Infancy and Childhood Nutrition

Objectives

• After reading Chapter 13, this outline and answering infant nutrition questions, you will be able to:

1. Describe normal growth and weight gain

2. Identify nutrient needs

3. Compare breast milk and infant formula

4. Discuss advantages of breast milk

5. Discuss supplementation of full term infant

6. Discuss timeline for introduction of solid foods

7. Develop strategies for mealtime behaviors

8. Identify healthy snacks

9. Utilize BMI-for-Age Percentiles

Supplements for Full Term Infants

Vitamin D / Iron / Fluoride
Breastfed Infants
Birth to six months of age / X
Six months to one year / X / X / X
Formula-fed Infants
Birth to six months of age
Six months to one year / X / X

More on Supplementation of Full Term Infants (p.551)

1. Vitamin D supplementation is recommended for all exclusively breastfed infants and for any infant not receiving at least 500 ml (1.5 oz) of Vitamin D fortified formula.

2. Additional Iron is needed for all infants four to six months of age preferably in the form of iron fortified cereal and iron fortified formula for formula fed infants.

3. Fluoride supplementation is needed for all infants at six months if formula being used is not made with water that is fluoridated with at least 0.3 ppm.

Normal Infant Wt Gain

Weight gain during first 5 years

Breast Milk Advantages

• Immunological protection

– Colostrum: premilk substance of serum with antibodies and white cells; maternal antibodies

– Bifidus factors: promotes growth of “friendly” bacterium Lacto- bacillus bifidus in digestive tract

– Lactoferrin: iron-binding protein; interferes with bacteria growth; promotes iron absorption in infant’s bloodstream

– Lactadherin: protein; attacks virus causing intestinal diarrhea

– Growth factors: stimulate development and maintenance of infant’s digestive tract

– Breast milk enzymes: protect infant against infection (example: lipase)

• Allergy protection

– Lower incidence of allergic reactions

• Asthma, recurrent wheezing, skin rash

• Especially with family history of allergy

• Disease protection

– Lower blood cholesterol as adults

• Other potential benefits

– ?Protect against future weight gain

– ?Promote later intelligence

Infant Formula

• Risks of formula feeding

– Pure water supply; lead content

– Safe handling; refrigeration

• Infant formula standards

– AAP (American Academy of Pediatrics) - develops nutrient standards

– FDA (Food and Drug Administration) - mandates safety standards

Breast Milk vs Infant Formula

Infant Development and Recommended Foods

Age (mons) / Feeding Skills / Appropriate Foods to Add to Diet
0 - 4 / Turns head toward any object that brushes cheek.
Initially swallows using back of tongue; gradually begins to swallow using front of tongue as well / Breast milk or infant formula
4 - 6 / Extrusion reflex diminishes; ability to swallow nonliquid foods develops.
Indicates desire for food by opening mouth and leaning forward.
Sits erect with support at 6 months.
Begins chewing action.
Brings hand to mouth.
Grasps objects with palm of hand. / Begin iron fortified cereal mixed with breast milk, formula, or water.
Begin pureed vegetables and fruits
6 – 8 / Able to self-feed finger foods.
Develops pincer (finger to thumb) grasp.
Begins to drink from cup. / Begin textured vegetables, fruits.
Begin unsweetened, diluted fruit juices from cup.
8 - 10 / Begins to hold own bottle.
Reaches for and grasps food and spoon.
Sits unsupported. / Begin breads/cereals from table.
Begin yogurt.
Begin pieces of soft cooked vegetables and fruit from table.
Begin finely cut table foods
10 – 12 / Begins to master spoon; still spills some / Add variety; increase portions

Introducing Cow’s Milk

§ When to introduce cow’s milk is controversial

§ AAP advises no cow’s milk in the first year

§ At 1-2 years children need the fat in whole milk

o At 2-5 years a gradual transition from whole milk to lower fat milk can take place; whole milk is the young child’s source of essential fatty acids

§ Whole cow’s milk may cause intestinal bleeding in children younger than 6 months

§ Cow’s milk thus causes both a loss of iron and is a poor source of iron itself so does not replace lost iron

§ Cow’s milk is higher in calcium and lower in Vitamin C so the bioavailability of iron in infant cereal is less and reduced iron absorption occurs

Introducing Solid Foods: General Principles

§ Introduce solids when infant is developmentally ready

§ Introduce solids generally at 4-6 months

§ Purpose: Provide nutrient needs which can no longer be met by formula or breast milk

§ Introduce a single food at a time

§ Introduce a new food every 4-5 days

§ Use small portions

§ Gradually build intake to resemble the sample menu on p. 557, Fig 16-6

• Prevent food allergies and facilitate prompt identification

• Introduce a single food at a time

• Introduce rice cereal first

• Choice of infant foods

• Infant foods should be chosen using the same ABCD principles of healthy diet discussed in Chapter 2

• Adequacy, Balance, Calorie Control, Density, Variety and Moderation

• Introduce foods that provide iron

• At 4-6 months of age the infant’s rapid growth demands more iron than can be supplied by breast milk or formula

• Provide iron fortified cereal to meet increased iron needs

• Include meat and legumes for additional iron

• Include foods to provide Vitamin C

• Foods higher in Vitamin C improve iron uptake

• Fruits, juices, and vegetables are good sources of C

• Foods to omit

• Foods that might cause choking

• See list p. 557, side bar

• Foods containing Botulism

• Honey, corn syrup

• Foods containing concentrated sweets

• Example: Baby food “desserts”

• May contribute to childhood obesity

• Foods containing sugar alcohols

• May cause diarrhea

• Foods containing high amounts of salt and sodium

• Example: regular canned vegetables

• Foods at one year

• One year old needs 2-31/2 cups whole cow’s milk daily

• Beware of milk anemia – iron deficiency anemia that develops when an excessive milk intake displaces iron-rich foods in the diet

Strategies for Mealtime

As the infant develops into a toddler considerations other than nutrient needs may occur. Contrary and willful behavior may interfere with eating times. The following are a few suggestions for handling mealtime difficulties.

• Behavior

• Discourage unacceptable behavior

• Standing at the table or throwing food

• Remove from table until later

• Be consistent and firm not punitive

• Don’t make mealtimes a battle ground

• Exploration

• Allow exploration even if it is messy

• Let the child eat with his/her fingers

• Don’t force foods

• Rejection of new foods is to be expected

• Provide repeated exposure to new food

• Provide only nutritious foods

• Allow toddlers to choose from those foods

• Limit sweets

• Sweets have low nutrient density

• Do not use sweets as a reward

• Make mealtimes enjoyable

• Teach by example; making healthy food choices

• Provide good, pleasant environment for mealtimes

Development of Food Skills

Age 1 to 2 years, when large muscles develop:

• Uses short-shanked spoon

• Helps feed self

• Lifts and drinks from cup

• Helps scrub, tear, break, or dip foods

Age 3 years, when medium hand muscles develop:

• Spears food with fork

• Feeds self independently

• Helps wrap, pour, mix, shake, or spread foods

• Helps crack nuts with supervision

Age 4 years, when small finger muscles develop:

• Uses all utensils and napkin

• Helps roll, juice, mash, or peel foods

• Cracks egg shells

Age 5 years, when fine coordination of fingers and hands develops:

• Helps measure, grind, grate, and cut (soft foods with a dull knife)

• Uses hand mixer with supervision

Healthy Snacking

Grains

Grain products are filling snacks, especially when combined with other food groups.

§ Cereal with fruit and milk

§ Crackers with cheese

§ Whole grain toast with peanut butter

§ Popcorn with grated cheese

§ Oatmeal raisin cookies with milk

Vegetables

Cut up, fresh, raw vegetables make great snacks alone or in combination with other foods.

§ Celery with peanut butter

§ Broccoli, cauliflower, and carrot sticks with flavored cottage dip

Fruits

Fruits are delicious snacks and can be eaten fresh, dried, or juiced or in combination with other foods.

§ Apples and cheese

§ Banana and peanut butter

§ Peaches and yogurt

§ Raisins mixed with sunflower seeds or nuts

Meats and Legumes

Meats and legumes add protein to snacks.

§ Refried beans with nachos and cheese

§ Tuna on crackers

§ Luncheon meat on whole grain bread

Milk and Milk Products

Milk can be used as a beverage with any snack as can milk products such as yogurt or cheese.

A Final Statement on the

Nutritional Well-Being of Infants and Children

(A comparison of the intakes of milk and soft drinks)