1. Nutrition for Your Baby
Ashley Ritzo, rd

2. THE MOST IMPORTANT THING YOU CAN LEARN FROM THIS PRESENTATION…

4. Importance of Nutrtion
Lots of research has proven good nutrition during first 2 years of life builds foundation of health and development for the rest of your baby’s life
Some scientists even found that an unhealthy diet in 3 year olds decreased IQ scores in 8 ½ year olds!

5. Division of Responsibility
Infant/Baby:
You = What
Baby = how much (and everything else)
Older Babies, Toddlers and On:
You = what, when and where
Child = how much and whether

6. Overview Newborn Feeding and Nutrition Adding Table Foods/Weaning
Older Baby Feeding and Nutrition

7. Newborns

8. Newborns The best way to start out feeding your baby is “on-demand”
How to Feed Infants
The best way to start out feeding your baby is “on-demand”
Even newborns know when they are hungry and full and you can generally trust those signals
Your baby will calm self down best and eat best when he/she feels you’ll do what she wants

9. Newborns You know you’re too controlling when…
Parent & Baby Share Control
Parent too Controlling
Pay attention to what your baby tells you
Let your baby eat as much or as little as he/she wants
Feed on demand
Go by how you want to feed your baby
Make your baby eat a certain amount
Stop feeding before baby is full
Make your baby go by a schedule

10. Newborns You know you’re too controlling when…
Parent & Baby Share Control
Parent too Controlling
Sit still when you breastfeed or hold the bottle
Touch your baby’s lips to let him/her “open up” for the nipple
Feed smoothly; don’t interrupt
Move around during feeding
Jiggle the bottle
Push the nipple into your baby’s mouth
Stop feeding the baby to check how much your baby eats

11. Newborns You know you’re too controlling when…
Parent & Baby Share Control
Parent too Controlling
Try to solve problems
Let your baby slow down or stop sucking
Let your baby go back to eating after she pauses
Help your baby settle down if she gets fussy, and then offer more
Take “no” for an answer
Jump to conclusions about why your baby does what she does
Keep on feeding when your baby turns away or shuts her mouth
Stop feeding when she slows down, stops sucking, or fusses

12. Newborns How to Feed Infants
Start feeding your baby when he/she is fully awake and sending you signals that he/she is hungry
Hunger Signals
Eyes wide and bright
Moving hands and arms towards you
Turning head towards you
Raising head
Curl arms and legs up
May tuck hands under chin or start sucking on hands
Rooting reflex

13. Newborns How to Feed Infants
Start feeding your baby when he/she is fully awake and sending you signals that he/she is hungry
Over-hungry Signals
Making loud sucking sounds
Fussing

14. REALLY finished eating
Newborns
How to Feed Infants
Stop feeding your baby when he/she indicates he/she is finished
Satisfied
Relaxed arms and legs, extended
Fingers extended
Comes off the nipple
Rooting reflex goes away
REALLY finished eating
Push away with hand
Crying or fussing

15. Newborns How to Feed Infants
Sometimes babies just need to take a break from eating
Just Needs a Break
Looking away
Breathing fast
Yawning
Forehead wrinkled
Dull looking face and eyes
Frowning
REALLY needs a break
Back arching
Pushing hand towards you
Crying, fussing
Falling asleep

16. Newborns
How to Feed Infants
Try not to feed/rock your baby to sleep – if she doesn’t learn how to calm herself down she will learn that she can’t go to sleep without it

17. Newborns Enough Concerned Breastfeeding 8 or more times in 24 hours
6-8 wet diapers per day
3-4 or more stools per day with at least a small amount of yellow or green poopy stain
Not seeing enough pees and poops
Few feedings
Number of feedings is decreasing
Overly sleepy
Weak suck
Baby doesn’t show much interest in feeding

18. Newborns
With a baby that is gaining weight slowly – it helps to keep a daily record of feedings, wet and dirty diapers
Baby’s growth should be smooth and consistent on growth chart
Only compare baby’s growth to his/herself, not to other babies

19. Newborns

20. Newborns
As long as baby is growing consistently you have nothing to worry about even if baby falls out of these ranges – some days may eat a lot and some days may only eat a little

21. Newborns Bottle feeding - Positioning
Keep bottle tilted so nipple is fully filled with formula
Loosen ring on glass or plastic bottles to allow air in bottle as your baby eats
Plastic liner bottles

22. Newborns Bottle feeding Nipple doesn’t matter as long as it flows well
Boil water for 3 minutes for first 6 months; also boil nipples, rings and bottles for first 3 months
Warm formula in warm tap water or under running warm water – don’t microwave

23. Newborns Bottle feeding - Safety
Make sure you mix the formula EXACTLY right
Keep formula fresh and cool between feedings

24. Adding Table Foods & Weaning

25. Adding Table Foods & Weaning
Weaning/How to start solids
Go by what your baby can do, not by how old
Some baby’s may take longer to get ready than others
With children that have medical or oral-motor challenges, it can take the whole first year or longer to get that nipple-feeding step to go smoothly
Don’t wait too long – makes it harder to transition

26. Adding Table Foods & Weaning
Generally around 5-7 months
After sitting up on own you can check to see what his mouth is doing every few days
Sit up alone or with support
Use muscles in neck to hold head up straight
Mouth fingers and toys
Open mouth when sees something coming
Turn head away if he doesn’t want it
Keep tongue flat and low so you can put spoon into his mouth
Close lips over the spoon
Scrape food from spoon with lips
Keep food in mouth rather than squeezing it back out onto his chin – if most of the food is coming out, he isn’t ready to start solids

27. Adding Table Foods & Weaning
Gagging is a normal part of learning to eat and won’t scare your baby unless it scares you or you get too pushy
To be safe, just make sure food pieces aren’t too big so they can plug windpipe
Choking Hazards:
Popcorn
Peanuts
Dried fruits
Whole grapes, peas or corn
Uncut, stringy meats
Hot dog pieces
Hard, raw fruits or vegetables like apples
Sticky foods like peanut butter that can get stuck in the back of the mouth
Any other pieces of food that your baby cannot chew because he or she does not have good chewing skills yet.

28. Adding Table Foods & Weaning
Difference between gagging and choking
Your child is choking if:
Only making squeaky, whistling, inhaling sound

29. Adding Table Foods & Weaning
Once baby is ready:
Positioning
Put in high chair
Sit straight up and face you – swallow easier and prevent choking
Sit directly in front of him
Use a baby spoon

30. Adding Table Foods & Weaning
Important to still share control
Offer spoon and wait until he clearly indicates he is ready before you try to feed him
Hold spoon about a foot away from mouth and wait for him to look at it, or you, and look interested
At first, just put a little on his lips so he can taste it – he will lick lips
Offer him the spoon again, and do what he tells you
If he parts his lips a little, just give him a little more on his lips
If he turns away, quit
Only put the spoon in his mouth if he opens up
Feed as slowly or as fast as he wants to eat, but wait for him to show you he’s ready before you offer the next spoonful
Let him touch his food when he wants to. This gets messy, but that’s ok

31. Adding Table Foods & Weaning
When you start solids, offer nipple feeding first and the solids afterward
Offer solids partway through nipple feeding – after 1 breast or when he takes a breather from his bottle
Finish by offering rest of breast or formula feeding
Wait to offer solids first, before nipple feeding, until baby is ready to drink from a cup

32. Adding Table Foods & Weaning
Progression
Baby cereal
Fruits and Vegetables
Cooked or canned
Soft raw without skin
Dry cereal (Cheerios, Rice Chex, Corn Flakes)
Wheat products (bread, crackers, tortilla) at 7 months
Meat around the time baby comes to the table
Only offer moist meats
Wait to offer eggs until at least 9 months
Wait to offer peanut butter until at least 12 months

33. Adding Table Foods & Weaning
Baby Cereal
Start with baby cereal mixed with formula or breast milk (not juice or water) – keep it lukewarm
Don’t put cereal in bottle
Don’t sweeten cereal with sugar – it might make baby accept cereal sooner, but it is better if he learns to enjoy the taste unaltered
Start thin and work up to thicker
Keep feeding cereal alone until bay is good at eating from spoon and eats at least a couple of tablespoons a day (dry measure), twice a day, then thicken it up and even leave in a few lumps to encourage baby’s developing mouth skills  this step should take a month or so

34. Adding Table Foods & Weaning
Once he is good at eating cereal, ready to add fruits and vegetables
Texture should be mashed with a fork or put through baby food mill or grinder
Pureed food or commercial baby food are all right but not necessary
Use cooked or canned at first
Progress to raw fruits (e.g. peaches, plums, pears) with skins removed
Offer same cooked vegetables the rest of the family is eating – don’t add salt or seasoning
e.g. mashed peas or potatoes, cut-up cooked green beans, anything with a texture that he can mush up with his jaws and swallow without choking.

35. Adding Table Foods & Weaning
Add 1-2 tablespoons of fruit/veg along with cereal, but don’t mix together – baby needs to learn about new taste separate from cereal taste
Take time adding new tastes
Work up until two or three cereal and fruit or vegetable “meals” a day

36. Adding Table Foods & Weaning
Next, start giving dry cereal on his high chair tray (Cheerios, Corn Chex, Rice Chex, Corn Flakes)
Wait to add strips of bread or wheat tortillas until 7-10 months to reduce the risk of allergies
Introduce 1 food at a time and wait a few days to check for any allergic reactions

37. Adding Table Foods & Weaning
Everything is new to babies and it takes time to get used to all the new tastes and textures
Some foods baby will accept readily (grains and fruits); whole other foods will take a while for baby to learn to like (meats, vegetables)
Expect the baby to taste a new food and not want any more of it – make sure you put a bit on a baby’s lips first before giving them a full bite to let them know to expect a new taste
Don’t stop offering the rejected food or your baby won’t learn; it may take 5, 10, 15 or even 20 times of offering a food before he becomes learns to like the flavor, but he will get so he likes most foods

38. Adding Table Foods & Weaning
Start feeding meat around 9-12 months when baby arrives at the family table
To make meat and poultry easier to eat, cook it using moist heat until it is tender, chop or cut it up very finely across the grain and moisten it a bit with broth or cooking liquid from vegetables
Have ground beef patties on hand in case the family is eating some type of meat that is too difficult for the baby to choose – ok to modify foods for baby’s safety, but not if the goal is to get baby to eat well
Wait until about 9 months before you offer eggs and 12 months before offering peanut butter to avoid developing food allergy

39. Adding Table Foods & Weaning
Working into a schedule as toddlers
By months baby should be eating 3 meals and 3 snacks
How to work into a schedule
Start shaping solid foods into meals, offering cereal and fruit for one meal and cereal and vegetable for another meal
The rest of the time, continue to breast feed or formula feed as usual
Quietly discontinue mealtime nipple feedings one at a time and he won’t even miss them
Once baby is at least 1 year old and eating 3 meals a day at the table start substituting whole, pasteurized milk for breast milk or formula

40. Adding Table Foods & Weaning
Your child will use nipple feeding as a bid for attention if you let him/her
Do not let your child misuse nipple feeding to put self to sleep, run around with bottle
If baby is too old for you to hold the bottle or baby while you feed him/her, he/she is too old for a bottle or to be breastfed

41. Older Babies & Toddlers

42. Older Babies & Toddlers
How to Feed an older baby/toddler
Toddler = 1-3 years old
Learning about life and independence
Division of responsibility
You provide the what, when, where
Toddler decides how much and whether to eat

43. Older Babies & Toddlers
Toddlers are skeptical
Toddlers are unpredictable

44. Older Babies & Toddlers

45. Older Babies & Toddlers
Toddlers are skeptical
Toddlers are unpredictable
Toddlers are stubborn

46. Older Babies & Toddlers
You cannot have any particular agenda with regards to eating – the toddler can smell it a mile away
All you can do is maintain the division of responsibility and your child will learn to eat

47. Summary Maintain the Division of Responsibility
Watch growth to make sure it’s smooth and consistent
Choose a healthy, variety of foods to offer your child