Infant Nutrition Birth to 12 Months Power Points 03 21 21

1. Infant Nutrition Birth to 12
Months

2. ©McGraw-Hill Education
Section 13.3 Infant Nutrition1
Learning Outcomes
• Discuss the physiological processes of lactation
and breastfeeding.
• Discuss the nutrient and energy needs of a
lactating woman.
• Describe benefits that women derive from
breastfeeding and infants derive from consuming
their mother’s milk.

3. ©McGraw-Hill Education
Section 13.3 Infant Nutrition2
Learning Outcomes
• Compare the energy and nutrient contents of
human milk, cow’s milk, and infant formulas.
• Describe signs that an infant is ready to eat solid
foods, and identify appropriate foods for infants.
• Discuss a healthy infant’s rate of growth.

4. INFANT GROWTH
And
INFANT FEEDING
MODULE 1

5. ©McGraw-Hill Education
Healthy Infant Growth Rates
Weight:
• Birth weight doubles by 4 to 6 months
• Birth weight triples by 1 year
Length:
• Increases by 50% from birth to 1 year

6. • When do infant growth
spurts Occur?
• Typical times for Infant
Growth:
• 2-3 Weeks; 6 Weeks; 3 -6
Months
• But, it is important to note
that they can occur at any
time and even as
frequently as every few
weeks
Growth Spurts and Infant Feeding
• Frequency and durations of feedings may increase;
This increase may be Temporary
• Breastfeeding Mom Concerns during Growth Spurts
“All I do is feed my baby; I am feeding all the time”
“I must not be making enough breastmilk”;
They perceive that their breastmilk supply is
insufficient.
• Breastfeeding mothers need additional
encouragement and support during growth spurts.
• Remind Breastfeeding mothers that their breastmilk
inadequacy feelings are normal
• AVOID giving breastfed infant or any young infant
supplements, like infant cereal in a bowl or in the
bottle.

7. Strict Feeding Schedule for Infants should not be allowed; A clock or
the parent’s/caretaker’s schedule should not determine the feeding
Examples of Strict Feeding Schedule:
• “I feed my baby every 3 hours no matter what I am doing.”
• “I set an alarm for a certain time and wake my baby up to eat.”
• “My grandmother told me to feed my baby 8 ounces every 4 hours.”
Division of Responsibility for the Infant
• This means the infant must lead their own feeding.
• This means the infant Not the Parent/Caretaker must determine the
amount and timing of the feeding.
• Letting the infant take the responsibility of the feeding with set up a
lifetime of healthy relationships with food.
• Use infant hunger cues and fullness cues to lead and direct their
feeding.
Healthy infants should never be forced to adhere to a strict feeding
schedule neither with the amount or timing of feeds.
Feeding Frequency and Division of Responsibility
Cluster Feeding
Breastfed infants may “cluster
feed”. Cluster feeding is when a
breastfed baby feeds frequently
and then goes for an extended
period without feeding.
• Remember: Breastmilk storage
capacity is different for each
mother and each or her breast.
This means mom’s right breast
may hold more breastmilk than
her left breast.

8. BABY BEHAVIOR
MODULE 2

9. Understanding Baby Behavior
• Seeing, Recognizing, and Responding to Cues:
• Crying
• Engagement and Disengagement
• Hunger and Fullness
• Sleep
• Helps parents and caregivers meet baby’s needs more
appropriately
• Results in positive outcomes

10. CRYING
• All babies cry
• Newborns have to be fed more often and they are more
likely than older babies to be hungry when they cry
• Watching and responding to early cues can help prevent
some crying

11. Feeding Cues
Early
Hunger Cues
Soft sounds and
increased alertness
Licking lips, sticking
tongue out
Placing hands in or
near mouth
Increased
Hunger Cues
Rooting
Increased
movement and
fidgeting
Restlessness
Late Hunger
Cues
Crying
Frantic Movements

12. Infant Sleep
• A baby “sleeping through the night” is not an infant developmental milestone
• Parents/caretakers should not force or rush the infant to “sleep through the night”.
• Why are night feedings important for an infant?
• Why are night feedings important Nutritional Needs?
• • Provide necessary nutrients for good growth and development
• • For breastfeeding mom, helps mom maintain a healthy milk supply. And, helps mom’s breast from
being overly full.
• • An infant's digestive system is not designed to go an extended amount of time without food.
• Babies should wake frequently for the following reasons:
• Waking frequently serves important purposes:
• Feeding (Baby ready to breastfeed or Baby needs a bottle of formula).
• Comfort (Baby might need diaper changed)
• Temperature (Room may be too hot or too cold)

13. Infant Sleep Needs
0-3
Months
•15-17 hours/day
3-12
Months
•13-15 hours/day

14. Infant Sleep Patterns
3 to 4 months
• begin in deep sleep
• wake less often
• about 4 hours
6 Months
• Up to 6 hours – “sleeping through the night” ; Many parents
consider this “sleeping through the night” since baby sleeps
longer.
• Parents/caretakers are excited because they can get more rest
at night when this happens.
• It is a normal sleep pattern for most 6 month old infants.
• It has nothing to do with an infant’s intelligence.
• Parent/caretakers must remember that each infant is different.
These sleep patterns are just estimated patterns.

15. Breastfeeding vs Formula Feeding
MODULE 4

16. ©McGraw-Hill Education
Breast Milk Is Best Milk
Human milk is designed to meet the
nutritional needs of a newborn baby.
What is colostrum?
• Yellowish fluid secreted from breasts soon after
birth
• Contains antibodies needed for immunity and
Lactobacillus bifidus for a healthy GI tract

17. ©McGraw-Hill Education
Breastfeeding
Hormones:
• Prolactin
• Milk production
• Oxytocin
• Let-down
Milk production requires
approximately 800 kcal/day.
• + 300 – 400 kcal/day can
meet mother’s needs and
may promote her weight
loss
Figure 13.5
Mother breastfeeding: ©Blend Images/Getty Images RF

18. ©McGraw-Hill Education
Is Breast Milk a Complete Food?
Healthy infants can be exclusively breastfed for
about the 6 months.
Infant foods added at 4 to 6 months
Breastfeeding combined with solid foods should
continue until 12 months.
• Human milk may be inadequate in vitamins D & B-12,
iron, and fluoride.
• AAP recommends vitamin D supplements (400 IU/day) until
breastfed baby consumes adequate vitamin D from food or
infant formula.
• Lactating vegetarians need B-12 supplements.
• Babies should have a source of iron by 6 months.

19. ©McGraw-Hill Education
Infant Formula Feeding
Most infant formulas contain heat-treated
cow’s milk, lactose and/or sucrose,
vegetable oils, vitamins, and minerals.
• Some provide DHA & AA (fatty acids derived
from essential amino acids)
AAP recommends iron- fortified formula for
infants who are not breastfed.

20. ©McGraw-Hill Education
Breastmilk vs. Formula
Is there a Difference?
Comparison Chart Nutrients Breastmilk vs. Formula
Open up these links to review these documents.
https://www.askdrsears.com/topics/feeding-
eating/breastfeeding/why-breast-is-
best/comparison-human-milk-and-formula
Which one is Best ?
https://www.michigan.gov/documents/mdch/Breastf
eeding_Handout_287493_7.pdf

21. COMPLEMENTARY FOODS
MODULE 3

22. Introducing Solids:
Complementary Foods
• Food and beverages other than
breastmilk and infant formula
• Provide additional nutrients
• Important for sensory and motor
development
What
•6 months
When

23. Why wait until 6 Months to give infants
solids or complementary foods ?
• Infant not has the an increased ability to digest and
absorb proteins, fats, and carbohydrates, other than
those in breast milk and formula
• Infant’s kidneys develop the ability to excrete the
waste products from foods with a high renal solute
load, such as meat
• At 6 months, most Infant’s neuromuscular mechanism
develop can now recognize and accept a spoon,
chew, and swallow foods that are not liquid

24. Early Introduction of Complementary Foods
Reasons for Early Introduction
• Infant perceived as fussy/hungry
• Caregiver’s desire to feed baby
something other than
breastmilk/formula
• Guidance from healthcare provider;
“Doctor told me to give my baby
solids now”
• Caregiver belief of increased sleep;
“This will cause my baby to sleep
through the night”
Risks associated with early introduction of
complementary
• Risk of aspiration (Accidental entry of
food or liquid into an infant’s airway
causing infant to choke)
• Caregiver either overfeeds or underfeeds
infant adequate calories or nutrients
• Sets infant up for an increased risk of
obesity later in life
• Infant’s digestive system is not ready for
solids or complementary foods; This may
lead to an upset stomach.

25. Complementary Foods
Introduces
new
tastes and
textures
self-
feeding
positive attitudes
toward feeding
and food
Supports
jaw and muscle
development
speech
development
Introduction of Complementary Foods

26. Infant Feeding Topics
MODULE 4

27. First Foods: Develop a Positive Feeding
Relationship
• Expect a mess – practice patience
• Allow play and exploration
• Make eating fun; Avoid nagging infant to eat
• It is the infant’s responsibility to set the amount
and frequency of feedings.

28. First Foods and Infant Cereal
Types
• Rice*
• Oatmeal*
• Barley
• Multigrain
• Whole
Wheat
Benefits
• Easily
absorbed
form of iron
• Fortified
with zinc
Concerns
• Arsenic:
most infant
rice cereals
have levels
below the
acceptable
cut off
Preparation
• Mix with
breastmilk
or infant
formula

29. First Foods – What Foods?
• No particular order of introduction, no need to
avoid acidic foods
• Single ingredient
• Nutrient dense, wide variety
• High in zinc and iron
• Well-cooked lean beef, chicken, turkey, eggs, or legumes
• Infant cereals
• Without added sugar or salt
• Spices and seasonings can be added once plain foods are
tolerated
• One new food every 3-5 days: watch for adverse
reactions

30. First Foods: Foods to Avoid
Cow’s Milk
Honey
Foods with Added Sugar
Cereal or Foods in the Bottle

31. ©McGraw-Hill Education
What About Cow’s Milk?
Not appropriate for babies under 1 year of
age.
• It is too high in minerals and protein, and too low
in carbohydrate.
• It may cause intestinal bleeding and iron
deficiency.
• Reduced-fat or fat-free milks are too low in
energy.
• Casein, the main protein in cow’s milk, is difficult
for infants to digest.
• Its proteins may cause allergies.

32. First Foods: Foods to Avoid
Large Predatory Fish
Raw Sprouts
Unpasteurized Dairy Products
Raw or Undercooked Meat, Seafood, Eggs
Unheated Deli and Processed Meats

33. What does it mean when my baby rejects or
accepts solids or complementary foods?
• Common reaction to something new: Baby may not
take “new” or unfamiliar food first time it is offered;
Baby may make a “mean” face
• Baby rejection of food ≠ Dislike of food
• Avoid only offering what an infant “likes”
• It may take 10-15 exposures to a food before baby
accepts it.
• If a food is rejected, continue to offer it again in 1-2
weeks, without pressure
• Familiarity plays a significant part in acceptance
• Takes time to adapt to new flavors and textures

34. Advancing Food Stages
MODULE 5

35. Commercial Infant Food Stages
• single ingredient
• small container size
• smooth texture
Stage 1
• single or mixed ingredients
• larger container size
• smooth texture
Stage 2
• single or mixed ingredients
• much larger container size
• thicker texture with chunks
Stage 3

36. • Follow infant’s cues
• Teeth are not needed to chew foods
• Stages of Progression:
Advancing Through Textures
Smooth
(strained or
pureed)
Mashed
(smooth with a
few tiny
lumps)
Chopped
(more lumps)
Small
pieces
of food

37. Finger Foods
Signs of Readiness
• pincer grasp developed
• ability to chew with up and down movement (Teeth present are not
required)
• ability to move tongue from side to side
First Finger Foods
• small pieces of peeled soft fruits and soft cooked vegetables*
• small pieces of cooked meat, chicken, or turkey
• mashed cooked beans, egg, or tofu
• small pieces of toast, unsalted crackers, or soft tortilla
• small slices of cheese
• cut-up, cooked noodles, or rice
*avoid canned vegetables that contain sodium

38. Choking
MODULE 6

39. Infant Gagging vs. Infant Choking
• Gagging ≠ Choking
• Choking is a life threatening event that results in obstruction of the
airway
• Young infant tongue majority back portion of tongue initiates gag
reflex
• Older infant around 9 months old small portion of tongue initiates gag
reflex which means infant can now handle finger foods.
• Gagging is good: It helps infants regulate the prevention of choking

40. Characteristics of Choking
Hazards
Size
• Small Hard pieces, like nuts or seed or Large pieces of Food
Shape
• Food that is round on have a cylinder shape, like a cucumber.
Texture/Consistency
• Firm, smooth, or slick food textures may slide to back of throat
and cause choking
• Dry or hard like nuts, pretzels, hard raw vegetables

41. Common Choking Hazards
Hot Dogs,
Meat Sticks,
Cheese
Sticks
Whole Grapes,
Cherry
Tomatoes
Nuts and Seeds
Chunks of
Nut/Seed
Butters
Raw or
Undercooked
Vegetables
Large Pieces of
Canned or Raw
Fruit
Dried Fruit Popcorn, Chips
Marshmallows Large Pieces of
Soft Bread
Hard, Gooey, or
Sticky Candy
or Peanut
Butter

42. BEVERAGES
AND
INFANTS
MODULE 7

43. Beverage Types
Offer
• Breastmilk
• Infant Formula
• Water
• No more than 8 oz./day*
Avoid
• Fruit Juice
• Sweetened Beverages
• Artificially Sweetened Beverages
• Caffeine-Containing Beverages
• Teas
*Some health conditions may temporarily increase water needs.

44. BEVERAGES
AND
INFANTS
MODULE 7

45. Weaning From a Bottle
When?
• Begin around 6
months
• Completely by 1
year
How?
• Begin by replacing
a bottle with a cup
at the “least
favored” feeding
times
• Gradual process:
wait 1-2 weeks
before introducing
a cup at another
feed
Risks of
Continued Bottle
Use
• Increased risk of
tooth decay
• Decreased solids
intake
• Increased risk of
anemia

46. • 4-6 months: Allow child to play with and
explore the cup first; demonstrate how to drink
from a cup
• 6 Months: Offer 1-2 oz. of expressed
breastmilk, infant formula, or water
• Parents/caregivers should assist
• Messy and little liquid is actually consumed
Introducing the Cup

47. • Cautions Against Sippy Cups
• Feeding Difficulties:
• limits or delays a child’s ability to develop a more mature swallow pattern,
potentially causing challenges when learning to chew and swallow new
foods and more advanced textures
• Speech and Language Development:
• impacts teeth alignment
• Impacts oral motor skills needed for clear speech
First Cups

48. • Sippy Cup Alternatives
• Straw and Open-Top Cups
• Allows tongue to elevate
• Builds strength in tongue, cheeks, lips
• Promotes mature swallow pattern
• Cup Progression
First Cups
9 months
• Drink from
straw cup
independently
12-18
months
• Drink from open-top
cup with assistance
18
months+
• Drink from
open-top cup
independently

49. • Counseling Tips for Sippy Cups
• Avoid cups with soft, “nipple-like” tops similar to a
bottle
• Remove valves - valves are the “spill proof” feature of
the cup
• Offer the cup at meal and snack times, and then put
the cup away
• Avoid prolonged use
• Avoid juice and sweetened beverages
• Choose straw, open-top, or 360 style cups
First Cups

50. COMMON CONCERNS:
INFANTS
6 – 12 MONTHS
MODULE 8

51. Allergy
• Reaction of the immune system
• Can be severe or life threatening
Intolerance
• Physiological response, less
serious
• Causes:
• Absence of enzyme needed to
fully digest food
• Irritable bowel syndrome
• Sensitivity to food additives
• Recurring stress or
psychological factors
• Celiac disease
What’s the Difference
Allergy vs. Intolerance

52. Introducing Common Allergenic Foods
• Early introduction
• Top 8 Allergy Causing Foods:
Cow’s
Milk
Soy Eggs Wheat
Peanuts Tree Nuts Fish Shellfish

53. • Affect 4-8% of children in US
• Reaction of the immune system
• May or may not be immediate
• May not develop until subsequent introductions
• Common symptoms:
• Systemic – anaphylactic shock, failure to thrive
• Gastrointestinal – diarrhea, vomiting, abdominal pain
• Respiratory – coughing, wheezing, ear infections
• Cutaneous – skin rashes
Allergic Reactions

54. • After 1-2 other solid foods have been fed and
tolerated
• At home or Health Care Provider (HCP) office
• Early in the day vs. late
• Discuss plan for introduction with health care provider
if:
• Moderate to severe eczema
• Parent/sibling allergy
• Previous allergenic reaction
Introducing Allergenic Foods

55. • Mix into infant cereal
• Spread a thin layer on whole grain toast
• Use in a dip or marinade
• Incorporate into muffin, pancake, or waffle
batter
Introducing Peanut Butter

56. • Breastfeeding
• Early introduction of common
allergenic foods
Reducing Risk of Adverse Reactions
to Allergenic Foods

57. Diarrhea and Constipation
Diarrhea
• Frequent passage of loose,
watery stools
• Variety of causes
• Proper formula mixing and
storage are important
• Continue feeding infant’s usual
diet
• Refer to health care provider, as
necessary
• Certain “P” foods may loosen
stools
Constipation
• Condition when bowel
movements are hard, dry, and
difficult to pass
• Consistency of stool more
important that frequency of stool
• Not common among infants who
consume adequate, varied diets
• Not related to iron intake
• Certain foods may be more
constipating than others

58. INFANTS
AND
DENTAL HEALTH
MODULE 9

59. • Caries = Cavities = Tooth Decay
• Some infants’ genetics are born with
propensity to develop cavities because
they have more cavity causing bacteria in
their bodies
• Parents/caregivers can spread bacteria
• Avoid sharing utensils, cleaning
pacifiers in mouth, pre-chewing food
Dental Health

60. • Avoid added sugars, including juice
• Avoid bottle propping, putting to bed with bottle
• Breastfed infants have lower risk of tooth decay
• Wean from bottle by 1 year of Age
• Dental Care For Baby Until 1 Year of Age:
Dental Health: Prevention
wipe
gums with
damp
cloth
Before
Teeth
Appear
brush morning
and night with
rice size amount
of fluoride
toothpaste
Once
Teeth
Appear
visit
dentist
1st
Birthday