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Infant Feeding & Nutrition

Growth and Development


Nutritional Requirements
Feeding Choices
Breastfeeding
Formula Feeding
Cow's Milk
Soy-Based and Special Formulas
Solid Foods
A Proper Start in Life

Babies deserve the best of everything that can be offered. The first year of life is the most
critical for a child, particularly from a nutritional standpoint. Since parents are primarily
responsible for their baby's health, it is extremely important for them to understand the
unique nutritional requirements of infants.

Growth and Development


Throughout the first year of a baby's life, amazing changes take place. During this period an
infant experiences the most rapid growth and development period in its lifetime. Nutrition is
critical at this time, as the baby's diet must support this rapid growth rate. Consider the
following examples, which illustrate just how fast this growth rate is:
An infant's weight at birth usually

doubles by about four or five months of age, and


triples by about the first birthday

In terms of length, babies generally

grow 10 to 11 inches between birth and the first birthday, and


grow an additional two to three inches by 18 months of age.

Aside from these obvious external physical changes, important growth also takes place in an
infant's vital organs. In fact, the brain, heart and kidneys double in size by a baby's first
birthday. By 18 months of age, most of the brain cells have been formed. Therefore,
appropriate amounts of essential nutrients such as protein, carbohydrate, fat, vitamins, and
minerals are necessary to ensure and sustain this rapid yet normal rate of growth and
development.
Proper nutrition during the early months of life cannot be overemphasized as it also
influences the structure and function of vital organs. Obviously, it is of utmost importance
that the infant's nutritional needs are met through a diet adequate to support proper growth
and development.

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Nutritional Requirements
Because a baby typically receives all nutrients from a single food source or a limited number
of sources, it is imperative that the right kinds of nutrients at the right levels be present in that
source or sources. A proper balance of protein, fat, carbohydrate, vitamins, and minerals is
essential. Too much or too little of any one nutrient in a baby's diet should be avoided.
Remember an infant's nutritional needs are unique. They are, indeed, quite different from an
adult's and even from those of older children. Protein consumption is one example when
balance in the infant's diet is essential. Although some parents think that a baby cannot be fed
too much protein, this is not the case; too much protein can unduly stress an infant's
developing kidneys.
Too little of any nutrient may cause problems, as well. Iron deficiency is the most common
nutritional problem, affecting infants in all socioeconomic groups. A healthy baby born after
a normal, full-term pregnancy generally has enough iron stored in the body to meet iron
requirements for the first four to six months of life. Before this iron is depleted, iron should
be supplied in the diet as research suggests iron deficiency in early childhood may lead to
long-term changes in behavior that may not be reversed even with iron supplementation
sufficient to correct the anemia. Possible sources of iron in an infant's diet include breast
milk, iron-fortified infant formula, iron-fortified infant cereals and iron supplements. Iron is
important because of its role in the formation of hemoglobin, which carries oxygen through
the blood to the rapidly growing cells and tissues. Iron deficiency may result in irritability,
listlessness and anemia. Research also has shown iron to be essential for proper mental
development.
During the initial and most crucial months of growth and development in a baby's life,
nutrition and diet should be a major concern to parents.
What an infant consumes must

supply the right type and amount of protein, fat, carbohydrate, vitamins and minerals
in order to maintain the rapid, yet normal, rate of growth expected during this time,
and yet
not stress the baby's developing digestive system and kidneys

Feeding Choices
Choosing a method for feeding an infant is ultimately the parent's decision. However, in
making this decision, parents should rely on the advice of health professionals. Physicians,
nutritionists and other health professionals are extensively trained in this area and can provide
sound counsel regarding each infant's unique physiologic and metabolic demands.
Parents should be aware of certain important facts when deciding whether to breastfeed or
formula feed their infant. Breastfeeding is the preferred and recommended method of feeding.
However, if the decision is made not to breastfeed, breastfeeding is not possible, if a
breastfeeding supplement is needed, or if breastfeeding is stopped before the baby is one year

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of age, a commercially prepared iron-fortified infant formula is the best alternative to human
milk.
The American Academy of Pediatrics recommends,
"Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and
development for approximately the first 6 months after birth. Infants weaned before 12
months of age should not receive cow's milk feedings but should receive iron-fortified infant
formula."
Parents should work with the health professionals caring for their baby to help assure that
their baby's nutritional needs are met.

Breastfeeding
Breastfeeding is the preferred mode of infant feeding for a variety of reasons:

Breast milk supplies the nutrients required for an infant's growth and development.
Breast milk supplies the proper balance of nutrients, minimizing the likelihood of
excesses or deficiencies.
Breast milk does not stress a baby's developing digestive system and kidneys.
Breast milk is bacteriologically safe and provides immunological protections. By
breastfeeding her newly born infant, a mother will pass on some of her own
immunities to infections the baby may be exposed to during the first weeks of life,
before the baby's own immune system is fully developed.
Breast milk is convenient and economical for the mother. There is no need to
"prepare" a feeding. Mother's milk is ready whenever and wherever she is.
Breastfeeding involves physical contact between a mother and child. Emotional
growth, just as important as physical growth and development, is promoted by this
close, enjoyable mother-child interaction.

A mother who plans to breastfeed should be healthy and should eat an adequate and
nutritious diet to ensure the quality and quantity of her milk supply. A breastfeeding mother
needs an increased caloric intake, additional vitamins, minerals and protein, and an adequate
fluid intake. The diet of a breastfeeding mother affects not only her own health and wellbeing, but that of her child, as well. Some physicians recommend that the diet of the breastfed
infant be supplemented with vitamin D, iron, and fluoride beginning early in the infant's life.
In fact, the American Academy of Pediatrics "recommend[s] a supplement of 200 IU per day
[of vitamin D] for[a]ll breastfed infants unless they are weaned to at least 500 mL per day
of vitamin fortified formula or milk."

Formula Feeding
The best alternative feeding or supplement to breastfeeding is commercially prepared, ironfortified infant formula. Historical accounts show that use of replacements for breast milk
began centuries ago.

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It was not until the later 19th century, though, that scientists and physicians began scientific
investigations of breast milk substitutes. Certain discoveries regarding infectious diseases
were made, benefits of pasteurization became apparent, and the first studies on infant
metabolism began.
The "modern" era of infant formulas of known composition, as a complete food, began in
1915. Processed milk was developed with a fat content adapted to simulate human milk. Soon
after, modified evaporated milk formulas came into general use and became widely accepted
for a number of decades.
Today's infant formulas are much different than the early formulas, and are modeled on
breast milk and the breast-fed infant. Years of development, careful clinical and other
research, and continuing refinement have resulted in commercially prepared infant formulas
that provide the needed protein, fat, carbohydrate, vitamins and minerals.
Like breast milk, formula also

provides the proper nutrients at appropriate levels necessary for a baby to sustain a
rapid rate of growth and development, and
will not stress the infant's delicate and developing organ systems.

Because of the special nutritional needs throughout the first year, the baby should be
breastfed or receive an iron-fortified formula until at least one year of age, even after the
infant is eating solid foods.
The infant formula industry, recognizing the importance of human milk and breastfeeding
and fully acknowledging breastfeeding as the preferred feeding practice for babies, is
committed to providing the highest quality alternatives possible. Formulas on the market
today are produced to meet the nutritional recommendations of the Committee on Nutrition
of the American Academy of Pediatrics. In keeping with this commitment, the International
Formula Council (an association representing manufacturers of infant formula in the United
States) endorsed the Infant Formula Act of 1980 and the subsequent amendments to this Act,
which incorporate into law the Committee on Nutrition's recommendations and further assure
the safety and appropriate nutrient composition of infant formulas.

Cow's Milk
The American Academy of Pediatrics emphatically states that ordinary cow's milk is not
suitable for infants under one year of age. Although nutritious for older children and adults,
cow's milk is not appropriate for infants because

Cow's milk is a poor source of iron. As stated earlier, iron deficiency is the most
common nutritional deficiency in infants.
Cow's milk that has not been specially heat processed (such as the heat processing
used in infant formula) can cause intestinal blood loss in some babies.
Cow's milk contains only small amounts of vitamin C, vitamin E, and copper.
Cow's milk contains an excessively high level of protein -- approximately two to three
times higher than either breast milk or infant formula.
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The fat in cow's milk, different from that present in breast milk and infant formula, is
difficult for young babies to digest and absorb.
The amount of sodium in cow's milk is greater than the amount an infant should
receive.

Soy-Based and Special Formulas


For infants allergic to cow's milk, milk from goats and other animals or formulas containing
large amounts of intact animal protein are inappropriate substitutes for breast milk or cow's
milk based formulas. If a baby has a family history of allergy or exhibits symptoms of milk
(formula) intolerance, the physician may recommend a soy-based formula to help avoid
possible allergic reactions. The Academy of Pediatrics states: "In term infants whose
nutritional needs are not being met from maternal breast milk or cow milk based formulas,
isolated soy protein based formulas are safe and effective alternatives to provide appropriate
nutrition for normal growth and development."
A baby with confirmed allergies will often be given an extensively hydrolysed formula, one
in which the protein has been predigested so it will decrease the likelihood of an allergic
reaction, or if allergic symptoms persist, a free amino acid-based formula. Both soy,
extensively hydrolysed and amino acid-based formulas are nutritionally complete and do not
contain whole cow's milk protein.
Other special formulas are available for infants with special needs. Premature infants, infants
unable to digest and absorb nutrients adequately, and infants born with genetic disorders of
metabolism (i.e., rare disorders in which the body cannot turn food into energy normally)
often require special formulas. Such formulas meet unique nutrient requirements and should
only be used under the direction of a physician.

Solid Foods
Most experts agree that the introduction of solid foods is not necessary before four to six
months of age. Breastmilk or iron-fortified infant formula can provide all of a baby's nutrient
needs in the first few months of life. Introducing solid foods too early can contribute to
overfeeding in some infants. Some solid foods (notably those made by pureeing adult table
foods) may supply too much sodium and too many calories for the young infant.

A Proper Start in Life


An informed decision regarding an infant's diet should be based on health professional advice
as well as the parents' lifestyles and preferences. The final decision to breastfeed, formula
feed or use a combination of both rests with the parents. Breastfeeding is the preferred
method of infant feeding. However, if breastfeeding is not adopted, is supplemented or is
discontinued before 12 months of age, iron-fortified infant formula is the best alternative.
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The infant formula industry abides by exacting standards of quality, including careful
monitoring of nutrient composition, strict manufacturing policies and properly maintained
facilities. Before a new infant formula is introduced, it undergoes extensive clinical testing to
assure its safety and nutritional adequacy. Special attention is paid to all of these areas
because the industry is dedicated to providing sound nutrition for the optimal health of
infants.

REFERENCES
Walter T, DeAndraca I, Chadud P et al. Iron deficiency anemia: Adverse effects on infant
psychomotor development. Pediatrics, 1989, 84:7.
Lozoff B, Brittenham GM, Wolf AW et al. Iron deficiency anemia and iron therapy effects on
infant developmental test performance. Pediatrics, 1987, 79:981.
The American Academy of Pediatrics Clinical Report. Prevention of Rickets and Vitamin D
Deficiency: New Guidelines for Vitamin D Intake. Pediatrics, 2003, 111:908.
The American Academy of Pediatrics Committee on Nutrition. Hypoallergenic Infant
Formulas. Pediatrics, 2000, 106: 346.
The American Academy of Pediatrics Committee on Nutrition. Soy Protein-based Formulas:
Recommendations for Use in Infant Feeding. Pediatrics, 1998, 101:148.
The American Academy of Pediatrics Work Group on Breastfeeding. Breastfeeding and the
Use of Human Milk. Pediatrics, 1997, 100: 1035.
The American Academy of Pediatrics Committee on Nutrition. The use of whole cow's milk
in infancy. Pediatrics, 1992, 89:1105.
Infant Formula Act of 1980. Public Law No. 96-359, 94 Stat. 1190 [codified at 21 U.S.C.
350(a), 301, 321(aa), 331, 374(a)]. Sept. 26, 1980.
Public Law No. 99-570, 100 Stat. 3207 [codified at 21 U.S.C. 350(a) Sec. 4014. Infant
Formulas]. Oct. 27, 1986.

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