Guidelines about feeding children under the age of 2 are generally consistent, but there are some inconsistencies, such as the minimum recommended age to which breastfeeding should be continued, says a new report from the National Academies of Sciences, Engineering, and Medicine. There is substantial opportunity to harmonize the development of future feeding guidelines across government agencies, professional societies, and nonprofit organizations ― in order to establish more consistent guidance, avoid duplicate efforts, and ensure effective communication and dissemination, says Feeding Infants and Children from Birth to 24 Months: Summarizing Existing Guidance. The report ― which reviews 43 guideline documents from authoritative groups ― compares recommendations across these groups, evaluates their breadth and consistency, and assesses the type of evidence underpinning each recommendation. Recommendations are grouped into 26 topics covering “what to feed” and “how to feed.” “Every day, people make decisions about what and how to feed infants and young children ― and these decisions have important implications for child health and development. Health care providers and parents have a wealth of resources available, from position statements to social media posts, but even when guidance comes from authoritative groups, there can be inconsistencies in advice,” said Kathryn Dewey, distinguished professor emerita in the department of nutrition at the University of California, Davis, and chair of the committee that wrote the report. “We hope this report provides a framework for developing harmonized feeding guidelines that are based on high-quality evidence, and promoting guideline uptake in pediatric care, policy, and federal programs that provide food and nutrition assistance to young children.” Among the “what to feed” topics in the report, the committee reviewed recommendations on breastfeeding; formula-feeding; the suitability of cow’s milk; substances to avoid or limit; vegetarian and vegan diets; introduction of foods associated with allergies, including peanuts; and the use of nutrient supplements. The “how to feed” topics include the safety of certain foods and feeding practices; bottle use and propping; hunger and satiety cues; the introduction of complementary foods (foods other than breast milk or infant formula); and food consistency and texture. For many of the topics, the recommendations from the various sources were consistent or had only slight nuances in wording. However, there was some inconsistency in the specific ages or age ranges stated in some of the recommendations, and other recommendations varied in their specificity. For example, some organizations made recommendations about the timing of introduction of peanuts based on the infant’s risk of peanut allergy, while others did not differentiate on that basis. Communication and Dissemination of Feeding Recommendations Of the 43 guideline documents reviewed, most were targeted to health care providers (particularly physicians, nurse practitioners, nurses, dentists, and registered dietitian nutritionists), who are typically expected to provide the information to parents and guardians. Other important audiences include early care and education providers, policymakers, and administrators of programs such as the Child and Adult Care Food Program and the Special Supplemental Nutrition Program for Women, Infants, and Children. The report calls for guideline developers to identify effective ways to communicate with all stakeholders. The committee also identified several evidence gaps related to the communication and dissemination of feeding guidelines, including the use of telehealth; the impact of social media dissemination; and the role of community health workers and peer counselors in sharing information with socio-economically vulnerable, rural, and other hard-to-reach populations. Future Directions for Guideline Harmonization The report offers insights to help align and improve future guidelines, including collaboration between organizations during the guideline planning and development process; the use of best practices for guideline development; and timely and effective dissemination of evidence-based recommendations, based on the principles of dissemination and implementation science. The study ― carried out by the Committee on Scoping Existing Guidelines for Feeding Recommendations for Infants and Young Children Under Age 2 ― was sponsored by the Centers for Disease Control and Prevention, the National Institutes of Health, and the National Academy of Sciences’ W.K. Kellogg Foundation Fund. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln. https://www.nationalacademies.org/news/2020/07/existing-feeding-recommendations-for-birth-to-24-months-often-consistent-opportunities-exist-to-harmonize-guidance