Infant Nutrition

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AAP recommendations on how to avoid risky behaviors associated with overweight and obesity begining in infancy - Click here

HealthyChildren.org: recommendations on infant feeding with links to articles for each stage

 

General Overview of Infant Nurtition

Caloric requirements

  1. 0-3 months - 116kcal./kg./d
  2. 3-12 months- 100kcal./kg./d

Composition of the diet

  1. 40-50% fat
  2. 40% carbohydrates
  3. 10% protein

General guidelines to diet

  1. 0-12 months- breast milk or cow protein based formula
  2. 4-6 months- introduction of solid foods
  3. Breast milk supplies adequate nutrition for the first 6 months of life except for Vit. D which should be supplemented
  4. High fat content of diet should continue throughout the first 2 years to insure adequate CNS growth and development. This may be accomplished with whole milk from 12-24 months.

 

Breast Feeding

  1. Supplies adequate calories
  2. Need Vitamin D supplementation, 400 IU/d, especially in dark skinned infants with inadequate sunlight exposure
  3. Supplies adequate iron until 6 months of age when the diet should be supplemented with iron fortified cereals. The requirement is 1mg/kg/d
  4. Helps protect infant against respiratory and gastrointestinal infections and may enhance immunologic response to vaccines.
  5. May increase IQ
  6. May decrease incidence of obesity
  7. Decreases the incidence of breast, uterine, and ovarian cancer in breast feeding mothers.  May return to pre-pregnancy weight faster
  8. If breast feeding curtailed before one year of age, iron fortified formula should be introduced.
  9. Contraindications to breast feeding
    1. HIV
    2. Active Tuberculosis
    3. Mother receiving Chemotherapy

 

Cow's Milk Formula

  1. Recommended when breast milk is not available
  2. 20 cal./ounce
  3. Supplemented with necessary daily requirements of vitamins and iron (11-12mg./liter)
  4. Unmodified cow's milk not recommended for 1st year of life because has high protein content, inadequate iron, low vitamin C, causes loss of blood from the upper GI tract, presents an increased solute load, and has decreased amounts of zinc.
  5. Cow's milk used in formula should be paseurized, homogenized, or evaporated. 

 

Soy Protein Formulas

  1. There is no advantage for using soy based formulas over cow's protein formulas
    1. No decreased incidence or severity of colicky symptoms
    2. Does not decrease the incidence of the development of atopy
    3. Should not use if there is a true milk protein intolerance.
  2. Recommended for infants with galactosemia and lactase deficiency
  3. Recommended for strict vegans
  4. 20 cal./ounce

 

Goat's Milk

1. Not recommended because of lack of folate and iron and may not be adequately pastuerized

 

Specialized Formulas

  1. May be necessary in rare carbohydrate intolerance syndromes such as lactase deficiency, sucrase-isomaltase deficiency, and glucose-galactose malabsorption
  2. In true cow's milk and soy protein allergy and sensitivity, should start hydrolyzed protein or an elemental formula.

 

Diet Supplements

  1. Vitamin D
    1. All breast-fed babies should be supplemented with 400
  2. Iron
    1. Most full term infants have enought iron stores for six months and therefore supplementation not needed.
    2. With the introduction of iron fortified formula and dietary supplementation of iron in cereal, the need for routine testing for anemia at 9-12 months of age, has been questioned.
    3. preterm and low birth weight newborns and infants with diets that have inadequate sources of iron, should be tested for anemia. 
  3. Fluoride
    1. Currently the AAP does not recommend supplementation with fluoride until the infant is 6 month old and lives in an area with < 0.3ppm of fluoride supplementation in the water supply. 
    2. A good history should ascertain whether the infant is getting sufficient water to prevent tooth decay. If not, fluoride supplementation should be suggested. 
    3. Many available commercial infant waters are supplemented with fluoride. 

 

Solid Food Introduction

  1. The introduction of solid foods should begin between 4-6 months when the child has developed motor skills to be able to eat off a spoon and have adequate motor skills to indicate to the feeder that they are full.
  2. Foods should be soft and pureed. 
  3. The order of introduction of foods is not important.  One common order begins with vegetable, green to orange, then fruits to introduce foods from blandest to sweetest.  Many recommend introducing one food at a time to recognize any food allergies.
  4. Usually iron fortified cereal is introduced first but current recommendations are that any food may be introduced including eggs, nus, fish, etc
  5. Prevention of choking should be of paramount importance. 

 

Evaluation of Nutrition

  1. Growth parameters including head circumference, weight, and length and plotting on growth curves to evaluate velocity and comparison to previously established patterns
  2. Complete physical examination.
  3. Composition of the diet.

If there is normal growth and the composition of the diet is adequate, the infant's nutrition is presumed to be normal. 

 

 

 

Reference

  1. Aldous, Michael. Nutritional Issues for Infants and Toddlers. Pediatric Annals February 1999.
  2. American Academy of Pediatrics, Committee on Nutrition. Soy Protein-baed Formulas: Recommendations for Use in Infant Feeding. Pediatrics. 1998: 101(1):148-153.
  3. Bhatia, Jatinder, Bucher Colleen, and Bunyapen, Chantrapa. Nutrition in Infancy: Implications for Practice. Pediatric Annals. August 1998.
  4. American Academy of Pediatrics. Use of Soy Based Formulas in Infant Feeding.  May 2008

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