childhood obesity

Solid Food Feeding Guidelines for Infants

A new study1 has identified situations in which infants could potentially reach unhealthy weights, even though their caregivers follow complementary solid food feeding guidelines. These findings suggest that current guideline-based portion sizes may need to be changed.

To dive deeper into these findings, Cardiology Consultant reached out to the lead authors of the study, Bruce Y. Lee, MD, MBA, and Marie C. Ferguson, MSPH. Here are the answers to our burning questions.

Dr Lee is a professor of Health Policy and Management at the City University of New York (CUNY) and executive director of Public Health Computational and Operations Research (PHICOR) in New York, New York.

Dr Ferguson is a senior Research Foundation of the City University of New York associate at CUNY and project director of PHICOR in New York, New York.

Consultant360: For your study, you and your team created virtual situations in which infants were fed according to 4 different feeding guides. Findings showed that none of the simulations resulted in normal weight at 12 months, when infants were also being breastfed. Is there something to be said about formula feeding? Might formula feeding have a different effect?

Marie Ferguson: Current research shows a positive correlation between formula feeding and childhood obesity, and we would have likely seen a different impact in the results had virtual caregivers fed infants formula instead of breastmilk. By not testing formula feeding, we aimed to be more conservative in our findings.

Dr Bruce Y. Lee: While there may be similarities, formula is not the same as breast milk. The body does not necessarily treat them the same. Therefore, if real breast milk is available, it is generally better to go for that option. 

C360: Your results also showed that halfing breastmilk portions led to overweight body mass indices (BMIs) between 9 and 11 months when caregivers followed Children's Hospital of Philadelphia, Johns Hopkins Medicine, and Enfamil guidelines. How might these guidelines be changed to support healthy BMIs in infants?

Ms Ferguson: Our results suggest that future complementary feeding guidelines be more specific (e.g., provide more restricted or narrower portion sizes to prevent over or underfeeding) tailored to the characteristics (e.g., BMI and current growth trajectory) and other feeding patterns of the child (frequency and amount of formula or breastmilk).

Dr Lee: New technology approaches like simulation modeling can now test the impact of different types of feeding approaches on infant growth and BMI. So this could help produce more-tailored guidelines.

C360: Weight control during infancy is critical because it may affect weight later in life. What nutritional approach may result in healthier BMIs in infants?

Ms Ferguson: It is important for caregivers to learn and recognize their infant’s hunger cues and feed in a responsive manner, rather than feeding forcefully, in order to avoid over or underfeeding an infant. Caregivers can work with their pediatrician to monitor the weight of an infant and adjust feeding patterns as needed.

Dr Lee: Guidelines are not a replacement for paying attention to the infant and having a good pediatrician.

C360: Although recommendations for healthy portion sizes are crucial for promoting healthy weight gain, large organizations like the Centers for Disease Control (CDC) and World Health Organization (WHO) do not outline portion sizes in their feeding guides. What role do CDC and WHO play in publishing universal guidelines that encompass new data? Do you think a new set of guidelines endorsed by large entities would ultimately trump the rest?

Ms Ferguson: The CDC and WHO do provide general feeding guidelines for infants; however, they do not provide specific portion size guidelines for different types of solid foods. Now that we have the capability to test different sets of recommendations under different circumstances using computational simulation modeling, the CDC and WHO can work toward offering specific and tailored guidelines to meet the varying needs of infants. Even though caregivers’ infant feeding choices are influenced by many different sources (i.e., books, media, family members, pediatricians), national and international guidelines play an important role in establishing a starting point for caregivers when making decisions about what and how to feed.

Dr Lee: With the childhood obesity epidemic continuing with no end in sight, it is important to take a closer look at how early life feeding may be contributing. Since our study did show many situations in which following existing guidelines can still lead to overweight and obesity, a closer look at all the different guidelines out there and coming up with stronger guidance on what to follow under what circumstances would be helpful.


  1. Ferguson MC, O'Shea KJ, Hammer LD, Hertenstein DL, Schwartz NJ, Winch LE, Siegmund SS, Lee BY. The impact of following solid food feeding guides on BMI among infants: a simulation study. Am J Prevent Med. 2019;57(3):355-364.

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