Chapter 16 Feeding Infants

Infant Growth Patterns Infants experience rapid growth during the first year: Gains approximately 2/3 ounce/day between birth and 6 months; gains of 1/2 ounce/day between 6 and 12 months are typical. Length increases by approximately 10 inches. Basal metabolic rate (BMR) is higher than an adults’.

Low Birth Weight Infants The data on low birth weights is worrisome because such babies — those born at less than 5.5 pounds — are at greater risk of dying in infancy or experiencing long-term disabilities.

Determinants of Infants’ Nutrient Needs Rapid growth Small stomach capacity Physiological and developmental readiness ©2012 Cengage Learning. All Rights Reserved.

Determinants of Infants’ Nutrient Needs (continued) Rapid growth Infants require approximately 45 to 55 calories per pound/body weight during the first six months; 40 to 50 calories/pound are needed during the second six months Small stomach capacity Infants are able to consume only limited amounts at each feeding so they must eat often ©2012 Cengage Learning. All Rights Reserved.

Determinants of Infants’ Nutrient Needs (continued) Physiological and developmental readiness: Intestines—are not fully functional; they do not produce the enzyme amylase, which is needed for digesting starches (i.e., cereals). Kidneys—are not effective in filtering waste products, thus making infants more prone to dehydration. Tongue—reflexes allow infant to suck but not to move food from front to back of mouth. ©2012 Cengage Learning. All Rights Reserved.

Feeding Infants Breast milk or formula provide all the nutrients an infant needs for optimal growth and development during the first four to six months with the exception of vitamin D. The American Academy of Pediatrics recommends a daily supplement of 400 IU of vitamin D for breast fed infants. Formula-fed infants do not require this because formulas contain vitamin D Semisolid (pureed) foods should not be introduced before this time. ©2012 Cengage Learning. All Rights Reserved.

Breast-Feeding Advantages (for infant): Provides the right mix of protein, carbohydrates, and fats in forms that are easy to digest Is high in calories to meet the infant’s growth and energy needs Is especially high in calcium, phosphorus, iron, and vitamin C Provides friendly bacteria that help the infant’s intestines to develop ©2012 Cengage Learning. All Rights Reserved.

Breast-Feeding (continued) Advantages (for infant) (continued): Provides the infant with temporary protection (antibodies) against many viral and bacterial illnesses Less likely to cause an allergic response Volume is produced in response to the infant’s needs Always ready on demand Breast-fed infants have been shown to have lower rates of obesity ©2012 Cengage Learning. All Rights Reserved.

Breast-Feeding (continued) Advantages (for mother): A convenience food—no mixing, correct temperature, no dishes to wash Less expensive—no formula to purchase; however, mothers must increase their dietary intake of certain nutrients Sanitary conditions—always clean; less chance for introduction of harmful bacteria Helps to return the reproductive system back to normal ©2012 Cengage Learning. All Rights Reserved.

Breast-Feeding (continued) Disadvantages (for mother): Must be available May limit father’s involvement in the feeding process Mother must pay attention to the quality of her diet Requires family support and freedom from anxiety May not be advisable if mother is ill or taking certain medications ©2012 Cengage Learning. All Rights Reserved.

Formula Feeding Commercial formulas are similar in composition to breast milk, but do not contain protective antibodies. Manufacturers have recently added two essential fatty acids (DHA and ARA) previously missing from U.S. formulas. Mixing with bottled water is recommended to avoid introducing environmental contaminants. ©2012 Cengage Learning. All Rights Reserved.

Breast Milk versus Formula Both methods adequately meet an infant’s nutrient needs and provide an opportunity for bonding. Mothers may choose not to nurse or to use a combination of breast- and formula feeding based on a variety of factors, including: Illness or mother’s need to take certain medications Mother needs to be away from the infant periods of time Personal choice Mother uses addictive drugs, including tobacco ©2012 Cengage Learning. All Rights Reserved.

How to Determine an Infant’s Nutrient Needs An infant’s nutrient needs are based on: Growth (height, weight) that continues at an appropriate rate Energy for active play Absence of frequent illness ©2012 Cengage Learning. All Rights Reserved.

Introduction of Solid Foods—Knowing When an Infant Is Ready for Solid Food Is able to accept foods and swallow Is able to sit up in a chair Is able to assert self (turns head away, indicates when no longer hungry) Is ready to interact and socialize Begins to enjoy touching and picking up foods ©2012 Cengage Learning. All Rights Reserved.

Introduction of Solid Foods (continued) 5–6 months iron-enriched cereals 6–8 months vegetables, followed by fruits 8–9 months meat and meat substitutes Initially, it is better to offer individual foods rather than mixtures. If an allergy or sensitivity develops, the offending food can be readily identified. Sugar, salt, and butter should not be added to an infant's food. Parents may choose to prepare pureed foods at home or purchase commercially prepared food. Either is acceptable as long as the foods are nutritionally adequate. Table foods (removed before they have been seasoned) can be pureed in a blender. For example, if the family is having baked chicken, peas, and rice, an appropriate serving for the infant might be 2 tablespoons chicken, 2 tablespoons peas, and ¼ cup rice (all pureed). Preparing food in this manner can expose the infant to a wider variety of items and allows families to have more control over what is offered. Initially, it may be wise to limit high-fiber foods. Home-prepared pureed food can also be frozen in ice cube trays, removed after frozen and stored in a tightly sealed container, and thawed for use as needed. If the decision is to use commercially prepared baby food, it is better to use plain fruits, vegetables, and meats rather than “dinners,” or “desserts,” which are often extended with starches and other additives. Information on the labels of commercially prepared infant and toddler foods should be read carefully in order to make healthful selections (Figure 16–3). Remember that ingredients on food labels are listed in descending order according to the amount present. The first ingredient in an acceptable infant food should always be fruit, vegetable, or meat—not water, cereal or other starch. When feeding a child prepared baby food, a small portion should be removed, placed in a bowl, and the rest of the jar's contents returned to the refrigerator. This reduces the chance of contaminating the remaining food with bacteria and enzymes found in the saliva, which can also cause the food to break down and become “watery.”

Introduction of Solid Foods (continued) Usually foods are introduced in the following order: Cereals—rice being the first because it is less likely to cause an allergic response Vegetables Fruits Meats and other proteins Avoid honey or foods containing honey; they may contain botulism spores. This process may be delayed and take longer for some children who have special needs. ©2012 Cengage Learning. All Rights Reserved.

Feeding Cautions Choking is common during an infant’s transition from milk to solid foods. Children with certain types of special needs may be more prone to choking. Know how to perform the Heimlich maneuver and CPR. Always cut food in small pieces! Avoid serving foods that are hard to chew (raw carrots) or sticky (peanut butter) and difficult to swallow. ©2012 Cengage Learning. All Rights Reserved.

Common choke foods for infants and toddlers include: uncut spaghetti uncut hot dogs, peanuts, and hard or gooey candy whole grapes popcorn nuts chunks of peanut butter (if your toddler isn't at risk for food allergies and you decide to give him peanut butter, spread smooth peanut butter thinly on bread or a cracker) chewing gum raisins raw vegetables chunks of meat chunks of cheese

Case Study MissyT. is the mother of 6-week-old Hayden. Hayden is Missy's first child. Missy's mother lives nearby and is happy to help out with Hayden's care. Missy complains of being tired and mentions to her mother that Hayden awakens several times during the night and acts hungry. Her mother advises her to add cereal to his bedtime bottle in order to “fill him up so he will sleep through the night.” She also advises cutting larger holes in the nipple so the cereal won't block the opening.

Case Study Should Missy follow her mother's advice? What are the dangers, if any, of feeding a 6-week-old baby cereal from the bottle? Do child care practices change from generation to generation? Consider possible short- and long-term consequences of feeding semi-solid food from a bottle. How would you respond if you were the teacher and a parent asked that you feed an infant in this manner?

Children with Special Needs Infection Medication side effects and unpleasant medical treatments Swallowing difficulties Dental problems Special diets Fatigue Infants who are born prematurely Have a range of health problems Genetic disorders and congenital malformations Conditions that require surgery Many infants with special needs are enrolled in early childhood programs today. Teachers must work closely with their families to learn as much about the child's condition, medical treatments, nutritional needs, and ways they can collaborate to assure the infant's healthy development. infants who are born prematurely or who have a range of health problems, including genetic disorders and congenital malformations, may present special feeding challenges and nutritional needs. For example, infants born with Down syndrome typically have weak facial muscles, which make sucking difficult and less efficient. Later, these children have a tendency to overeat and to gain excessive weight. Some infants may have conditions that require surgery, which can increase their need for certain nutrients at a time when they may not be receptive to food. It is especially important that infants with special needs obtain all of the nutrients necessary for healthy growth and brain development during the months following birth.

Bottle Mouth Syndrome Do not to allow a baby to sleep with a bottle. Can result in such rampant decay of a child’s teeth that the child will suffer pain and may lose teeth at a very early stage. Acidic liquids damage the enamel physically. Liquids high in sugar content (including milk) encourage bacterial growth in the mouth. Carbonated cold drinks and pure fruit juice are both of these and should be avoided in bottles. Try to use only water in the bottle if your baby insists on lying down with one. Do not to allow a baby to sleep with a bottle. Baby bottle tooth decay (BBTD) is caused by allowing infants to feed for prolonged periods of time, such as putting them to bed with a bottle or giving them fruit juice in a bottle to drink at their convenience. Sugars in formula, breast milk, or juices can lead to a high rate of tooth decay when they remain in contact with developing teeth. Infants should be fed in a reasonable amount of time and the bottle or breast removed.

Bottle Mouth Syndrome Letting a baby drink a bottle lying down can also increase the risk of ear infections. Ear infection from feeding usually comes about by milk flowing into the baby's ear, where the warmth of the ear combined with the wetness and sugar of the milk provide a perfect breeding ground for germs.

NC Nutrition Requirements for Infants 10A NCAC 09 .0902 GENERAL NUTRITION REQUIREMENTS FOR INFANTS (a) The parent or health care provider of each child under 15 months of age shall provide the center an individual written feeding schedule for the child. This schedule must be followed at the center. This schedule must include the child's name, be signed by the parent or health care provider, and be dated when received by the center. Each infant's schedule shall be modified in consultation with the child's parent or health care provider to reflect changes in the child's needs as he or she develops. The feeding instructions for each infant shall be posted for quick reference by the caregivers, except in centers licensed for three to 12 children located in a residence.

NC Nutrition Requirements for Infants (b) Each infant will be held for bottle feeding until able to hold his or her own bottle. Bottles will not be propped. Each child will be held or placed in feeding chairs or other age-appropriate seating apparatus to be fed. (c) Infants shall not be served juice in a bottle without a prescription or written statement on file from a health care professional or licensed dietitian/nutritionist.

Case Study Lindsey, 5 months old, has begun attending a child care program as her mother recently returned to work. Lindsey was started on cereal mixed with pureed fruit prior to entering child care. Lindsey's mother pumps and freezes her breast milk and delivers it to the center to be thawed and fed as needed. Lindsey is now experiencing some diarrhea and apparent abdominal pain.

Case Study Questions What are some possible causes of Lindsey's discomfort? Do you know how the breast milk is handled at home? What are safe procedures for handling breast milk at child care? Given Lindsey's age, is she ready to have fruit added to her diet? What other food/liquids could be used to mix in her cereal; what type of cereal should she be fed? ANSWERS TO CASE STUDY