Response to Federal Register Comments

Appendix QQ
FNS Response to Nestle Comments

United States
Department of
Agriculture
Food and
Nutrition
Service
3101 Park
Center Drive
Alexandria, VA
22302-1500

June 12, 2012
Kathleen Reidy, Dr Ph. RD
Nestlé Nutrition U.S.
12 Vreeland Road, Box 697
Florham Park, New Jersey 07932-0697
Tel: (973) 593-7558
Fax: (973) 593-7661
[email protected]

Memo: Responses to Nestlé Nutrition U.S. - 60 Day Federal Register Notice for WIC
Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2)

Dear Kathleen Reidy, Dr Ph, RD:
FNS would like to thank Nestle Infant Nutrition/GERBER Products Company (Gerber)
for its thoughtful comments on the WIC ITFPS-2. We appreciate having a partner that
has taken such a careful and thorough look at the instruments and value your feedback.
Your FITS 2002 and 2008 studies were very helpful as we designed the WIC ITFPS-2.
We included a number of questions from the instruments used in FITS 2002 and 2008,
and we appreciate your willingness to share with us some of the unpublished data from
those studies.
As you know, developing a study as comprehensive as WIC ITFPS-2 requires multiple
passes and input from a number of researchers. The draft you reviewed was one of the
earlier drafts. Our research team had many of the same concerns; we believe that the
updated version is a stronger instrument. Other items you raised deserved another look.
In the document attached, we engage the discussion item by item, as listed in your letter.
We look forward to the continued dialogue, and thank you again for your very careful
review of the instruments for what we all agree will be an important study. It will help
the WIC program and its partners better understand how caregivers make decisions about
feeding their infants and toddlers, as well as the impact of those decisions on major public
health concerns, such as obesity prevention and access to healthy foods. We believe that
the results will enable policymakers to continue to strengthen important programs that
serve our youngest Americans.

Sincerely,
Steven Carlson

Enclosed: Attachments A and B

Attachment A
(a) Necessity and practical utility of the data collection for WIC ITFPS-2
FNS agrees with Gerber that this is a very important study that will address critical public health
concerns, including obesity and improving nutrition and eating habits.
(c) Ways to enhance the quality, utility and clarity of the information collected
In this section, we address each concern by item as listed in the original letter. As appropriate, we
provide an example from the updated instrument, referenced by question number in Attachment B.
In many cases, we agree with Gerber’s assessment and have modified the phrasing accordingly. In
others, while we agree that additional information would be interesting, we were not able to include
the additions because of the potential to increase respondent burden. We will try to speak with the
same women 12 times over a two-year period. As with any longitudinal study, we run the risk of
substantial participant attrition at each survey, which, in turn, affects our results and findings. To
reduce this risk, we have tried diligently to keep each interview to 30 minutes. This limits what we
can include, and we have tried to focus on key research questions and, importantly, the ability to
compare our findings to those of previous studies. In some cases, this means we have repeated the
question from a prior study verbatim in order to maintain comparability. We hope you will agree
that the updated version of the questionnaire balances our goals of answering the key research
questions with limiting the respondent burden.
Gerber’s first bullet noted three concerns that:
(1) the description of baby foods in a jar is too specific, and that the phrasing “in a jar”
should be more inclusive,
(2) WIC-provided and non-WIC-provided foods should be addressed separately, and
(3) home-made food preparation be clearer.
Response:
(1)
We agree that noting only ‘jarred baby foods’ could unintentionally limit the responses. We
went through several iterations and the instrument development team had extensive discussions
about how to describe commercial packaging in simple, effective ways. In pretesting, we found that
overly long descriptions or complex vocabulary tended to make respondents lose focus. The term
“commercial baby food,” used by FDA-IFPS-2, is too complex a language level for the WIC
sample, which is anticipated to have lower education levels than the FDA IFPS-2 consumer panel
sample. We also considered “store-bought baby food,” but this term posed some difficulties because
ingredients for homemade baby foods and finger foods are also store-bought. Although, “baby food
from a jar” tested well during cognitive interviews, we recognize that this language may not sound
sufficiently inclusive. As a result, we revised the language to the more inclusive “store-bought baby
food in a jar or container.” This affects wording in several questions, including KA3, KA7, CF37,
CF38, CF39 (NOTE: CF39 also contains an edit about puree and mash intended to mirror needed
changes to clarify these terms when translated into Spanish). We have included an example of two
of the affected questions in Attachment B (KA3, KA4, CF37, CF38). In addition, the sequence of
questions in the Automated Multiple Pass Method (AMPM) used to collect the 24-hour dietary

recall data will ensure that all pre-packaged baby foods are accurately collected. The AMPM is
conducted with each interview please see Attachment B for series of questions that will be asked.
(2)
We agree with Gerber that the types of foods should be addressed separately for WIC
provided and non-WIC-provided foods. We have added a series of questions (“CF33 series” and
CF37), which ask the respondent separately about each type of food. This distinction is also
addressed in CF38, where respondents can answer that they purchased only some food items with
WIC vouchers. The AMPM recall will also ask questions about the types of foods.
(3)
We agree with Gerber and included CF39, which addresses the concern about homemade
food preparation. It asks separately about a number of ways a caregiver might prepare homemade
foods.
KA3-4: Past Infant Feeding Practices
Gerber raised six concerns regarding Past Infant Feeding Practices.
Response:
(1)

Introduction of infant cereal.

We appreciate Gerber’s comment and modified question KA3 to address introduction to infant
cereal in a bottle and at what age (see Attachment B). However, we did not separate out the
introduction of infant cereal and puree baby foods in KA3 due to the respondent burden since this is
asked at baseline, which is the longest interview.
(2)

Addressing the introduction of infant cereal through a bottle.

We concur with Gerber’s observation that many babies are introduced to infant cereal initially when
it is added to a bottle of formula or breastmilk. We added the phrase “please be sure to include
infant cereal you might have added to your child’s bottle” to the affected questions KA3 and KA7
(Attachment B). Also, the introduction of infant cereal to the target child’s bottle is addressed in
question CF36 a and b (Attachment B). It asks the mother specifically whether she added cereal or
sweeteners to the baby’s formula or breast milk in the bottle, and if so, why.
(3)

Ensuring store-bought baby foods are not limited to jarred baby foods.

As noted above, the instrument was modified to reflect an expanded definition of store-bought baby
foods.
(4)

Separating variety of baby foods and WIC-foods versus non-WIC foods.

Questions KA3 and KA4 target past infant feeding practice (i.e. not for the target child, but for
older siblings), and are specifically trying to determine the age at introduction of baby foods and
table foods. However, the study is mainly concerned about the timing of the introduction of solids
(Research Question 49b asks: “When did she first give baby foods and table foods to siblings on
WIC?”). In this instance, we are concerned about respondent burden, and are afraid that adding
additional response choices would lengthen the survey without adding to the research objectives.
We agree with Gerber that the types of foods should be addressed separately. We have added a
series of questions (“CF33 series”) and CF37 to the target child, which ask the respondent

separately about each type of food. The categories ask separately about WIC-approved and nonWIC-approved foods. The AMPM recall will also ask questions about the types of foods.
(5)

Type infant cereal

We agree that getting this information on the type of cereal would be interesting. However, the
study is mainly concerned about the timing of the introduction of solids [Research Question 49b
asks: When did she first give baby foods and table foods to siblings on WIC?]. In this instance, we
are concerned about respondent burden, and are afraid that adding additional response choices
would lengthen the survey without adding to the research objectives.
(6)

Breastfeeding and Formula Feeding Exclusivity

We agree with Gerber that getting information on how mothers combine breastfeeding and formula
feeding is important. Question CF1 (Attachment B) asks whether a mother exclusively breastfeeds,
formula feeds, or does a combination.
K4: The distinction between KA3 and KA4
Response: As with the response to #4 above, KA3 and KA4 are addressing the timing of
introduction of baby foods and table foods. In cognitive pretesting, when we asked respondents to
define table foods they described them as regular foods that other people in the family eat.
KA7-8: Questions are redundant or confusing
Response: We agree that this is confusing in paper form. This survey will be conducted through a
CATI system. When programming into the CATI system, the questions will be sequenced based on
the number of other children the respondent has. The same respondent will not be asked both KA3
and KA7. Instead, if the respondent has no older children, she will not be asked the KA series; if
only one older child, she will be asked KA3 and not KA7; if she has more than one older child, she
will be asked KA7. As noted above, the instrument was modified to reflect and expanded KA7 to
include putting cereal in the bottle (Attachment B).
Gerber noted that WC12 and WC13 would not get to whether or not WIC vouchers were
sufficient to cover a participant’s needs. We organized Gerber’s concerns from this bullet as
followed:
(1)
Recommended adjusting to determine if WIC moms are using all their WIC
vouchers (mom uses her own money to buy additional food), and
(2)
If the vouchers are not fulfilling all their requirements
(3)
Allow analysis of baby food products separately
Response:
(1)

WC12 and WC13 are intended to capture mom’s usage of the WIC vouchers, but are not
intended to be comprehensive. Instead, the results will go into a table summarizing WIC
mom’s general usage of a number of WIC services. In this case, the table will show
whether, in a given month over two surveys (prenatal and at 3 months) moms had used their
full voucher amount. It will also have an option for “haven’t shopped yet.” The scope of
this study does not conduct an analysis of the amount of benefits used or what was used to
buy additional formula and baby foods with moms’ own money. Although as mentioned

above, the series of questions CF33 and question CF37 will ask the respondent separately
about each type of food.
(2)

Because WIC is a supplemental food program, we expect that WIC foods do not address all
of a participant’s needs. Also, CF38 address where respondents can answer that they
purchased only some food items with WIC vouchers. The AMPM recall also will allow the
study to examine how WIC foods fit into the overall diet, including the other foods a
participant consumes beyond those provided through WIC.

(3)

The AMPM recall will provide a comprehensive view of participants’ diets and allow for
individual analysis of foods.

WC16F
Response: Question WC16F on satisfaction with breastfeeding support has been removed from the
final questionnaires.
MH13: Mother’s perception of her weight
Response: We are collecting mothers’ height and weight in order to calculate BMI. While we
agree that a mother’s perception of her weight could influence her feeding practices, those analyses
are not currently in the research design. We would not be able to add those analyses at this stage
without a significant change to the scope of work, but we agree that this would be an important
consideration in a future study.
24-Hour dietary recall
Response: The AMPM will collect detailed information about food preparation.
SD 7, 8 and 9 questions
Response: The timing of questions was not clear in the paper-based instrument due to the use of the
CATI system. These questions will be asked at the first interview after the baby is born. If the
mother was recruited prenatally, they will be asked at 1 month.
SD12: Caregiver
Response: We agree that it is important that we ask these questions of the person making the
primary shopping and food decisions. SD12 is one of several questions that, together, give us
confidence that we will interview the correct respondent.
HF18
Response: We agree that a mother may only receive one item; however, results from the cognitive
pretesting indicated that mothers interpreted this question to be inclusive of diaper bags with
multiple items inside, or single-item (usually formula) gifts as a “gift pack”. This coincides with
findings from several studies, like the Pregnancy Risk Assessment Monitoring System (PRAMS)
and FDA IFPS-II study sponsored by CDC, that asked the similar question which find that formula

samples are included in respondents interpretation of “gift pack.”1,2 We anticipate this question to
be clearly understood, and will still pick up single-item gifts, with the current language.
CF1: Cow’s milk
Response: When the instrument is coded into the computer-based survey, this question will be
sequenced with a series of other questions that first ascertain whether or not the child has had
anything other than breastmilk or formula. Once the response to that question is “yes,” the
sequencing of subsequent questions addresses the types of milk and the fat content of the milk (i.e.,
skim, 1%, 2% or whole). This will also be captured in the AMPM recall.
CF4
Response: We agree that getting this information would be interesting, but are concerned doing so
would lengthen the survey. As mentioned above, we have tried to keep each survey less than 30
minutes to minimize the risk of attrition.
CF18, CF27 and CF31
Response: These are questions used in previous studies. We have kept the same language as what
was used in those surveys for comparability.
CF 21: Return to work
Response: We will collect information on the impact of returning to work on breast- and formula
feeding through a combination of two questions, CF21 and CF4 (attachment B). This will show
whether the respondent felt that breastfeeding was inconvenient or felt that returning to work was a
barrier.
Gerber raised three concerns with CF33 regarding the introduction of supplemental foods.
(1)
CF33 f) distinction between sweetened and unsweetened teas
(2)
CF33 specific grain-based finger foods designed for a baby
(3)
CF33 w) first fed beans
Response:
(1)
We appreciate the second look Gerber has given us for CF33, which asks a series of
questions about the types of foods and drinks offered, and the timing of those offerings.
CF33e asks about sweetened beverages, and specifies “sweet tea.” CF33i specifies other
drinks, “including teas and broths.” This series of questions asks about sweetened beverages
before it asks about tea; therefore, sweetened teas would be captured in CF33e. The mother
is asked about sweetened beverages (including sweet tea) in CF33e, which is before the
question on other drinks and liquids. Therefore, CF33i is not specifically asking about
sweetened teas. The important element for the data is that the mother includes sweet tea
under sweetened beverages, so that we have an age for first introduction of sweetened
beverages. If the mother duplicates her response under teas and broths that would not be
inaccurate, and the wording of the questions as “other drinks or liquids” will likely minimize
this issue. Most mothers who indicated teas during pretesting were talking about medicinal
1

Kenneth D. Rosenberg, Carissa A. Eastham, Laurin J. Kasehagen, and Alfredo P. Sandoval. Marketing Infant Formula Through Hospitals: the
Impact of Commercial Hospital Discharge Packs on Breastfeeding. American Journal of Public Health: February 2008, Vol. 98, No. 2, pp. 290-295.
2
Ann M. DiGirolamo, PhD, MPHa, Laurence M. Grummer-Strawn, PhDb, Sara B. Fein, PhDc. Effect of Maternity-Care Practices on Breastfeeding.
Pediatrics Vol. 122 No. Supplement 2 October 1, 2008 pp. S43 -S49. 

teas rather than regular teas; our assessment was that there would not be a problem with
overlap.
(2)

The AMPM will capture details about the types of cereals and grain products the
infant/toddler consumed the data before the interview. This will capture the Ready-to-Eat
(RTE) products that the child will learn to use as finger foods.

(3)

The primary question on beans specifies the type of beans; the follow up question refers to
the primary question.

CF36 b)
Response: We agree that this is a common reason; however, the research team was concerned that
this could influence a mother to begin this practice. Therefore, the research team agreed that the
existing response options were sufficient.
CF37
Response: As mentioned above, this has been revised to address description of baby foods
(Attachment B).
KA25
Response: We agree that ensuring respondents understand we are referring to the WIC package is
important. The latest version of the instrument has this as a two-part question. KA24 specifies the
WIC package, and is followed by KA25, which asks about its importance in the breastfeeding
decision. When programming into the CATI system, the questions will be sequenced based on a
participant’s WIC participation and food package.
KA35 and KA36: Sources of counseling and information
Response: These two items are designed to address specific research questions for WIC ITFPS-2.
KA35 is designed to address research question #53 [53: Did the mother receive counseling on infant
feeding and care and by whom? 53a: Where did the mother receive her counseling on infant feeding
and care (e.g., clinical dietitian from hospital, nurse practitioner, or WIC nutritionist at clinic)?].
This research question focuses on counseling/education provided directly by health professionals in
contrast to other sources, such as friends and family, that are not necessary trained in the health
field. If the mother received counseling or education from a doctor or nurse through a hotline, it
would be represented here.
KA36 is designed to capture a wider range of potential sources of advice, including friends and
family. It addresses research question #56 [56: Where does the mother/caregiver get nutrition
information (e.g., WIC, websites, social media, family, friends, social networks, healthcare
providers, etc.)?]. If a mother turns to any of the resources sponsored by Nestle Gerber’s Start
Healthy Stay Healthy Initiative for nutrition information we expect we will capture it within the
parameters of the existing question.
CF50: Infant bottle feeding practices
Response: Infant satiety cue are collected via KA26 (Attachment B).

CF43
Response: This question is asked at 13, 15, 18, and 24 months because WIC does not offer these
foods prior to one year. The only foods offered prior to 13 months are formula, infant cereal and
baby foods (WIC no longer gives baby juices prior to 13 months).
CF49 and 51: Satiety questions at an earlier age
Response: Satiety cues are explored at 3 months with a 5-item set of questions (KA26). Also,
during the first year we ask about control and inappropriate bottle feeding practices (CF50, at 3 and
9 months). During the second year we ask questions about beliefs about feeding toddlers including
control beliefs (KA11-KA17 at 15 and 24 months), understanding of the child’s satiety cues (KA27
at 13 and 24 months), introduction of new foods (CF49 at 15, 18, 24 months), and toddler feeding
rules (CF51 at 15 and 24 months).
The emphasis on the second year for questions on introduction of new foods and feeding
rules/beliefs is a reflection of the greater variety of foods introduced and consumed during the
second year. Taken together, the set of questions mention above (CF50, KA11-17, KA26-27,
CF49, and CF51) this addresses the issues of satiety, control, inappropriate feeding practices, and
feeding beliefs and rules for the scope of the study.

Attachment B: Affected Instrument Questions referred to in Attachment A.
Source of baby food (homemade or purchased; if purchased, was it all with WIC vouchers or
some purchased without WIC vouchers)
7, 9, 11, 13
CF37. For each food category I read to you, please tell me about how much of the food fed to your
baby over the past 7 days was store-bought baby food in a jar or container. Baby foods in a jar
or container are those sold especially for babies. Foods that are not baby foods in a jar or
container include fresh fruit, fruit juices other than those especially sold for babies, foods you
prepare especially for the baby, and table food. [Source: FDA IFPS-2, modified]
a.

Fruit and vegetable juice
All store-bought baby food ........................................................ 01
Mostly store-bought baby food .................................................. 02
Some store-bought baby food .................................................... 03
No store-bought baby food......................................................... 04
Not fed this food in past 7 days.................................................. 05

b.

Fruit
All store-bought baby food ........................................................ 01
Mostly store-bought baby food .................................................. 02
Some store-bought baby food .................................................... 03
No store-bought baby food......................................................... 04
Not fed this food in past 7 days.................................................. 05

c.

Vegetables
All store-bought baby food ........................................................ 01
Mostly store-bought baby food .................................................. 02
Some store-bought baby food .................................................... 03
No store-bought baby food......................................................... 04
Not fed this food in past 7 days.................................................. 05

d.

Meat, such as beef and chicken
All store-bought baby food ........................................................ 01
Mostly store-bought baby food .................................................. 02
Some store-bought baby food .................................................... 03
No store-bought baby food......................................................... 04
Not fed this food in past 7 days.................................................. 05

d.

Combination dinners
All store-bought baby food ........................................................ 01
Mostly store-bought baby food .................................................. 02
Some store-bought baby food .................................................... 03
No store-bought baby food......................................................... 04
Not fed this food in past 7 days.................................................. 05

AMPM Recall Question Prompts that address pre-packaged foods.
What kind of food was it? (Was it carrots, peaches, turkey rice dinner, vanilla custard
pudding, or something else?)
What was the brand name? Was it Gerber, Beech-Nut, Heinz or something else?
Was it First, Second, Third, Graduates, or something else?
Was it Baby's First, Stage 1, Stage 2, Stage 3, Table Time, or something else?
Was it Beginner, Strained, Junior Foods, or something else?
Was it strained, Junior Foods, or something else?
Was anything added to the {JBF005 ANSWER}?
What was it?
How much of this {JBF105 ANSWER} was added?
How much of this baby food did {YOU/SP NAME} actually eat?

CF38. [If all, mostly or some store-bought baby food indicated above, then ask:] Was all of the storebought baby food in jars or containers bought with WIC checks, only some with WIC checks,
or none with WIC checks? [Source: New Development]
All with WIC checks .................................................................. 01
Some with WIC checks .............................................................. 02
None with WIC checks .............................................................. 03
Don’t know ................................................................................ 98
Refused ...................................................................................... 99

Methods and frequency of methods used to prepare child foods
7, 9, 11, 13
CF39. [If mostly, some, or no store-bought baby food fed in past 7 days from above, ask:] I’m going to
read you some ways people prepare homemade food for babies. For each one, please tell me if
you do this to make food for {CHILD}. [Source: New Development]
a.

Puree, such as in a blender or food processor
Yes ............................................................................................. 01
No ............................................................................................... 02

b.

Mash, such as with a fork or spoon
Yes ............................................................................................. 01
No ............................................................................................... 02

c.

Chop or dice
Yes ............................................................................................. 01
No ............................................................................................... 02

d.

Chew foods yourself before giving to (him/her)
Yes ............................................................................................. 01
No ............................................................................................... 02

e.

Is there any other way you make food for {CHILD}

Yes (specify _____________________________) ................... 01
No ............................................................................................... 02

Past infant feeding practices
Baseline
KA3.

(If 1 other child) How old was your other child the first time you fed him/her infant cereal,
store-bought baby food in a jar or container, or homemade pureed baby food? When thinking
about the first time you fed any of these things, please be sure to include infant cereal you
might have added to your child’s bottle. [Source: New Development]
Age .............................................................. [weeks/months/years]
Not applicable ............................................................................ 97

KA7.

(If more than 1 other child): Thinking of all your other children, what was the earliest age that
you fed infant cereal, store-bought baby food in a jar or container, or homemade pureed baby
food to any of your other children? When thinking about the first time you fed any of these
things, please be sure to include infant cereal you might have added to a child’s bottle. [Source:
New Development]
Age .............................................................. [weeks/months/years]
Not applicable ............................................................................ 97

Time to introduction of supplemental foods
1, 3, 5, 7, 9, 11, 13, 15, 18, 24
Next I’m going to ask you some questions about when you first started feeding {CHILD} different
types of foods.Ask each food until answer is affirmative, then stop asking that food in subsequent

interviews
CF33. For each of the following, please tell me if {CHILD} has been given this food or drink,
and if so, how old {CHILD} was when he/she first had that food. [Sources: FITS 2008;
IFPS-1; WHO Toolkit 1996]
a.
Has [HE/SHE] been given plain bottled or tap water?
Yes ..................................................................................... 01
No ...................................................................................... 02
b.

(If yes) How old was {CHILD} when [HE/SHE] was first fed plain bottled or tap
water?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

c.

Has [HE/SHE] been given soda or soft drinks?
Yes ..................................................................................... 01

No ...................................................................................... 02
d.

(If yes) How old was {CHILD} when [HE/SHE] was first fed soda or soft drinks?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

e.

Has [HE/SHE] been given other sweetened beverages (such as Kool Aid, Hi-C,
Fruit Punch, sweetened juice, sweetened or flavored water, Gatorade, or sweet
tea)?
Yes ..................................................................................... 01
No ...................................................................................... 02

f.

(If yes) How old was {CHILD} when [HE/SHE] was first fed other sweetened
beverages?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

g.

Has [HE/SHE] been given 100% fruit juice such as apple juice, orange juice, or
other types of 100% juice. Do not include fruit-flavored drinks with added
sugar or fruit juice you made at home and added sugar to?
Yes ..................................................................................... 01
No ...................................................................................... 02

h.

(If yes) How old was {CHILD} when [HE/SHE] was first fed 100% fruit juice?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

i.

Has [HE/SHE] been given other drinks and liquids, including teas and broths?
Yes ..................................................................................... 01
No ...................................................................................... 02

j.

(If yes) How old was {CHILD} when [HE/SHE] was first fed Other drinks and
liquids, including teas and broths?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

k.

Has [HE/SHE] been given Cow’s milk, including whole milk, 2%, 1%, or skim?
Please include milk you add to other foods such as cereal.
Yes ..................................................................................... 01
No ...................................................................................... 02

l.

(If yes) How old was {CHILD} when [HE/SHE] was first fed cow’s milk?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

m.

Has [HE/SHE] been given dairy products other than cow’s milk including
cheese, yogurt, or goat’s milk? Please include any dairy products other than
cow’s milk that you add to other foods.
Yes ..................................................................................... 01
No ...................................................................................... 02

n.

(If yes) How old was {CHILD} when [HE/SHE] was first fed dairy products
other than cow’s milk?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

o.

Has [HE/SHE] been given baby cereal
Yes ..................................................................................... 01
No ...................................................................................... 02

p.

(If yes) How old was {CHILD} when [HE/SHE] was first fed baby cereal?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

q.

Has [HE/SHE] been given other cereal besides baby cereal?
Yes ..................................................................................... 01
No ...................................................................................... 02

r.

(If yes) How old was {CHILD} when [HE/SHE] was first fed other cereal besides
baby cereal?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

s.

Has [HE/SHE] been given eggs?
Yes ..................................................................................... 01
No ...................................................................................... 02

t.

(If yes) How old was {CHILD} when [HE/SHE] was first fed eggs?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

u.

Has [HE/SHE] been given fruit, including baby food or regular fruit?
Yes ..................................................................................... 01
No ...................................................................................... 02

v.

(If yes) How old was {CHILD} when [HE/SHE] was first fed fruit?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

w.

Has [HE/SHE] been given vegetables, including baby food or regular
vegetables?

Yes ..................................................................................... 01
No ...................................................................................... 02
x.

(If yes) How old was {CHILD} when [HE/SHE] was first fed vegetables?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

y.

Has [HE/SHE] been given beans, such as black beans, pinto beans, or chick
peas?
Yes ..................................................................................... 01
No ...................................................................................... 02

z.

(If yes) How old was {CHILD} when [HE/SHE] was first fed beans?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

aa.

Has [HE/SHE] been given peanut butter
Yes ..................................................................................... 01
No ...................................................................................... 02

bb.

(If yes) How old was {CHILD} when [HE/SHE] was first fed peanut butter?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

cc.

Has [HE/SHE] been given meats,, chicken, or fish, including baby food and
baby food combination dinners containing these foods?
Yes ..................................................................................... 01
No ...................................................................................... 02

dd.

(If yes) How old was {CHILD} when [HE/SHE] was first fed meat, chicken, or
fish?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

ee.

Has [HE/SHE] been given salty snacks, such as chips, pretzels, crackers, or
other snack foods including baby snacks?
Yes ..................................................................................... 01
No ...................................................................................... 02

ff.

(If yes) How old was {CHILD} when [HE/SHE] was first fed salty snacks?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

gg.

Has [HE/SHE] been given sweets, such as cake, cookies, candy, or jam
Yes ..................................................................................... 01
No ...................................................................................... 02

hh.

(If yes) How old was {CHILD} when [HE/SHE] was first fed sweets?
Age ............................................................... [weeks/months]
Don’t know ........................................................................ 98
Refused .............................................................................. 99

Cereal added to a bottle Response: Following are the infant cereal related questions.
Were foods other than breastmilk or formula fed by bottle? If so, why?
1, 3, 5, 7
CF36. Now I’m going to ask you some questions about things you might have added to your
baby’s bottle of infant formula or pumped breastmilk.: [Source: FDA IFPS-2,
modified; New Development for reasons]
a
In the past two weeks, how often have you added baby cereal to your baby’s
bottle?
Every feeding ..................................................................... 01
At most feedings ................................................................ 02
About once a day ............................................................... 03
Every few days .................................................................. 04
Rarely ................................................................................. 05
Never.................................................................................. 06
b.

(If anything other than never) Why did you add baby cereal to your baby’s
bottle?
To make him/her full ......................................................... 01
To make him/her drink more milk ..................................... 02
To give him/her a special treat........................................... 03
As a remedy ....................................................................... 04
A doctor or other health professional told me to ............... 05
A friend or relative told me to ........................................... 06
Other .................................................................................. 07

c.

In the past two weeks, how often have you added sweetener to your baby’s
bottle?
Every feeding ..................................................................... 01
At most feedings ................................................................ 02
About once a day ............................................................... 03
Every few days .................................................................. 04
Rarely ................................................................................. 05
Never.................................................................................. 06

d.

(If anything other than never) Why did you add sweetener to your baby’s bottle?
To make him/her full ......................................................... 01
To make him/her drink more milk ..................................... 02
To give him/her a special treat........................................... 03
As a remedy ....................................................................... 04
A doctor or other health professional told me to ............... 05
A friend or relative told me to ........................................... 06
Other .................................................................................. 07

e.

Have you added anything else?(Specify OTHER)_____________________) In
the past two weeks, how often have you added [OTHER] to your baby’s bottle?
Every feeding ..................................................................... 01
At most feedings ................................................................ 02
About once a day ............................................................... 03
Every few days .................................................................. 04
Rarely ................................................................................. 05
Never.................................................................................. 06

f.

(If anything other than never) Why did you add [OTHER] to your baby’s bottle?
To make him/her full ......................................................... 01
To make him/her drink more milk ..................................... 02
To give him/her a special treat........................................... 03
As a remedy ....................................................................... 04
A doctor or other health professional told me to ............... 05
A friend or relative told me to ........................................... 06
Other .................................................................................. 07

Cereal type
Response: The AMPM captures information about the type of cereal and the packaging.
AMPM
Was it dry or jarred?
What kind was it? (Was it barley, rice, oatmeal with bananas, rice with apples, or something
else?)
What liquid or food was mixed with the dry cereal? (Was it formula, baby food applesauce,
baby food grape juice, or something else?)
What was the brand name of the formula? (Was it Enfamil LIPIL, Similac Advance,
LactoFree LIPIL, or something else?)
Was the {DBC015 ANSWER} with iron, low iron, or something else?
How much liquid {DBC 015 ANSWER} was mixed with the cereal?
How much water was mixed with the cereal?
Was the milk 1%, 2%, whole, skim or something else?
How much {DBC015 ANSWER} was mixed with the cereal?
How much {DBC015 ANSWER} was mixed with the cereal?
What was the weight of the jar?
What was the size of the bottle?
How much dry cereal was mixed in?
How much of this prepared {DBC010 ANSWER} did {YOU/SP NAME} actually eat?

Formula definition
Response: Question CF1 is determining whether a child is still breastfeeding or formula feeding. If
the child is consuming cow’s milk it will be captured in the “neither” response shown below.
CF1. Are you currently feeding {CHILD} breastmilk either from your breast or from a
bottle, formula, (1-5 months: or both) (7-13 months: both, or neither)?
Only breastmilk ........................................................... 01
Only formula ................................................................ 02

Both breastmilk and formula ....................................... 03
Neither breastmilk nor formula ................................... 04
CF4.

I’m going to read you some statements about things that might make it hard to
breastfeed or keep you from breastfeeding. For each one, please tell me if this has
happened to you in the past month: [FDA IFPS-2, modified]
a. I had to return to work or school and I could not or did not want to pump or breastfeed
there. Did this happen to you in the past month?

CF50 Infant satiety cue are collected via KA26
Caregiver understanding of infant nonverbal satiety cues and crying; toddler satiety cues.
3, 13, 24
3 month questions:
KA26. I’m going to read you some statements about when babies are hungry or full. Please
tell me how much you agree or disagree with these statements. [Source: First Steps
Survey, modified]
a.
If a baby is crying, then he or she has to be hungry. Would you say that you:
Strongly agree .................................................................... 01
Agree.................................................................................. 02
Neither agree nor disagree ................................................. 03
Disagree ............................................................................. 04
Strongly disagree ............................................................... 05
b.

If a baby sucks his or her hand, then he or she has to be hungry. Would you say
that you:
Strongly agree .................................................................... 01
Agree.................................................................................. 02
Neither agree nor disagree ................................................. 03
Disagree ............................................................................. 04
Strongly disagree ............................................................... 05

c.

If a baby turns his/her head away from the nipple or bottle, then he or she has
to be full. Would you say that you:
Strongly agree .................................................................... 01
Agree.................................................................................. 02
Neither agree nor disagree ................................................. 03
Disagree ............................................................................. 04
Strongly disagree ............................................................... 05

d.

If a baby is given a bottle, the caregiver should always make sure he or she
finishes it. Would you say that you:
Strongly agree .................................................................... 01
Agree.................................................................................. 02
Neither agree nor disagree ................................................. 03
Disagree ............................................................................. 04
Strongly disagree ............................................................... 05

e.

A baby knows when he or she is full. Would you say that you:

Strongly agree .................................................................... 01
Agree.................................................................................. 02
Neither agree nor disagree ................................................. 03
Disagree ............................................................................. 04
Strongly disagree ............................................................... 05