Chapter 15Feeding Infants

Infant Growth Patterns

• Infants experience rapid growth during the first year. Their:– Weight increases by approximately 2/3

ounce/day between birth and 6 months; 1/2 ounce/day between 6 and 12 months.

– Length increases by approximately 10 inches.– Basal metabolic rate (BMR) is higher than an

adults’.

Nutrient Needs

Infants’ nutrient needs are

influenced by:

• Rapid growth• Small stomach capacity• Physiological and developmental readiness

Determinants of Infants’ Nutrient Needs

• 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 small amounts at

each feeding so they must eat often.

Determinants of Infants’ Nutrient Needs

• Physiological and developmental readiness:– Intestines—are not fully functional; they do not

produce the enzyme amylase, which is needed to digest 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.

Feeding Infants

• Breast milk or formula provide all nutrients an infant requires for optimal growth and development during the first 4 to 6 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 may not require this because most formulas contain vitamin D

• Semisolid (pureed) foods should not be introduced before this time.

Breast-Feeding

• Advantages (for the 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

Breast-Feeding

• Advantages (for infant):– Provides the infant with temporary protection

(antibodies) against many viral and bacterial illnesses– Less likely to cause an allergic response– Volume of milk 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

Breast-Feeding

• 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

Breast-Feeding

• Disadvantages (for mother):– Must be available– May limit father’s involvement in the feeding process– Mother must pay attention to her dietary intake– Requires family support and freedom from anxiety– May not be advisable if mother is ill or taking certain

medications

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 formula with bottled water is recommended to avoid introducing environmental contaminants.

Breast Milk versus Formula

• Both methods adequately meet an infant’s nutrient needs and provide an opportunity for emotional 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 for extended

periods of time– Personal choice– Use of addictive drugs and tobacco

How to Determine If An Infant’s Nutrient Needs Are Being Met

• It is likely that an infant is receiving adequate nutrients if he or she continues to:– Grow (increased length, weight) at an appropriate rate– Have energy for active play– Avoid frequent illness

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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

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

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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.

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

1. Should Missy follow her mother's advice?

2. What are the dangers, if any, of feeding a 6-week-old baby cereal from the bottle?

3. Do child care practices change from generation to generation?

4. Consider possible short- and long-term consequences of feeding semi-solid food from a bottle.

5. 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

• Infants who are born prematurely

• Have a range of health problems

• Genetic disorders and congenital malformations

• Conditions that require surgery

• Infection

• Medication side effects and unpleasant medical treatments

• Swallowing difficulties

• Dental problems

• Special diets

• Fatigue

Bottle Mouth Syndrome • 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.

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

1. What are some possible causes of Lindsey's discomfort?

2. Do you know how the breast milk is handled at home?

3. What are safe procedures for handling breast milk at child care?

4. Given Lindsey's age, is she ready to have fruit added to her diet?

5. What other food/liquids could be used to mix in her cereal; what type of cereal should she be fed?

Introducing Solid Foods

• Foods are usually 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 and foods containing honey; may contain botulism spores.

• This process may be delayed and take longer for some children who have special needs.