1. Feeding your Infant Birth to 1 year of age
The first year of life is a time of change. Intro: ask client to tell name, how old their baby is, and one way their baby has changed since birth. Today we will discuss developmental and nutritional changes to expect during your infant’s first year of life.

2. The American Academy of Pediatrics Recommends:
Exclusive Breastfeeding for the first 6 months after birth.
Continue for at least months, and thereafter as long as mutually desired.
In the first 6 months, water, juice , and other foods are generally unnecessary for the breastfed infant. Gradual introduction of solid foods in the second half of the first year should compliment the breast milk diet.

3. AAP recommends:
Infants who are not breastfed or are partially breastfed should receive an iron-fortified formula from birth to 12 months.
All of the formula offered at WIC is iron-fortified. WIC will provide supplemental formula until the infant is 1 year for those using formula. Milk should not be given until 1 year of age. Avoid putting your baby to bed with a bottle or propping the bottle.

4. The first 4-6 months of age your baby only needs:
Lots of love
Breastmilk
Or formula
Your baby will want to breastfeed every 1-3 hours for the first few months, then slowing down to every 2-4 hours. If you are formula feeding only, your baby is probably taking at least 24 ounces/day by 2-3 months of age. Responding to your baby’s hunger cues and feelings of fullness helps your baby to trust you and feel safe and loved. What does your infant do to show he is hungry? Discuss hunger cues and how to know infant is full.

5. Your infant may be ready for solids when he can:
Sit with support
Have good head and neck control
Open mouth & lean forward to show interest
Turn head to indicate he is full
Transfer food to back of tongue to swallow
Begin chewing movements
Before adding solids watch for these developmental signs of readiness. For most infant these occur around 5 to 6 months of age. If your infant was born premature these may occur later.

6. Starting solids
It is best to start with single grained cereal, like rice.
Always feed solid foods from a spoon.
Wait until at least 6 months to add other foods.
You baby’s vouchers will have plain infant cereals on them beginning at about 5 months. Spoon-feeding helps your baby learn how to eat properly, can improve speech development , and helps prevent overfeeding.

7. Beyond cereal: Add plain pureed fruits and vegetables one at a time.
Wait 3-5 days between introducing new foods.
Juice should be offered in a cup only.
Your infant may need a fluoride supplement.
Juice will appear on your infant’s vouchers after 6 months of age. The AAP recommends nothing sweetened ever be offered in a bottle. It is best to start with mild juices, such as apple or white grape. You can begin by offering an ounce or two, gradually increasing to 4-6 ounces by 1 year of age. Avoid citrus juice until 1 year of age. Also avoid any honey until 1 year.

8. What cup should my infant use?
Use a regular cup at home.
Avoid sippy cups with a small spout.
Don’t allow your baby to carry sippy cup around.
Work with your baby at home to learn to drink from a regular cup. A small clear cup is ideal (like a juice cup). IF you use a sippy cup be sure the spout is wide and take out the spill proof insert so the infant can learn the motions of drinking from a cup rather than sucking from a bottle. A straw cup is Ok also. As we just mentioned the AAP recommends that juice not be given in bottles but they also recommend it not be given in easily transportable covered cups that allow them to consume juice easily throughout the day.

9. Your infant may be ready for first finger foods when he can:
Sit independently and maintain balance
Reach and grasp objects with a palmar grasp
Once your infant can grasp with their whole hand you can begin offering some finger foods that are large and will not break into small pieces such as thick dry, infant toast. This usually happens around 6-8 months.

10. Your infant may be ready for the addition of smaller, soft finger foods when he can:
Pick up objects between his thumb and finger
You can then offer small pieces of soft cooked fruits and vegetables, pasta, and some dry cereals such as cheerios.

11. Your infant may be ready to transition to soft table foods when he can:
Use a munching type chewing (up & down, some diagonal)
Manipulate tongue and food easier
(Caution: Avoid foods which may cause choking)
Many infants begin eating soft table foods with the family between 8-12 months of age. At first they just chew up and down but gradually add a diagonal movement as they learn to transfer food from the center of their mouth to the sides to chew it (even if they do not have teeth.) Increase foods consistency and texture as tolerated. Watch the baby’s ability to chew or gum foods adequately. Avoid foods which may cause choking: pop corn, nuts, chips, raisins, raw vegetables, whole grapes or hot dogs.

12. The addition of protein foods
Wait to add meats until 8 or 9 months.
Egg yolks can be given at 9 months.
Yogurt and cheese can also be introduced.
Egg whites should not be given until 1 year of age. Wait to add whole milk to the diet until 1 year. Avoid giving any peanut butter until 1 year (or later if there is a history of allergies.)

13. Once your baby turns one he can:
Get off the bottle.
Drink whole milk from a cup.
Have eggs, citrus juices, peanut butter and honey (if no history of allergies)
Transition to family foods.
At one year your baby’s WIC food package will have eggs, juice, regular cereals, cheese, peanut butter alternating with beans and whole milk. Never put cow’s milk in a bottle. If your child is on formula, gradually decrease bottles of formula and increase cups of milk. He will need much less milk than he was taking of formula—only about 16 ounces/day of dairy products. If you are breastfeeding, it is great to continue as long as you both enjoy that time. You can gradually add some dairy to your toddler’s diet. The AAP recommends whole milk for children until age two. Limit juice to 4-6 ounces/day. The transition to eating what the family is eating usually happens anywhere from 1 year to 18 months.

14. Summary:
Breastfeeding or formula is recommended for the first full year of life.
Before beginning solids watch for signs that your infant is ready (usually 5-6 mo.)
Gradually introduce other foods as your infant seems ready.
Avoid egg white, citrus, peanut butter & honey until 1 year.

15. Other Resources: www.aap.org American Academy of Pediatrics
describes feeding and food readiness by phases: newborn, head up, sitter, crawler, beginning to walk
click on “First Finger Food” for good finger food ideas
At the American Academy of Pediatrics website you can search for information and recommendations related to the health and feeding of infants and children. Ignore the commercial aspects of the gerber and cheerios sites. The information is excellent.

16. AAP policy statement on Breastfeeding and the Use of Human Milk
AAP policy statement on Use & Misuse of Fruit juice in Pediatrics
AAP policy statement on Iron-fortification of Infant formulas
ADA FITS (Jan 2004 supplement 1)
Nutrition interventions for CSHCN
WIC Infant Feeding Class, November 2003
Infant Feeding Guide
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