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Background Bottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed.Objective Our aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG.Design We conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age.Participants/setting Participants were mothers (n ¼ 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August 2019.Main outcome measures Infant weight was assessed and standardized to sex-and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breastand bottle-feeding patterns, and perceptions of WIC experiences. Statistical analyses performed Logistic regression with estimation via generalizedestimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively.Results Infants in PSE clinics had significantly lower likelihood of exhibiting RWG (P ¼ .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P ¼ .098) and had more stable intentions to stay in the WIC program (P ¼ .002) compared with mothers in control clinics.Conclusions PSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.

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Online delivery of education can be an acceptable addition for WIC participants with online access. High-quality online education platforms represent an important avenue to promote continued satisfaction with nutrition education.

Objectives The COVID-19 pandemic has changed the way that the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) delivers services. The USDA granted multiple waivers to allow flexibility in WIC operations during the pandemic. The objective of this study was to hear from WIC participants about the impact of changes due to COVID-19. Methods In the summer of 2020, 60 semi-structured interviews were completed, half with English-speaking and half with Spanish-speaking WIC participants in the Los Angeles area. Interviews were recorded, transcribed, and analyzed using a deductive content analysis approach to describe responses and identify themes. Results Four themes emerged: 1) The pandemic has exacerbated the ckhallenges facing low-income families; 2) WIC continues to be a valued resource especially under the challenging circumstances; 3) WIC's transition to remote service delivery has ensured that families continue to receive not only critical WIC food benefits, but also nutrition education and support; 4) Lessons learned during COVID-19 can inform needed WIC modernizations to maximize WIC's proven benefits post-pandemic. Nearly 75% of WIC participants faced reductions in income due to job loss or reduced work hours. Nearly 60% of households reported experiencing food insecurity. Early in the pandemic, many reported challenges accessing WIC-eligible foods, resulting in lost food benefits. Approximately 43% reported getting food from a food pantry or church, with most (77%) reporting first time usage. Participants shared that even with the change to only remote education, they valued the information and were very satisfied with WIC services. The majority (83%) found the California WIC App helpful in informing what WIC foods they could purchase. Participants also reported that enrolling in WIC remotely was easier than coming in-person and they were comfortable providing documents related to income and eligibility determination remotely. Conclusions WIC has been essential in helping families cope with COVID. WIC's transition to remote service delivery has ensured seamless and safe delivery of services, helping families with young children during an unprecedented time of need. Funding Sources The David and Lucile Packard Foundation