The Feeding Infants and Toddlers Study (FITS) 2016: Moving Forward

Abstract

The years from birth through preschool involve more changes in growth, development, eating patterns, nutrition, and other functions than any other time of life (1). Food consumption during this time is dynamic and is influenced by rapidly changing trends in feeding practices for infants and young children, as well as by longer-term trends in family incomes and food programs. It is critical to know what children are being fed, what they are eating, and how practices are changing, if we are to craft interventions that lay a solid nutritional foundation for later health, decrease risks of inappropriate eating habits, and develop evidence-based feeding recommendations. Informal guidelines for feeding the young have been available since antiquity. Today, we use formal evaluation of the evidence before making recommendations (2–5). Of particular relevance here is the Birth to 24 Months (B-24) project to evaluate data and support the addition of the first ever recommendations for children younger than 24 mo to the 2020–2025 Dietary Guidelines for Americans (6). Sound recommendations must be based on up-to-date information, and yet data on intakes and eating patterns are sparse, particularly for those <24 mo of age. NHANES provides much useful information for children <24 mo of age, but the sample sizes of both breast- and bottle-fed infants and toddlers are insufficient to trace the rapid changes in intakes that occur during that time (7, 8). The Feeding Infants and Toddlers Study (FITS) 2016 contributes to this evidence base and complements NHANES by applying similar methods to a large sample of infants and toddlers aged <24 mo, including minorities, providing greater detail about the adequacy of usual nutrient intakes and the foods and food groups consumed. FITS 2016 is a cross-sectional study of caregivers of children under the age of 4 y living in the 50 states and Washington DC. Data collection occurred between June 2015 and May 2016. A recruitment interview (respondent and child characteristics, feeding practices including responsive feeding and reasons for starting or stopping breastfeeding, physical activity, screen use, sleep habits, participation in food assistance programs) was completed by telephone or online. This was followed by a feeding practices questionnaire and a 24-h recall conducted by telephone. A second 24-h recall was collected for a random subsample of 25% of the total sampled population. Because FITS is a telephone survey, direct anthropometric data could not be collected; the lack of accurate anthropometric data or other biomarkers to link the food consumption data collected to health outcomes is a limitation (9).