Cyclic formula feeding among infants participating in the special supplemental nutrition program for women, infants, and children

Abstract

Background: Low-income households often experience a cyclic pattern in food availability, with acute food shortages at month end. Variations in the monthly feeding of infant formula are understudied. Objectives: This study aimed to compare the amount and frequency of formula consumed at the beginning and end of the monthly Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance cycle and test associations with total energy intake and other feeding practices among infants aged 7 - 11 mo. Methods: This study was conducted between May 2020 and April 2021 in the southeastern United States and involved mothers of infants participating in WIC ' s fully formula package. Mothers were interviewed and 24-h feeding recalls were conducted at the beginning and end of the month. We de fi ned month beginning as 5 d following the fi rst WIC formula purchase and month end as 5 d before the next monthly cycle. Fifty mother-infant dyads participated in single or multiple monthly cycles, totaling 98 monthly cycles. Generalized linear mixedeffects modeling was used to test differences in formula feeding at month beginning and end. Results: Most participants (84%) were African American or Latino and > 90% purchased all formula within 2 - 3 d of the WIC issuance. The energy intake from formula at month beginning was signi fi cantly higher than at month end (67.63% and 57.85%, respectively; P 1 / 4 0.002), with no differences in total energy intake. The odds of infants being fed cow milk and fruit juices/drinks increased from month beginning to end ( P < 0.05). Conclusions: Infants in low-income households are at risk of experiencing a cyclic feeding pattern characterized by higher formula feeding at month beginning and an increase in feeding of nonrecommended drinks at month end. The WIC program policy could review educational and distribution options to reduce cyclic formula feeding and clarify caregivers ' understanding of infants ' formula needs. Household-level investigations into formula management and determinants of cyclic feeding are warranted.