Infant and Toddler Nutrition: Breastfeeding, Formula & Solid Foods
Nutrition of Infants and Toddlers
Breastfeeding:
Human milk is the ideal and uniquely superior food for infants.
- It is recommended that human milk be the only source of nutrition for the first 6 months of life.
- Intake may be continued for the first 2 years of life (1 year average) if accompanied with appropriate complementary foods.
Advantages of Breastfeeding:
For the infant:
- Decreased incidence or severity of diarrhea, respiratory illnesses, otitis media, bacteremia, bacterial meningitis, and necrotizing enterocolitis
- Immunological support for the infant – limits infections, reduces the incidence of food allergies and eczema
For mothers:
- Decreased risk of postpartum hemorrhage, longer period of amenorrhea, reduced risk of ovarian and premenopausal breast cancers, and possibly a reduced risk of osteoporosis
For society:
- Reduced health care costs due to the decreased incidence of illnesses
Other:
- Relatively low but highly bioavailable protein content
- Generous quantity of essential fatty acids, long-chain unsaturated fats
- Relatively low sodium
- Does not need to be warmed, does not require a clean water supply, and is generally free of microorganisms
Contraindications to Breastfeeding:
- Maternal infection with HIV in developed countries
- Maternal active TB, syphilis, or varicella – breastfeeding may be restarted once therapy is initiated
- Herpetic lesions on the breasts
- Infant Galactosemia
- Contraindicated maternal drug use:
- Radioactive compounds, antimetabolites, lithium, and certain anti-thyroid drugs
- Alcohol, nicotine, caffeine, and other recreational/street drug use
- Inability to discontinue recreational drug use
Breastfeeding Support:
- Breastfeeding rates are lower in several subpopulations – low-income, minorities, and young mothers.
- Many mothers face obstacles in maintaining lactation because of a lack of support from healthcare, families, or employers.
- Breast-pump use may be a useful aide in some cases.
- Breast tenderness, engorgement, and cracked nipples are the most common problems encountered by breastfeeding mothers.
Formula Feeding:
- Soy formula – infants with cow’s milk allergy
- Hypoallergenic formulas (partially hydrolyzed protein) – infants with atopy in family history
- Hypoantigenic formulas
- Malabsorption formulas (highly hydrolyzed protein, carbohydrates, and medium-chain triglycerides) – infants with cow’s milk allergy and other sorts of malabsorption
- Premature formulas (EFAs, increased protein content, carbohydrates – one-half glucose polymers, fortification with vitamins and trace elements and some minerals, low osmolarity)
- Antireflux formula (thickened with carob bean fiber) – infants with GE reflux
Cow’s Milk-Based Formulas
- Cow’s milk-based formulas are used as substitutes for breast milk for infants whose mothers choose not to or cannot breastfeed or as supplements for breastfeeding.
- The alternative to human milk is iron-fortified formula, which permits adequate growth of most infants and is formulated to mimic human milk.
- Formula 1 – typically used from birth to 4 months (may be prolonged)
- Formula 2 – for children aged 5 months to three years
Nutrition of Older Infants:
- Breastfeeding should ideally continue for 12 months.
- By approximately 6 months, complementary feeding of semi-solid foods is suggested.
- Oropharyngeal coordination is immature before 3 months, making feeding with solid foods difficult.
- Consumption of 3 regular meals per day, and 2 or 3 healthful snacks according to appetite, activity, and growth needs.
- Inclusion of a variety of foods. The diet should be nutritionally complete and promote optimal growth and activity.
- Fat should comprise < 35% of total calories; saturated fats should provide < 10% of total calories; monounsaturated fats should provide ≥ 10% of caloric intake.
- Cholesterol intake should be < 100mg/1000kcal/day (maximum 300mg/day).
- Carbohydrates should provide 45-65% of daily caloric intake with no more than 10% in the form of simple sugars; a high-fiber, whole-grain-based diet is recommended.
- Limitation of grazing behavior, eating while watching TV, and consumption of soft drinks and other sweetened beverages.
- Limitation of sodium intake (choose fresh over processed foods).
- An infant should never be put to sleep with a bottle or sippy cup filled with milk, formula, or juice → This may lead to infant bottle tooth decay.
- Consumption of meat, poultry, and fish should be encouraged; skinless or low-fat milk, soft margarine, and vegetable oils should be preferred.
- Foods with high allergic potential that should be avoided during infancy (especially if there is a positive family history) include: Fish, Peanuts, Tree nuts, Dairy products, Eggs.
- Honey should not be given before 1 year of age (danger of botulism).