WARMRegards July 2018 – WIC Services and Infant Feeding Practices
This month, we’d like to look at parallels between WIC services and clients’ feeding practices, as well as what WIC clinics can do to promote healthy infant feeding practices.
The USDA’s WIC Infant and Toddler Feeding Practices Study compiles years of data to shed light on the association between WIC enrollment and breastfeeding, infant nutrition, and weight status of children up to two years of age. The second study, reported in April 2018, lists several findings:
- WIC mothers return to work or school by about seven months postpartum, at which point fully employed mothers breastfeed significantly less than part-time or unemployed mothers.
- WIC children develop self-feeding skills at the expected rates for infants.
- WIC children receive a varied diet consisting of fruits, vegetables, meats, and dairy, but also consume more candy and sweets.
- With the exception of Vitamin D, nutrient levels in WIC children meet or exceed recommendations.
- WIC children exhibit a concerningly high weight-for-length status consistent with low-income children.
Overall, these findings show that WIC is working. WIC mothers are balancing work and breastfeeding and WIC children are receiving the nutrition they need to make developmental progress. However, there is still work to be done. The study shows that WIC children consume high levels of overly sweetened or salty foods, something that could be attributed to low-income lifestyles and the accessibility and affordability of these snacks. WIC children are also falling short on their Vitamin D intake. The high weight-for-length ratio seen in WIC children suggests a higher susceptibility to overweight or obese status later in life.
WIC agencies can implement responsive feeding programs to help mothers and children maintain healthy lifestyles and avoid the pitfalls of low-income eating habits.
Encouraging Responsive Feeding
The most important thing a WIC agency can do for child nutrition is keep mothers informed. A responsive feeding program, consisting of short educational videos and information mothers can watch and access on their devices at home, can teach mothers how to respond to their child’s hunger in a healthy way.
Responsive feeding is demand-based feeding. A good responsive feeding program should clue mothers in to the cues they should look out for that their child is actually hungry, not just distressed or wanting attention. Once the child is being fed, mothers should engage with their child during feeding and pace feeding according to signals given by the child, stopping when the child is full, not when the food runs out.
At the 2018 California WIC Association Conference, Dr. Alison Ventura discussed the implications of feeding children in the absence of hunger. When children are fed for reasons other than hunger (child is fussy, food is available, etc.), children are more likely to be at risk for obesity later in life. It is during this important developmental time that children establish self-regulation skills and learn how to recognize that they’re full. Difficulties recognizing satiety often lead to overeating in later childhood and adulthood.
Make sure that your clinic is providing mothers with information and support about breastfeeding and bottle feeding, as well as responsive feeding techniques. For breastfeeders, information should include:
- Latching and positioning
- Recognizing hunger and fullness cues
- Common breastfeeding problems
Formula feeders should be provided with information on:
- Recognizing hunger and fullness cues
- Common signs of overfeeding
- Paced bottle feeding
Benefits to Breastfeeding
The American Academy of Pediatrics states that breastfeeding is unequivocally better for babies than bottle feeding. Breastfed infants tend to:
- Consume lower volumes than bottle-fed infants
- Gain weight less rapidly
- Gain less weight in the first two years of life
- Get sick less often
This is because breastfeeding promotes responsive feeding. With breastfeeding, there is no visible amount of food, so mothers feed until the child begins to resist feeding, indicating they’re full. There is also valuable skin-to-skin contact and eye contact that engages the mother and keeps her from distractedly overfeeding.
Complications with Breastfeeding
Women who do not breastfed may make that choice based on a variety of reasons, though a common factor is prenatal obesity. Women with obese BMIs are more at-risk for a variety of pregnancy-related concerns and are less likely to breastfeed (2018 California WIC Conference).
You can provide valuable nutrition counseling to obese mothers to help them maintain a healthy weight and a healthy pregnancy. Be sure to focus on the prevention of risks, not on the prevention of weight gain and size. You can work with the mothers to focus on nutritious food choices based on cultural foods and favorite foods, while reducing non-nutritious snacks and oversized portions. Review food labels with mothers to discuss serving sizes and reasonable calorie intakes.
Nutrition counseling can be provided to mothers right at your clinic. However, some mothers may not have the time to attend nutrition counseling or may not be able to get to a clinic regularly. In these instances, a secure chat app may be a great way to communicate with mothers one-on-one in a safe environment, allowing you to respond to questions and provide information. You can also provide short, informative videos on your website that mothers can access from their devices at home.
A healthy mother is more likely to breastfeed, resulting in a healthier child. While WIC mothers are breastfeeding at a good rate, there is always room for improvement. Be sure to discuss breastfeeding often with your clients and provide them with easy-to-understand resources.
By Shela Ward