, there will be no families falling through the cracks because they will be fully supported in their infant feeding journey, therefore leading to an increase of breastfeeding exclusivity and duration rates, particularly in communities with low breastfeeding rates. Focusing attention and efforts on these communities will lead to a more equitable lactation landscape. Hopefully, this will help the nation reach the Healthy People 2030 goals of exclusive 6-month exclusive breastfeeding and 12 months duration rates for all groups.  Also, achieving CoC will reflect sustained, collaborative efforts among stakeholders and the establishment of a community lactation safety net, for those who need the most, with the implementation of sustainable policies, systems and environment solutions.

Photo by Trust “Tru” Katsande on Unsplash


Q: How can our readers help promote this work and get involved in the mission? 

A: We would love to engage with you all. There are several ways to get involved:

First, we would love to get everyone’s help to promote the blueprint launch, by sharing the promotional images and event registration link: http://bit.ly/CoCBlueprintLaunch  

During the event, we will also be announcing a Request for Applications (RFA) for organizations interested in implementing the blueprint. 

We will be maintaining a continuity of care resources website. We would love to hear your story and useful tools and resources you developed in your community to advance continuity of care and improve your lactation support infrastructure. So if you would like to share your resource, you can email us at breastfeeding@naccho.org 

Also, if you have expertise in any of the blueprint recommended actions, we will be interested in working with you to further develop tools and resources for each recommendation and help us provide technical assistance to local communities implementing the blueprint. Stay tuned for more upcoming information about that during the Fall 202. 

Finally, if you are not yet currently subscribed to our Breastfeeding in the Community monthly newsletter, please follow the instructions below to sign up for our newsletter.  

  • To subscribe, please log-in to your MyNACCHO account. If you do not have a “MyNACCHO” account, you can sign up here
    • Once logged on, click on “My Subscriptions” in the left navigation menu
    • Check the box for Breastfeeding in the Community
    • Click “Save” at the bottom of the page

Q: Is there anything else you’d like to add?

A: The blueprint launch event will be a kick-off of the 8-part webinar series on Continuity of Care in chest/breastfeeding support. No-cost Continuing education credits for lactation support providers and dietitians/nutritionists (1.0 CPEU) will be available for each session.  Other continuing education credits (CMEs, CNEs, CECHs, CPHs, CEUs) are pending approval. 

We would like to shout out a BIG THANK YOU to all who participated on our national surveys, monthly virtual meetings, and workshops throughout these past two years. We are grateful for those who shared their own perspectives on continuity of care in breastfeeding support gaps and their visions for the future of the field. 

Another shout out goes to our major partner in this project,  the U.S. Breastfeeding Committee, who worked side-by-side with us. Check out what they are up to for the National Breastfeeding Month at http://www.usbreastfeeding.org/nbm

Get ready for World Breastfeeding Week! Protect Breastfeeding: A Shared Responsibility

Mark your calendars for one of the globe’s greatest celebrations! Next week, we come together for the 29th Annual World Breastfeeding Week (WBW) (August 1-7) and everyone is invited. There are no unlikely guests at this party; protecting breastfeeding is a shared responsibility, in line with this year’s WBW theme.

The Protect Breastfeeding: A Shared Responsibility theme is aligned with area 2 of the WBW-SDG 2030 campaign which highlights the links between breastfeeding and survival, health and wellbeing of families and nations.

Support at the individual level is a crucial part of this shared goal, but breastfeeding must be considered a public health issue that requires investment at all levels. The concept of ‘building back better’ after the COVID-19 pandemic will provide an opportunity to create a warm chain of support for breastfeeding that includes health systems, workplaces and communities at all levels of society. A warm chain of support will help build an enabling environment for breastfeeding and protect against industry influence, as explained here.  

Organizations from locations all over the map have RSVPed to the celebration, answering the call to action by pledging their participation in WBW 2021. You can too through a simple process found here

WBW’s Relevant Resources page includes articles and documents about breastfeeding as not only an investment in improving health and saving lives, but as an investment in human capital development. A Save the Children document details strategies to effectively influence political commitment to breastfeeding. Another piece identifies successful multicomponent public health strategies. Together, these resources offer ample evidence and motivation to continue pushing for change for healthy families, nations and a healthy planet. 

The WBW 2021 Social Media Kit offers scheduled activities leading up to and during #WBW2021.   Use these hashtags in your social media posts: 

#WBW2021 #WABA #ProtectBreastfeeding #SharedResponsibility #breastfeeding #SDGs #worldbreastfeedingweek2021 #ProtectBreastfeedingaSharedResponsibility #protectbreastfeedingtogether #buildingbackbetter #warmchain4breastfeeding #breastfeeding4publichealth

In the aftermath of the COVID-19 pandemic and its persisting challenges, it has never been more important to protect healthy infant feeding; there’s no better time than now to inform, anchor, engage and galvanize action to protect breastfeeding at all levels.

The movement continues beyond WBW and into the month of August for National Breastfeeding Month (NBM). This year’s theme: Every Step of the Way with weekly observances:

Week 1: World Breastfeeding Week

  • Theme: Protect Breastfeeding: A Shared Responsibility

Week 2: Native Breastfeeding Week

  • Theme: Nourishing Our Futures

Week 3: Asian American Native Hawaiian and Pacific Islander Week

  • Theme: Reclaiming Our Tradition

Week 4: Black Breastfeeding Week

  • Theme: The Big Pause: Collective Rest for Collective Power

 In anticipation of NBM, you can Register for the launch event webinar for the “Continuity of Care in Breastfeeding Support: A Blueprint for Communities” on August 24, 1 p.m. ET.

You can celebrate in style during this vital, global initiative with Health Education Associates’ World Breastfeeding Week party pack. Get the swag here.  The United States Breastfeeding Committee (USBC) is also offering Limited Edition NBM 2021 Designs at their store here.

Integrating mental health services into primary care

Through play, children learn. Play teaches them how to process information, express themselves, self-regulate, and concentrate among its many other functions.

Photo by Rajesh Rajput on Unsplash

Early in her psychology studies, Laura Harford, PsyD, Licensed Clinical Psychologist and HealthySteps Specialist with the Mother and Child Integrated Mental Health Program (MAC-IMP) at NewYork-Presbyterian Columbia University Irving Medical Center became fascinated by the role that play plays curatively. 

“When you’re working with very young children therapeutically, it becomes nearly impossible to treat the child without addressing the parents’ needs as well,” Harford begins. 

Using play as a parental teaching tool and providing the parent with strategies and support, can promote more secure attachments and facilitate communication and understanding between a parent child dyad.

Photo by Larry Crayton on Unsplash

Play can increase parents’ understanding of their children’s needs and help them to feel more confident overall, Harford continues.  

Healthy Steps is part of the Zero To Three program designed to support new families around bonding, child development, and parenting concerns. 

More specifically, Zero to Three supports parents with practical resources, professionals with knowledge and tools that help them support healthy early development and policymakers in advancing comprehensive and coherent policies which support and strengthen families, caregivers and infant toddler professionals. 

The Healthy Steps model has identified five outcomes important to healthy child development and family well-being which include:

  • Breastfeeding
  • Child social-emotional development
  • Early childhood obesity
  • Maternal depression and 
  • Well-child visits.

As such, Harford was encouraged to complete the Lactation Counselor Training Course (LCTC) to help fulfill these priority outcome areas. 

Infant feeding can affect parental mental health, and the reverse is true too. 

Harford explains that if a mother is feeding her child “well” (“well” in quotes because this definition varies from individual to individual and family to family), she will likely feel more confident in her parenting abilities overall. If the child is not feeding “well”, feelings of anxiety and failure may creep into the picture. 

A mother who  presents with mental health issues may be less responsive to her child’s feeding cues in particular, contributing to a potentially fussy and irritable infant or to an infant who fails to thrive, Harford goes on.  

While breastfeeding can be preventative against perinatal mood disorders, support isn’t always easy to come by.   

 “There is no shortage of lactation specialists at [NewYork-Presbyterian Columbia University Irving Medical Center], but I wanted to be a more direct resource to ensure that any mother who is enrolled in my program and needs help can access support,” Harford explains.  

Harford works solely with individuals who receive Medicaid; as such, these families are often up against systemic barriers that challenge their ability to access health services. 

In the instance of virtual support, access to technology can be a barrier. Harford shares that as healthcare services shifted virtually as a result of the pandemic, their institution had various initiatives to support patients in maintaining connection to clinical care. 

Sometimes cost is prohibitory. Generally, navigating mental health care systems can be overwhelming and sustaining the effort to initiate services can be exhausting. 

That’s why Columbia University Irving Medical Center is working to provide these services directly through primary care, Harford says. 

Integrating health services allows for better continuity of care. 

“If there is one provider that the family trusts, then they will readily engage with the next they come across when these direct connections are made,” Harford explains.

There’s more time and energy available to facilitate those invaluable moments of play and connection between parents and their children when health services are integrated and the stressors of seeking out help are eliminated.

National Baby-Led Weaning Day and appropriate complementary feeding

We at Healthy Children Project  are so excited to see philosopher of the baby-led weaning (BLW) movement Gill Rapley’s work celebrated  this month. July 1 is now recognized as National Baby-Led Weaning Day!

In honor of this declaration, we are sharing one of our most popular Our Milky Way pieces originally published in 2018,  Food before one is NOT just for fun: appropriate complementary feeding and long-term health.


Unhealthy diets are costly for both children and the societies in which they live. (UNICEF 2016, page 90)

The United States performed poorly on almost all indicators set by the World Breastfeeding Trends Initiative (WBTi), an international tracking, assessment and monitoring system for national implementation of the Global Strategy on Infant and Young Child Feeding.

We did, however, score 10 out of 10 on Indicator 10: Mechanisms of Monitoring and Evaluation System, because in the words of Healthy Children Project Executive Director Karin Cadwell, “We are really good at keeping track of what we aren’t doing.”

The U.S. also managed 10 out of 10 on Indicator 15: Complementary feeding — Introduction of solid, semisolid or soft foods, which measures the percentage of breastfed babies receiving complementary foods at 6 to 8 months of age. The U.S. WBTi panel reported that although more than 80 percent of U.S. babies begin to breastfeed, only 22.3 percent are exclusively breastfed at 6 months, and by eight months, almost every baby has been introduced to complementary foods.

Actually, 20 to 40 percent of babies in the U.S. are introduced to complementary foods at younger than four months. [http://jandonline.org/article/S2212-2672(17)31734-3/fulltext]  

WHO/PAHO advise complementary food be introduced to infants’ diet at 6 months of age. Human milk is meant to be the primary staple of infants’ diets, but human milk alone cannot provide everything babies need nutritionally, especially micronutrients like zinc and iron… Food before one is NOT just for fun.

“While food is certainly a fun sensory experience, it’s also really important babies between 6 and 12 months get a broad exposure to healthy foods,” Healthy Children Project’s Cindy Turner- Maffei, MA, ALC, IBCLC said during one of her presentations at the latest International Breastfeeding and MAINN Conference.

But inconsistent messaging about feeding persists, as detailed in the WBTi U.S. report.

For instance, “…the American Academy of Pediatrics has inconsistent messaging regarding when to begin complementary feeding with a breastfed baby (4 versus 6 months); FDA child care guidelines differ significantly from WIC guidelines regarding infant feeding, etc.” (p 31)

Interestingly, it was after the Clean Label Project investigated pet food that consumers expressed interest in contaminants found in infant formula and baby food, perhaps a testament to our national priorities.

What’s more, the concept of which foods offer an appropriate complement to the diet of a breastfed infant as well as the food environment, including a booming baby food industry, have changed dramatically over the past 50 years, Turner-Maffei pointed out.

The packet apocalypse, where the convenience of “ready-to-feed-super- glop” has largely replaced the art of dining and sharing meals, is upon us in the U.S. Stocked shelves offer an overwhelming array of mostly highly processed snacks and meals in a pouch that generally lack texture diversity, can lead to tooth decay, and “may be predictive of future eating habits”. (UNICEF 2016)   

In light of National Nutrition Month, let’s take a look at what appropriate complementary feeding looks like and the importance of appropriate complementary feeding for long-term health through a summary of what Turner-Maffei and colleagues found after conducting a multi-source literature search and thematic review on complementary foods/feeding and child health/outcomes.

Importance of appropriate complementary feeding (CF)

Children with inadequate or inappropriate CF are at increased risk for growth stunting, potential changes to the microbiome, being overweight, and having micronutrient deficiencies.

Stunting and chronic nutrient deficiencies have significant consequences for health, growth and cognitive development and performance.

For instance, appropriate iron levels are needed for proper brain development; deficiency is associated with thought-processing and motor development issues.

Zinc is related to immune function and optimal cell growth and repair; deficiency is associated with impaired growth, increased susceptibility to infection and an increased risk of diarrhea.  

UNICEF’s From the First Hour of Life report points out that “If appropriate complementary feeding practices were scaled up to nearly universal levels, approximately 100,000 deaths in children under five could be averted each year.” (p. 17)

Guidelines to appropriate CF

Turner-Maffei detailed that foods offered to infants must be nutrient-dense because of their small stomach size. Dietary diversity, where babies are offered a wide variety of healthy foods, help ensure nutrient needs are met. How babies are fed matters too. That is, social interaction plays an important role in appropriate feeding.

PAHO/WHO set forth Guiding Principles for Complementary Feeding of the Breastfed Infant (2003) which states:

  1. Practice exclusive breastfeeding from birth to 6 months, and introduce complementary food at 6 months of age (180) days while continuing to breastfeed.
  2. Continue frequent, on-demand breastfeeding until 2 years of age or beyond.
  3. Practice responsive feeding, applying the principles of psychosocial care.
  4. Practice good hygiene and proper food handling.
  5. Start at 6 months of age with small amounts of food and increase the quantity as the child gets older, while maintaining frequent breastfeeding.
  6. Gradually increase food consistency and variety as the infant grows older, adapting to the infant’s requirements and abilities.
  7. Increase the number of times that the child is fed complementary foods as the child gets older.
  8. Feed a variety of nutrient-rich foods to ensure all nutrient needs are met.
  9. Use fortified complementary foods or vitamin-mineral supplements for the infant, as needed.
  10. Increase fluid intake during illness, including more frequent breastfeeding, and encourage the child to eat soft, favorite foods. After illness, give food more often than usual and encourage child to eat more.

Another important document, Indicators for assessing infant and young child feeding practices (WHO 2008), provides core indicators for infant and young child feeding.

It sets a minimum meal frequency guideline:

  • 2 meals for BF infants 6-8 months
  • 3 meals for BF infants 9-23 months
  • 4 meals for non-BF infants 6-23 months.

Children aged 6 to 23 months should consume from at least 4 of 7 food groups which are:

  1. Grains, roots, and tubers
  2. Legumes and nuts
  3. Dairy products (milk, yogurt, cheese)
  4. Flesh foods (meat, fish, poultry)
  5. Eggs
  6. Vitamin-A rich fruits and vegetables
  7. Other fruit and vegetables

Iron-rich or iron-fortified food should be consumed daily. In fact, “Vegetarian diets cannot meet nutrient needs at this age unless nutrient supplements or fortified products are used.” (PAHO/WHO, 2003, p. 37)

What can we do?

Three themes that arose from Turner-Maffei and colleagues’ study help direct our efforts to encourage ongoing healthy eating habits.

Theme one, the flavor bridge, refers to the flavors babies are exposed to through amniotic fluid and breastmilk. This exposure is linked to later acceptance of aromatic foods.

“A wide variety of flavors either ingested (e.g., fruit, vegetables, spices) or inhaled (e.g., tobacco, perfumes) by the mother are transmitted to her amniotic fluid and/or milk, significantly increasing in intensity in milk within hours after consumption. Infants’ experience with these volatiles and tastes modifies their acceptance in mother’s milk, formula, and solid foods.” (Mennella, 2014, p 706s)

Mennella makes clear, “breastfeeding confers greater acceptance of healthy foods…only if they are part of the mothers’ diet…” (2014)

The second theme Turner-Maffei, et al explored was dietary diversity. Part of the Global Exploration of Human Milk Study (GEHM) shows that the dietary diversity of an urban U.S. city falls significantly below that of the diversity achieved by the Shanghai site. (Woo, et al 2015)

The authors write: “Of particular concern is that only 28% of the highly breastfed Cincinnati infants between 6 and 12 months of age achieved adequate complementary diet diversity. This prevalence is consistent with infants in several developing nations, where obtaining adequate nutrition is a concern. Thus, the likelihood of achieving adequate nutrition may be lower in this group, even when concerns about food scarcity in the US are minimal.” (p. 5)

Increasing awareness of the “biologically-driven dependence of breastfed infants on high-quality, nutrient-dense complementary foods” could help shift this phenomenon.

With the prevalence of iron in U.S. diets, Turner-Maffei notes that iron absorption differs from non-heme elemental sources (like fortified cereals) and heme sources (meat). Unabsorbed iron can encourage the growth of unwanted microbes like Enterobacter, Salmonella, and Listeria.

Parental feeding styles make up theme three.  

Savage, Fisher and Birch define an ideal feeding style as responsive, supportive, non-manipulative, and authoritative.

Townsend and Pitchford found that Baby-Led Weaning (BLW) had a positive impact on the liking of foods that make up healthy nutrition.

Turner-Maffei, along with all of us at HCP, encourage you to help shift awareness that Food Before One is NOT Just for Fun!