Timing of Introduction of Complementary Foods to US Infants, NHANES 2009-2014

Although there has been inconsistency in recommendations regarding the optimal time for introducing complementary foods, most experts agree that introduction should not occur before 4 months. Despite recommendations, studies suggest that 20–40% of US infants are introduced to foods \u003c4 months. Previous studies focused on the introduction of solid foods and are not nationally representative.To provide a nationally representative estimate of the timing of introduction of complementary foods and describe predictors of early (\u003c4 months) introduction.Cross-sectional analysis of 2009–2014 National Health and Nutrition Examination Survey data.1,482 children aged 6 to 36 months.Timing of first introduction to complementary foods (anything other than breast milk or formula).Prevalence estimates of first introduction to complementary foods are presented by month. Logistic regression was used to assess characteristics associated with early (\u003c4 months) introduction.In this sample, 16.3% of US infants were introduced \u003c4 months, 38.3% between 4 and \u003c6 months, 32.5% between 6 and \u003c7 months, and 12.9% ≥7 months of age. In unadjusted analyses, early introduction varied by breastfeeding status, race/Hispanic origin, Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participation, and maternal age. In adjusted analyses, only breastfeeding status remained significant; infants who never breastfed or stopped \u003c4 months were more likely (OR = 2.27; 95% CI, 1.62, 3.18) to be introduced to complementary foods early than infants who breastfed ≥4 months.Despite using a broader definition of complementary foods, this analysis found a lower prevalence of early introduction in this nationally representative sample than previous studies that included only solids. However, many young children were still introduced to complementary foods earlier than recommended. Strategies may be needed to support caregivers to adhere to infant feeding guidelines.