Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at...

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Introducing... Solid Foods

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Page 1: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Introducing... Solid Foods

Page 2: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Current Guidelines

Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP)

Gradual introduction of solid foods after 6 months (AAP & AAFP)

No cow’s milk before 1 year ( American Academy of Pediatrics)

Page 3: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Exclusive breast-feeding for 6 months

First semi-solid foods should be:– cereals without gluten – vegetables and fruits with low allergenic

potential

Withhold foods with high allergenic risk until after 8-12 months

All household foods should be introduced gradually in the second year

Torun B. Eating behavior from birth to 5 years. [Spanish] Arch Latinoam Nutr 1999 Jun; 49(2):97-100.

Page 4: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Most Proven Allergens:– Cow‘s milk– Egg– Fish– Wheat– Soy– Nuts– Citrus-fruits

Stogmann W, Kurz H. Atopic dermatitis and food allergy in infancy and childhood. [German] Wein Med Wochenschr 1996;146(15):411-4.

Page 5: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Guidelines-Vegan Infants Breast-milk for the first 4-6 months

– may need B12 supplementation– soy-based formula is a possible alternative

Tofu, dried beans, and meat analogs should be introduced around 7-8 mnths– supplement zinc, iron and vit D and B-12

Mangels AR, Messina V. Considerations in planning vegan diets: infants. J Am Diet Assoc 2001 Jun; 101(6):670-7.

Page 6: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Guidelines-Vegan Infants

Soy milk should not be the primary beverage until after 1 year (Mangels)

Nutritional deficiencies have been found in children drinking “health food milk alternatives“– Rice milk kwarshiorkor (protein)– Soy milk rickets (vit D) (Carvalho)

Page 7: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Based on Development

The introduction of solid foods should parallel the developmental changes that occur throughout the first year

Bronner YL, Paige DM. Current concepts in infant nutrition. J Nurse Midwifery 1992 Mar-Apr;37(2Suppl):43S-58S.

Kwavnick BS, Reid DJ, Joffres MR, Guernsey JR. Infant feeding practices in Ottowa-Carleton: the introduction of solid foods. Can J Public Health 1999 Nov-Dec; 90(6):403-7.

Page 8: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Must consider... Development of digestive system

– Lack of digestive enzymes– Teeth

Choking – tongue thrust reflex (4 months)

• baby's tongue pushes food out

Immature kidneys– increased renal solute load

Food allergies

Page 9: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Signs of physical readiness:

Interested in the foods he sees the rest of the family eating

Can move foods from the front of his mouth to the back with his tongue– No tongue thrust reflex

Can sit up with support – Can control his head – Can control upper body movements

Page 10: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Signs of physical readiness:

Is at least 4 months old Has doubled his birthweight Wants to breast feed more than 8-10

times during a 24 hour period If formula fed, drinks more than 32 oz.

In a 24 hour period

Page 11: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Common Practices

Unfortunately, studies show that many mothers, around the world, are not following these guidelines...

Page 12: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

USA

Although recommendations for delaying introduction of solid foods until 4-6 months have been in place for more than a decade, about half the mothers in this study did so earlier

Skinner JD, et al. Transitions in infant feeding during the first

year of life. J Am Coll Nutr 1997 Jun;16(3):209-15.

Page 13: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Risk Factors

Mothers were more likely to introduce solid foods before 4 months if they:– did not breast feed– were younger– had lower education– lacked support after birth– smoked

Kwavnick BS, Reid DJ, Joffres MR, Guernsey JR. Infant feeding practices in Ottowa-Carleton: the introduction of solid foods. Can J Public Health 1999 Nov-Dec; 90(6):403-7.

Page 14: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Low Income Mothers & Feeding Believed that it was better to have a heavy

infant because infant weight was the best marker of child health and successful parenting

Feared that their infants were not getting enough to eat (therefore introduced rice cereal and other solid foods before recommended ages)

Used food to shape their children‘s behaviors (calm fussiness)

Page 15: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Low Income Mothers & Feeding

“Acknowledged that some of these behaviors went against the advice of WIC

nutritionists and physicians but chose instead to rely on their mothers‘ advice.”

Researchers stressed the importance of including grandmothers in educational programs

Baughcum AE, et al. Maternal feeding practices and childhood obesity: a focus group study of low-income mothers. Arch Pediatr Adolesc Med 1998 Oct;152(10):1010-4.

Page 16: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Cultural Norms...

Page 17: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

African American Studies report the addition of semi-solids as

early as 1-2 weeks of age

Cultural norm to feed cereal in the bottle and to feed other semi-solid foods within the first month of life

Grandmothers played a dominant role in deciding what the infant would eat

Bentley M, Gavin L, Black MM, Teti L. Infant feeding practices of low-income, African-American, adolescent mothers: an ecological, multigenerational perspective. Soc Sci Med 1999 Oct; 49(8):1085-100.

Page 18: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Asian Indian Americans Asian Indian American (AIA) mothers breast

fed for shorter durations and introduced formula and solids at a younger age that Anglo American mothers

AIA mothers based these decisions primarily on the family network, not healthcare professionals

Kannan S, Carruth BR, Skinner J. Infant feeding practices of Anglo American and Asian Indian American mothers. J Am Coll Nutr 1999 Jun; 18(3):279-86.

Page 19: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Early introduction of solids…

What’s the big deal?

Page 20: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Early introduction of solid foods

Results in a displacement of energy intake from breast milk/formula

–decreased caloric intake from protein and fat

– increased carbohydrate

Mehta KC, Specker BL, Bartholmey S, Giddens J, Ho ML. Trial on timing of introduction to solids and food type on infant growth. Pediatrics 1998 Sep;102(3 Pt 1):569-73.

Page 21: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Nutritional deficiencies? Diabetes?

Page 22: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Opinion against early introduction of solid foods is based on concerns about– renal solute load– obesity– celiac disease– food allergy

Haschken F. The Nutrition Committee of the Austrian Society of Pediatrics and Adolescent Medicine. Comment on nutrition with solid foods in infancy and early childhood. [German] Patiatr Padol 1992;27(3):57-9.

Page 23: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Dangers of Early Solids

Research has shown links to… Respiratory illness Eczema Allergies Asthma Diabetes

Page 24: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Introducing Solids

Page 25: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Introducing Solids

Accustoming infants to solid foods is a lengthy process... Patience!

– Begin at a time that‘s relaxing for both you and your baby

– If your baby is very hungry, prevent frustration by feeding him a little breast-milk or formula first

Page 26: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Introducing Solids Use a very small spoon

– plastic coated to protect gums

Never use a bottle or infant-feeder for semisolid or solid foods– increase the possibility of choking

and/or overfeeding

Page 27: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Introducing Solids Remember that breast-milk or formula is

still the main source of nutrition during the first year

Increase the size of feedings very gradually– start with a tablespoon or two until your baby

gets the idea

Respect baby's signals for being full – start to play, blowing bubbles, pushing the

spoon away or turning the head

Page 28: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Introducing Solids

Introduce only one food at a time– wait a week before introducing another food

Always watch to see if the baby has any reaction– Vomiting– Diarrhea– Wheezing– Skin rash

Page 29: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Do not add salt, sugar or other seasonings to food!

Infants consuming commercially prepared baby foods had significantly less sodium in their diets than infants fed primarily table foods.

Endres J. Poon SW, Welch P, Sawicki M, Duncan H. Dietary sodium intake of infants fed commercially prepared baby food and table food. J Am Diet Assoc 1987 Jun; 87(6):750-3.

Page 30: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

As they grow…

6-9 months old, start encouraging the infant to drink from a cup

As your baby gets more teeth, you can start to give him finger foods – teaches him how to feed himself

Page 31: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Finger Foods Acceptable finger foods include

– hard toast, melba toast, crackers, zwieback and soft/cooked vegetables and fruits

The following foods can cause choking and should not be used until your baby is older:– berries, grapes, cherries, and raw vegetables such

as peas and carrots, nuts, raisins, adult dry cereals, whole kernel corn, hot dogs, chips, pretzels, and popcorn

Page 32: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Common Questions

Page 33: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Fruit Juice

4-6 oz of juice per day (1 food serving of fruit) is more than adequate– must be pasteurized– not “drink”, “cocktail” or “beverage”

fruit juice offers no nutritional advantage over whole fruit– doesn’t promote “fruit-eating behavior”

Committee on Nutrition. American Academy of Pediatrics: The use and misuse of fruit juice in pediatrics. Pediatrics 2001 May; 107(5):1210-3.

Page 34: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Fruit Juice No nutritional indication to feed juice to

infants younger than 6 months

Could risk having juice replace breast milk (formula) in the diet– reduced intake of protein, fat, vitamins, and

minerals (Fe, Ca, Zn)– malnutrition and short stature have been

associated with excessive consumption of juice

Committee on Nutrition. American Academy of Pediatrics: The use and misuse of fruit juice in pediatrics. Pediatrics 2001 May; 107(5):1210-3.

Page 35: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Iron Absorption

Drinks that contain ascorbic acid consumed simultaneously with food can increase iron absorption by twofold

Fruit juice should be used as part of a meal or snack– not to be sipped throughout the day

Committee on Nutrition. American Academy of Pediatrics: The use and misuse of fruit juice in pediatrics. Pediatrics 2001 May; 107(5):1210-3.

Page 36: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Fruit Juice... Concerns Excessive juice consumption has been

associated with chronic diarrhea, excessive flatulence, abdominal pain, and bloating– malabsorption of carbohydrate

Dental caries have been associated with juice consumption– prolonged exposure of the teeth (begin to erupt

at approx. 6 months) to sugars

Committee on Nutrition. American Academy of Pediatrics: The use and misuse of fruit juice in pediatrics. Pediatrics 2001 May; 107(5):1210-3.

Page 37: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

American Academy of Periodontics recommend that:– juice be offered in a cup, not a bottle– infants should not be put to bed with a

bottle (of any kind)– should not allow children to sip juice

throughout the day• not only dental carries, also displaces nutrients

Committee on Nutrition. American Academy of Pediatrics: The use and misuse of fruit juice in pediatrics. Pediatrics 2001 May; 107(5):1210-3.

Page 38: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Whole milk or 2%?

No differences in height, weight or % body fat

Reduction in total fat and saturated fat intake in toddlers can be achieved through the use of 2 % milk without compromising growth

Wosje KS, Specker BL, Giddens J. NO differences in growth or body composition from age 12-24 months between toddlers consuming 2% and toddlers consuming whole milk. J Am Diet Assoc 2001 Jan;101(1):53-6.

Page 39: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Commercial vs. Homemade?

Homemade is cheaper and not as much work as it may seem

• Super Baby Food by Ruth Yaron• e.g.. beets and spinach (nitrates in the soil)

If using commercially prepared baby foods, best to buy organic

Page 40: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Commercial Baby Food Modified food starches are used in strained and

junior foods and in some infant formulas Few studies on the effect of starch feeding on

the growth of young infants– bioavailability

– effect on nutrient absorption

– intestinal changes

– toxic mutagenic and carcinogenic effects

Caution that they should be used prudently and sparingly

Lanciers S, Mehta DI, Blecker U, Lebenthal E. Modified food starches in baby foods. Indian J Pediatr 1998 Jul-Aug; 65 (4):541-6.

Page 41: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

Definite need for continued research In the meantime, conservative approach

is warranted– minimize potential problems

Page 42: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

References

Baughcum AE, et al. Maternal feeding practices and childhood obesity: a focus group study of low-income mothers. Arch Pediatr Adolesc Med 1998 Oct;152(10):1010-4.

Bentley M, Gavin L, Black MM, Teti L. Infant feeding practices of low-income, African-American, adolescent mothers: an ecological, multigenerational perspective. Soc Sci Med 1999 Oct; 49(8):1085-100.

Borresen HC. Rethinking current recommendations to introduce solid food between four and six months to exclusively breast feeding infants. J human Lact 1995 Sep;11(3):201-4.

Bronner YL, Gross SM, Caulfield L, et al. Early introduction of solid foods among urban African-American participants in WIC. J Am Diet Assoc 1999 Apr; 99(4):457-61.

Page 43: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

References

Bronner YL, Paige DM. Current concepts in infant nutrition. J Nurse Midwifery 1992 Mar-Apr;37(2Suppl):43S-58S.

Carvalho NF, Kenney RD, Carrington PH, Hall DE. Severe nutritional deficiencies in toddlers resulting from health food milk alternatives. Pediatrics 2001 Apr;107(4):E46.

Chandra RK. Food Allergy. Indian J Pediatr 2002 Mar;69(3):251-5.

Cohen RJ, Brown KH, Canahuati J, Riviera LL, Dewey KG. Effects of age of introduction of complimentary foods on infant breast milk intake, total energy intake, and growth: a randomized intervention study in Honduras. Lancet 1994 Jul 30;344(8918):288-93.

Committee on Nutrition. American Academy of Pediatrics: The use of whole cow‘s milk in infancy. Pediatrics 1992 Jun;89(6 Pt 1):1105-9.

Page 44: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

References

Committee on Nutrition. American Academy of Pediatrics: The use and misuse of fruit juice in pediatrics. Pediatrics 2001 May; 107(5):1210-3.

Dewey KG, et al. Do exclusively breast-fed infants require extra protein? Pediatr Res 1996 Feb;39(2):303-7.

Donath SM, Amir LH. The introduction of breast milk substitutes and solid foods:evidence from the 1995 National Health Survey. Aust NZ J Public Health 2002 Oct: 26(5):481-4.

Edwards N, Sims-Jones N, Breithaupt K. Smoking in pregnancy and postpartum: relationship to mothers‘ choices concerning infant nutrition. Can J Nurs Res 1998 Fall; 30(3):83-98.

Endres J. Poon SW, Welch P, Sawicki M, Duncan H. Dietary sodium intake of infants fed commercially prepared baby food and table food. J Am Diet Assoc 1987 Jun; 87(6):750-3.

Page 45: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

References

Esfarjani F, Azar MR, Gafarpour M. IDDM and early exposure of infant to cow‘s milk and solid food. Indian J Pediatr 2001 Feb; 68(2):107-10.

Fergusson DM, Horwood LJ. Early solid food diet and eczema in childhood:a 10-year longitudinal study. Pediart Allergy Immunol 1994;5(6 Suppl):44-7.

Fergusson DM, Horwood LJ, Shannon FT. Early solid feeding and recurrent childhood eczema: a 10-year longitudinal study. Pediatrics 1990 Oct;86(4):541-6.

Forsyth JS, Ogston SA, Clark A, Florey CD, Howie PW. Relation between early introduction of solid food to infants and their weight and illnesses during the first two years of life. BMJ 1993 Jun 12;306(6892):1572-6.

Page 46: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

References

Freeman V, van‘t Hof M, Aschke F. Patterns of milk and food intake in infants from birth to age 36 months: the Euro-growth study. J Pediatr Gastroenterol Nutr 2000; 31 Suppl 1:S76-85.

Gerrish CJ, Mennella JA. Flavor variety enhances food acceptance in formula-fed infants. Am J Clin Nutr 2001; 73:1080-5.

Gustafson D, Sjoberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis-a prospective follow-up to 7 years of age. Allergy 2000 Mar;55(3):240-5.

Hampton SM. Prematurity, immune function and infant feeding practices. Proc Nutr Soc 1999 Feb; 58(1):75-8.

Page 47: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

References

Haschken F. The Nutrition Committee of the Austrian Society of Pediatrics and Adolescent Medicine. Comment on nutrition with solid foods in infancy and early childhood. [German] Patiatr Padol 1992;27(3):57-9.

Hornell A, Hofander Y, Kylberg E. Introduction of solid foods and formula to breast fed infants: a longitudinal prospective study in Uppsala, Sweden. Acta Paediatrr 2001 May; 90(5):477-82.

Kannan S, Carruth BR, Skinner J. Infant feeding practices of Anglo American and Asian Indian American mothers. J Am Coll Nutr 1999 Jun; 18(3):279-86.

Kostraba JN, et al. Early exposure to cow‘s milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes 1993 Feb;42(2):288-95.

Page 48: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

References

Kwavnick BS, Reid DJ, Joffres MR, Guernsey JR. Infant feeding practices in Ottowa-Carleton: the introduction of solid foods. Can J Public Health 1999 Nov-Dec; 90(6):403-7.

Lanciers S, Behta DI, Blecker U, Lebenthal E. Modified food starches in baby foods. Indian J Pediatr 1998 Jul-Aug; 65 (4):541-6.

Mangels AR, Messina V. Considerations in planning vegan diets: infants. J Am Diet Assoc 2001 Jun; 101(6):670-7.

Mehta KC, Specker BL, Bartholmey S, Giddens J, Ho ML. Trial on timing of introduction to solids and food type on infant growth. Pediatrics 1998 Sep;102(3 Pt 1):569-73.

Mennella JA, Jagnow CP, Beauchanp GK. Prenatal and postnatal flavor learning by human infants. Pediatrics 2001 Jun; 107 (6):E88.

Page 49: Introducing... Solid Foods. Current Guidelines n Children should be exclusively breast fed for at least 6 months (WHO, AAP & AAFP) n Gradual introduction.

References

Skinner JD, et al. Transitions in infant feeding during the first year of life. J Am Coll Nutr 1997 Jun;16(3):209-15.

Stogmann W, Kurz H. Atopic dermatitis and food allergy in infancy and childhood. [German] Wein Med Wochenschr 1996;146(15):411-4.

Sullivan SA. Birch LL. Infant dietary experience and acceptance of solid foods. Pediatrics 1994 Feb;93(2):271-7.

Torun B. Eating behavior from birth to 5 years. [Spanish] Arch Latinoam Nutr 1999 Jun; 49(2):97-100.

Wosje KS, Specker BL, Giddens J. No differences in growth or body composition from age 12-24 months between toddlers consuming 2% and toddlers consuming whole milk. J Am Diet Assoc 2001 Jan;101(1):53-6.


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