Understanding What’s Happening in Infant Feeding: A Look at Baseline Clinical Data for the Optimize Infant and Toddler Feeding for Obesity Prevention Collaborative

Background: Evidence increasingly supports the importance of the first 1000 days of development for obesity prevention and overall child health. However, recent national studies highlight many relevant gaps in early child nutrition. Only 36% of children are breastfed for the recommended duration (≥12 months). In addition, 55% of infants are introduced to complementary foods before ≅6 months, and 16% before 4 months. On a given day about a quarter of children ages 6-12 months reportedly eat no fruits or vegetables, but about a third consume sugary beverages/snacks, a value that more than doubles before age two. Resources are now available to assist primary care providers (PCPs) in supporting optimal nutrition/healthy weight for children <2, making this area of care ripe for intervention. Objectives: To examine baseline results of clinical measures for a novel quality improvement (QI) project, to support optimal nutrition and healthy growth for children <2 and to further analyze dietary/nutrition data, to compare results with known gaps in child nutrition and inform PCP training. Design/Methods: Optimize Infant and Toddler Feeding for Obesity Prevention is a brief (19-week), team-based, virtual QI collaborative to foster healthy behaviors/weight in children <2 during well visits. Key drivers aim to help PCPs provide comprehensive care related to early nutrition/obesity prevention for all children <2 (Figure). Teams attend national webinars and local meetings, complete required trainings, and conduct iterative practice changes, with ongoing access to tools and technical assistance. Three clinical data cycles, based on ≥20 randomly selected charts/practice, are used to calculate 10 clinical measures, with a 4th cycle submitted after 6 months. Nineteen teams began participating in January 2020, but the project was paused in mid-March, due to the pandemic, with plans to resume by summer. Baseline clinical measures were analyzed descriptively; dietary intake data were also analyzed by sub-category and child age. Results/Discussion: Pre-/perinatal obesity risk factors were rarely assessed (19% of visit) and weight-for-length-percentile was assessed only about half of the time (52%) (Table). Parental concerns were regularly assessed and addressed (91% and 95%, respectively). Dietary intake was almost universally assessed (98%), but counseling occurred somewhat less often (81%). Breastfeeding assessment and counseling peaked early (≤1mo.) and declined throughout infancy, suggesting a need to emphasize continuation. Complimentary food introduction assessment and counseling were highest around the recommended time of food introduction, suggesting a need to advance guidance to earlier ages. Unhealthy beverage assessment and counseling were absent during early infancy, indicating possible missed opportunities for early intervention. Conclusion: Baseline clinical data identified important gaps in care relevant to promoting healthy nutrition and growth in children <2 and support further analysis by dietary subtopic and child age, to optimize PCP training. Two additional data cycles are expected by September 2020.