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 Breastfed Infants Birth to six months of age Six months to one year Formula fed Infants Birth to six months of age Six months to one year X X Iron Fluoride X X 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 4 6 6 8 8 10 10 12 Turns head toward any object that brushes cheek Initially swallows using back of tongue gradually begins to swallow using front of tongue as well 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 Able to self feed finger foods Develops pincer finger to thumb grasp Begins to drink from cup Begins to hold own bottle Reaches for and grasps food and spoon Sits unsupported Begins to master spoon still spills some Breast milk or infant formula Begin iron fortified cereal mixed with breast milk formula or water Begin pureed vegetables and fruits Begin textured vegetables fruits Begin unsweetened diluted fruit juices from cup Begin breads cereals from table Begin yogurt Begin pieces of soft cooked vegetables and fruit from table Begin finely cut table foods 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 More on Introducing Solid Foods 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 ironrich 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