1. NUTRITION FOR INFANTS AND CHILDREN

2. Objectives
To recognize the changing nutritional needs of developing children through infancy
To understand that nutritional recommendations for children vary by age, stage of development, and gender.
To recognize that nutritional and dietary behaviors learned in children can have a significant impact on nutrition later in life

3. Why is Nutrition Important?
Energy of daily living
Maintenance of all body functions
Vital to growth and development
Therapeutic benefits
Healing
Prevention

4. Feeding the Newborn What are the options? Breast feeding
Colostrum: Transitions around days 3-5 and mature by day 10
The American Academy of Pediatrics recommends exclusive breast feeding for 6 months.
Formula feeding

5. Breast Feeding Questions
Why should I breast feed my baby? I thought formula was the identical alternative.
How often and for how long will my baby nurse?
How do I know if the baby is getting enough?
How many months can I breast feed the baby and when can I add formula?

6. Breast Feeding Advantages to Infants
It's usually more easily digested than formula. So breastfed babies are often less constipated and gassy.
It may lower the risk of sudden infant death syndrome in the first year of your baby's life.
It may raise your child's intelligence. Studies show breastfed babies have higher levels of cognitive function.
Decreased incidence of ear infections, UTI, gastroenteritis, respiratory illnesses, and bacteremia.
Convenient and ready to eat.
Fosters mother-infant bonding.

7. Breast Feeding Advantages to Mothers
May delay return of ovulation.
Cost effective
Suppresses post-partum bleeding.
Reduced risk of breast cancer, diabetes, heart disease, osteoporosis, and ovarian cancer.

8. Assessment of Breast Feeding
Weight pattern - consistent weight gain.
Stooling - generally more stools than formula.
Feed-on-demand ~ every 2-3 hours.
Duration of feedings - generally min/side.
Primary source of nutrition first 6 months

9. Storing Breast Milk
Store in hard plastic container with a label stating time and date. Store at 40˚ F or below and transport on ice Do not leave at room temperature and do not reuse

10. Breast Fed Infants
My 8 week old breast fed baby has not had a bowel movement in 6 days. He gets 1 or 2, 4 oz bottles of iron fortified formula at night as well. He is happy and active. His appetite is good. He is not vomiting. His abdomen is soft and nontender. What should I do?

11. What should I do? - cont.
Discontinue the iron formula, it may be constipating.
Give 1 tsp of mineral oil per day until he goes.
Give a suppository each day until he goes.
Add cereal to the bottle to help his bowels and to sleep.
Dilute the formula to give more water.
Give 1 oz apple juice per day until he goes.
Do nothing, breast fed infants may not have a bowel movement for up to 7 days.

12. Infant Formula
3 Forms:
Ready to feed - most expensive, does not require water.
Concentrate - requires mixing with water in equal parts.
Powder - requires mixing with water.

13. Composition of Standard Infant Formula
Caloric density: standard formulas contain 20 calories/oz (0.67 calories/cc).
Protein content: ratio of whey to casein varies- most are 60:40 similar to human milk.
Fat: most provide ~50% of calories from fat from saturated and polyunsaturated fatty acids.
Carbohydrate: lactose, beneficial effect on mineral absorption (Ca, Zn, Mg), and on colonic flora.
Micronutrients: Higher vitamin and mineral content than human milk

14. Special Formulas
Soy: used for vegetarians, lactase deficiency, galactosemia.
Lactose free: cow’s milk-based formula.
Protein hydrolysate: infants who can not digest or are allergic to intact protein.
Free amino acids.
Pre-term infant: unique for premies, predominant whey protein, cow’s milk based, higher protein and calcium, % MCT.
Pre-term follow up

15. Feed Within 30 Min. of Preperation
Checking the temperature of baby's bottle...
If feeding baby formula or preserved breast milk, some babies prefer their milk and sometimes even the nipple warmed. Test the temperature of the milk by sprinkling a few drops on the back of the hand or the inside of the wrist. It should be tepid…not hot.
Feed Within 30 Min. of Preperation
Use caution if using a microwave to heat the bottle. The milk or formula is heated unevenly. Shake before feeding.
Warming milk is NOT necessary, but once baby becomes accustomed to it, they may refuse cold milk.

16. Do’s and Don’ts Need soft and squeeze easy
Check condition of nipple, should drip out steadily
Nipple should be kept full of milk to avoid excessive air swallowing
Never prop bottle - choke more often when bottles are propped. They also fall asleep with milk in their mouth, promoting gum disease and tooth decay. Milk runs down the face and into the ears, causing more ear infections
Never put baby to bed with bottle- can cause tooth decay

17. NO COWS MILK UNTIL 1 YEAR OLD
Feeding Schedule...
Proponents of breastfeeding encourage mothers to feed their babies “on demand”, with no schedule established. It provides baby with comfort as well as nutrition.
NO COWS MILK UNTIL 1 YEAR OLD
If bottle feeding, whether it is with formula or expressed breast milk, baby needs one ounce per hour If they drink 4 ounces, therefore, they can usually wait about 4 hours before they eat again.

18. Introducing baby foods...
4-6 months
Until baby has teeth and is able to chew food well, they should eat only pureed food. Pediatricians recommend starting with a bland rice cereal, followed by oatmeal and then barley cereals. Vegetables such as peas and carrots come next, followed by fruits.
There are some foods that should be avoided for the entire first year, as baby has or easily develops allergies to them: chocolate, citrus fruits, peanut butter (it also presents a choking hazard for children under 3), egg whites, honey (may contain botulism food poisoning), wheat products, cow’s milk
When starting baby on solid foods, introduce only one new food every 3 days. If your baby has an allergy to this food, you will be able to pinpoint which food is a problem and avoid it. Babies do not need a wide variety of foods in their diet, and very bland foods are flavor- packed for baby!

19. Feeding Skills Development
4-6 mos - experience new tastes.
Give rice cereal with iron.
6-7 mos - sits with minimal support.
Add fruits and vegetables.
8-9 mos - improved pincer grasp.
Add protein foods and finger foods.
10-12 mos - pulls to stand, reaches for food.
Add soft table food, allow to self-feed.

20. Feeding Skills Development
12-18 mos - increased independence.
Stop bottle, practice eating from a spoon.
18 mos -2 yrs - growth slows, less interest in eating.
Encourage self-feeding with utensils.
2-3 yrs - intake varies, exerts control.