Comparing Food Intake Among Infants and Toddlers Participating in a
South-Central Texas WIC Program Before and After Food-Package Changes

Changes in WIC

In recent years, concerns about feeding practices among very young US children have emerged. For example, despite the known benefits of sustained breastfeeding, breastfeeding duration remains low, especially among low-income populations¹. We also know that the diets of very young children are high in calorie-rich foods but lack whole foods such as fruit and vegetable². Poor dietary trends have been accompanied by weight gain, with nearly 10% of children under the age of two having excess weight, and 31.8% of children ages 2-19 being overweight or obese3. Low-income children experience even higher rates of obesity³.
With the intent of addressing feeding practices among WIC participants, in 2009 the USDA implemented an interim rule⁴ that instigated considerable changes in the WIC food packages. These changes were designed to promote:

• Longer durations of breastfeeding;
• Introduction of fruit, vegetables, and iron rich foods to infants at around 6 months;
• Offering fresh fruit and vegetables and whole grains to toddlers; and
• Omitting or limiting juice intake, depending on the age of the child. South-central Texas WIC study

This cross-sectional, observational study

compared feeding practices and dietary intake between 2 predominantly Hispanic cohorts of infants and toddlers ages 4 to 24 months participating in a south central Texas WIC clinic in 2009 (before the package change; n=84) and in 2011 (after the package change; n=112). Results of 24-hour dietary recalls administered to caregivers of eligible infants and toddlers were used to tally intake of foods and beverages identified in WIC packages. Any individual food or beverage consumed by the child, regardless of portion size, was counted as an “exposure” to that item. Feeding practices, health history, and demographic data were also collected.

Early feeding practices

While breastfeeding initiation rates were high in both study years, duration did not increase. However, the age of introduction of formula was significantly later in 2011 (10.0 weeks) than in 2009 (8.9 weeks; P<0.05) and the age of introduction of complementary foods was approximately 2 weeks later in 2011 (P=.053). Age of introduction of juice did not change with approximately 25% of caregivers in both study years offering juice before 6 months.

Complimentary foods

Jarred baby food fruit and vegetable exposures in infants 6-12 months were similar in the two study years, with about half of the sample having a baby food fruit and half having a baby food vegetable on the day studied. However, strikingly, 10% of infants 6-12 months in 2009 and 20% in 2011 received no jarred baby food fruit or vegetables on the day studied.

Toddler feeding practices

In 2011, significantly fewer toddlers consumed any fresh vegetables on the day studied.  Of note, in 2011 almost a third of toddlers received no fresh fruit or vegetables at all on the day studied, compared to 12% in 2009. Exposure to whole grains (primarily corn tortillas and whole wheat bread) among toddlers was not different after the package changes.

Next steps…

This small regional analysis of the WIC package changes in a high-risk community in south central Texas revealed that few of the USDA’s intended dietary practices were realized after the 2009 interim rule was implemented. Some larger studies have reported positive changes in breastfeeding and general availability or intake of package-related foods after the 2009 changes⁵. However, very few studies focus on measuring changes in actual consumption of baby food fruit and vegetables, fresh produce, whole grains, and juice among young infants and toddlers. Further studies are necessary to fill the gaps in knowledge and elucidate the full impact of the WIC package changes on the feeding practices of infants and toddlers participating in WIC.