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Background  The start of complementary feeding in infancy plays an essential role in promoting healthy eating habits. Evidence shows that it is important  what  infants are offered during this first introduction of solid foods: e.g. starting exclusively with vegetables is more successful for vegetable acceptance than starting with fruits.  How  infants are introduced to solid foods also matters: if parents are sensitive and responsive to infant cues during feeding, this may promote self-regulation of energy intake and a healthy weight. However, the effectiveness of the  what  and the  how  of complementary feeding has never been experimentally tested in the same study. In the current project the  what  and  how  (and their combination) are tested in one study to determine their relative importance for fostering vegetable acceptance and self-regulation of energy intake in infants.    Methods  A four-arm randomized controlled trial (Baby’s First Bites (BFB)) was designed for 240 first-time Dutch mothers and their infants, 60 per arm. In this trial, we compare the effectiveness of (a) a vegetable-exposure intervention focusing on the  what  in complementary feeding; (b) a sensitive feeding intervention focusing on the  how  in complementary feeding, (c) a combined intervention focusing on the  what and how  in complementary feeding; (d) an attention-control group. All mothers participate in five sessions spread over the first year of eating solid foods (child age 4–16 months). Primary outcomes are vegetable consumption, vegetable liking and self-regulation of energy intake. Secondary outcomes are child eating behaviors, child anthropometrics and maternal feeding behavior. Outcomes are assessed before, during and directly after the interventions (child age 18 months), and when children are 24 and 36 months old.    Discussion  The outcomes are expected to assess the impact of the interventions and provide new insights into the mechanisms underlying the development of vegetable acceptance, self-regulation and healthy eating patterns in infants and toddlers, as well as the prevention of overweight. The results may be used to improve current dietary advice given to parents of their young children on complementary feeding.    Trial registration  The trial was retrospectively registered during inclusion of participants at the Netherlands National Trial Register (identifier  NTR6572 ) and at ClinicalTrials.gov ( NCT03348176 ).  Protocol issue date: 1 April 2018; version number 1.

bmc pediatrics

Baby’s first bites: a randomized controlled trial to assess the effects of vegetable-exposure and sensitive feeding on vegetable acceptance, eating behavior and weight gain in infants and toddlers