PROMOTING NUTRITIONAL HEALTH OF AN INFANT

 The best food for an infant during the first 12 months of life (and the only food
necessary for the first 6 months) is breast milk.
 A breastfed or partially breastfed infant should receive 400 IU of vitamin D
supplement starting at 2 weeks of age. (AAP,2017)
 It is recommended that infants be exclusively breastfed for 6 months, and it is
optimal that breastfeeding is continued through the entire first year. (Whitney &
Rolfes, 2012)
 For infant’s whose mother choose not to breast feed or are unable to breast feed,
a commercial iron-fortified formula will supply adequate nutrition for the infant year.
 Infants who are changed to cow’s milk before 1 year of age should receive
supplementary form of vitamin C and Iron and possibly fluoride to make up for the
deficiency of these components in cow’s milk.
 Not recommended as protein in cow’s milk is difficult for infants to digest
possibly leading to: intestinal irritation, slight gastrointestinal bleeding
occurs -> anemia.

RECOMMNEDED DIETARY ALLOWANCES FOR INFANTS

 The entire first year of life is one of extremely rapid growth, so a high-protein, high-
calorie intake is necessary.
 Calorie allowances can be gradually reduced during the first year from a
level of 120 calories per kilogram of body weight (50 to 55 calories per
pound) at birth to approximately 100 calories per kilogram (45 calories per
pound) of body weight at the end of the first year to prevent babies from
becoming overweight.
 Although heredity plays a role, a baby who is overweight during the first year of life
is more likely to become an adult who is obese than one whose weight is within
normal limits.
 Breastfed infants gain less weight than those who are formula fed and so usually
tend to be somewhat lighter in weight and have less risk of becoming overweight.
(Thilo & Rosenberg, 2011)

INTRODUCTION OF SOLID FOOD

 From a nutritional standpoint, a normal full-term infant can thrive on breast milk
or a commercial iron-fortified formula without the addition of any solid food until
6 months (Conti, Patel,& Bhat, 2011)
  Delaying solid food until this time also helps prevent overwhelming an infant’s
kidneys with a heavy solute load, as well as it may delay the development of
food allergies in susceptible infants and be yet another way to help prevent
future obesity. (Gaffney, Kitsantas, & Cheema, 2012)
 Parents can’t tell infants are physiologically ready for solid food when they are
nursing vigorously every 3 to 4 hours and do not seem satisfied or when they
are taking more than 32 oz (960 ml) of formula a day and do not seem satisfied.
 Infants are not ready to digest complex starches until amylase is present in
saliva at approximately 2 to 3 months.
 Biting movements begin at approximately 3 months.
 Chewing movements do not begin until 7 to 9 months. Therefore, foods that
require chewing should not begin until this age.
 Extrusion reflex should fade before infants accept food readily, as when
the extrusion reflex is intact anything placed on the anterior third of an infant’s
tongue it is automatically extruded or thrust out of the mouth by the
tongue.
o Life-saving reflex in early infancy as it prevents swallowing or aspirating
foreign objects that touch the mouth.
 The reflex fades at 3 to 4 months about the time the gastrointestinal tract has
matured to be ready to digest solid objects.

TECHNIQUES FOR FEEDING SOLID FOOD

 The introduction of solid food begins a new type of interaction between parents
and their infant and may require a period of adjustment. (AAP, 2017)
 A typical pattern for the introduction of solid food beginning at 6 months
includes:
 Iron fortified infant cereal mixed with breast milk, orange juice, or
formula – aids in preventing iron-deficiency anemia
 Vegetables – good source of vitamin A and add new texture and flavors
to diet
 Fruit – best sources for vitamin C and vitamin A
 Meat – good source of protein, iron, and B vitamins
 By 6 months of age, egg yolk – a good source of iron can be added.
 Commercial jar food is used in the hospital environment, but the appropriate
consistency table food is recommended for home use.
 Caution parents to omit wheat, tomatoes, oranges, fish, and egg whites if
there are allergies within the family as these foods are most likely to cause
allergies.
  Never use honey as a sweetener because it may contain botulism spores.
 Never use cow’s milk because it can cause microscopic intestinal bleeding.
 Offer new foods one at a time and to allow their child to eat that item for about
3 to 7 days before introducing a new food – this system helps parents identify
possible food allergy as well allowing the infant to get used to the experience.
 A newborns stomach can hold approximately 2 tablespoons (30 ml). By 1
year, a stomach can hold no more than about 1 cup (240 ml).
 For the first solid food feeding, it is best if an infant is held in the parent’s arms
as if for breastfeeding or bottle feeding.
 This reduces the newness of the experience and minimizes the amount
of stress associated with it.
 Babies have distinct taste preferences even at young ages and may spit out
food they do not like the taste of.
 When preparing baby food, parents should avoid preparing spinach, carrots,
beets, green beans, and squash – as these contain excessive amounts of
nitrates that are not processed well by infants.
 Commercial baby food has the nitrates removed.

CEREAL

 Infant cereal is fortified with B vitamins and iron. It is supplied as a precooked,

fine dry powder to which expressed breast milk, infant formula, or juice is added.
Adding sugar to cereal is unnecessary.
o Extra sugar in the diet can lead to diarrhea.
 Remind parents to buy the fortified product.
 The first cereal introduced is usually rice cereal because fewer children are
allergic to rice products as compared to wheat and corn products.
 Usually, this is offered twice day, in the morning and evening. Once the child has
taken rice cereal for a week, if they wish, parents can try another kind.
 Caution parents not to mix cereal into the infant’s bottle – as it is necessary to cut
a large hole in the bottle nipple for cereal and milk mixture to flow freely and danger
an infant may aspirate.
o This denies the child opportunity of learning to eat from a spoon and
experiencing different food tastes and textures.
 Infant cereal is so rich in iron that parents should continue feeding it at least
through the first year.
VEGETABLES AND FRUIT

 Iron content in vegetables is generally higher than that of fruits, that’s why
vegetables ae usually the second food added to the diet (after 6 months of age).
 To prepare their own, a parent simply cooks a vegetable and then blends or
process it, so it does not have to be chewed.
 Caution parents not to add butter, sugar or salt to the preparation because infants
have difficulty digesting fats until almost the end of the first year, and the added
salt or sugar is unnecessary.
 If parents use commercial baby food, they should being with level 1 types (single
ingredient and pureed) and feed from a dish rather than directly from the jar.
o This is because, if the spoon carries salivary enzymes from an infant’s
mouth back to the food jar, the enzymes will quickly liquefy what remains in
the jar.
o Baby food jars should be refrigerated once they are opened, and
manufacturers recommend they be used no longer than 48 hours after
they were first opened.
 Vegetables are mostly offered during lunch time. Remind parents to offer both
green and yellow vegetables.
 Fruits is usually offered 1 week after beginning vegetables (after 6 months of
age). It can be given in addition to cereal for breakfast and dinner.
 Parents should offer a selection so an infant is exposed to different tastes and
textures.

MEATS AND EGGS

 Meat is usually introduced at 9 months of age because this is the time an

infant’s iron stores are beginning to be depleted.
 Parents can grind a portion of the meat they have prepared for their own meal
so it is tender, or they can use commercially prepared baby food.
 If they use commercial baby meat, remind them to use the plain meat
preparations, not vegetable and meat dinners because these contain mostly
vegetables.
 Beef and pork have more iron than chicken , so encourage parents to offer a
variety
 When meat is added to an infant’s diet, it is usually added as part of the
evening meal in place of cereal.
 Egg yolks are offered after 6 months of age. It contains the bulk of iron
content of eggs.
 o Eggs may be hard boiled (then a little formula or breast milk can be
added to the mashed yolk to make it more liquid) or purchased as
commercial baby food.
o Soft boiling or poaching is not usually recommended because
salmonella.

TABLE FOOD

 With the introduction of solid food, encourage parents to establish a three-meal-

a-day pattern, if that is the family’s lifestyle and to have the infant join the family
at the table.
 If an infant is too distracted by the activity at a family table to eat well, parents may
find the infant eats more if fed first and then given a cracker to chew on while just
sitting at the table and being with the family.
 Encourage parents to use homemade foods rather than relying on commercially
prepared junior or toddler foods (often labeled as level 4 foods) – infant will have
less difficulty switching to a parent’s cooking when older.
 Mashed potatoes or peas and cut-up meatloaf are examples of table foods that
infants older than 6 months of age like to eat and busy parents can prepare quickly.

ESTABLISHMENT OF HEALTH EATING PATTERNS

 There are no hard-and-fast rules for infant feeding. The rules are only guidelines
based on what seems to work well with most infants.
 Encourage parents to individualize their approach according to the cues their child
is giving them for readiness and to understand that refusing a teaspoon of carrots
is refusing a teaspoon of carrots and nothing more.
 If an infant does refuse to eat, ask the parents what foods they are offering. Have
them list the exactly the types and amounts of foods the child eat they day before.
 If intake is inadequate, and the child is indeed a fussy eater ask about the parent’s
method of feeding.
 Some babies, particularly those with an intense temperament, may be so hungry
at mealtime that they cannot tolerate the frustration of spoon feeding until some of
their hunger is relieved.
o They may need to drink 2 to 3 oz of formula or nurse at the breast for a few
minutes before they will eat a spoonful of food.
 If infants are fatigued or overstimulated, they also may not eat well. Provide a quiet
environment away from older brothers or sisters or other distractions before meal
time.
  Encourage parents not to for infants to eat if they do not seem hungry.

WEANING

 Mothers are advised to exclusively breastfeed for the first 6 months and continue
breastfeeding for the full first year with complementary solids.
 Infants are capable of approximating their lips to a cup, and they can drink
effectively from one at about 9 months of age.
 The sucking reflex begins to diminish in intensity between 6 and 9 months, which
makes this time to consider weaning from a bottle.
 To wean from either formula or breast milk, the parent needs to choose on feeding
a day and begin offering fluid by the new method at that feeding.
 Choosing a time of the day that is not an infant’s fussy period is helpful.
 After 3 days to 1 week, when an infant has become acclimated to the one change,
the parent then changes a second feeding and so on.
 No set number of weeks should be prescribed to complete weaning.

SELF-FEEDING

 At approximately 6 months of age, infants become interested in handling a spoon

and beginning to feed themselves.
 Their coordination, unfortunately has not developed enough for them to use a
spoon without a great deal of spilling, so they are much more adept at feeding
themselves with their fingers.
 When infants play with their food by squeezing it through their fingers or dabbing
it in their hair, it is time to end the meal. Infants who are hungry eat; those who
are full, play.

A VEGETARIAN DIET

 An infant eating a vegetarian diet should continue to be breastfed or ingest an iron-

fortified commercial formula for the entire first year.
 If a milk allergy is present, a soy-based formula can be substituted.
 As soon as they are introduced to slid food, they can begin vegetarian foods (Amit,
2010).
 Assortments of food should be provided such as:
 Peas, potatoes, and carrots
 Fruits: such as apples, prunes (high in iron) and bananas
  Infant cereal: tofu, wheat germ, legumes, brewer’s yeast and synthetic
vitamin D.
 Dairy products can be added toward the end of the first year as usual.
 Vegetarian diet are high in fiber, infants who eat them may have more frequent
and looser than usual bowel movements.
 Advise parents to change diapers frequently to avoid skin irritation.
 Using less fibrous, more concentrated forms of protein such as tofu and
powdered nuts may solve this problem.