Category: Pediatric

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Learn how to give your little one a healthy start with these tips on proper nutrition.

CCK & SEE

The Basics
Proper early nutrition is important. The eating patterns established in infancy determine how well a baby grows and also influence lifelong food habits and attitudes.

New parents probably worry more about feeding their baby than any other aspect of early child care. What if I can’t breast-feed? How do I know if the baby is getting enough? Too much? Should I give the baby vitamins? When do I start solid food? Parents quickly learn that almost everyone is eager to answer such questions — grandparents, neighbors — even strangers in the supermarket. As might be expected, however, much of the advice is conflicting and adds to a parent’s feelings of confusion and uncertainty. So let’s begin with a few anxiety busters:

Get to know your baby. No two infants are alike. Some enter the world ravenously hungry and demand to be fed every hour or two. Others seem to prefer sleeping, and may even need to be awakened to eat.

Try to relax. It’s natural for new parents to feel nervous and apprehensive, but raising a baby should be a joyful experience.

Trust your own judgment and common sense. If a baby is growing and developing at a normal pace, he’s getting enough to eat.

Keep food in its proper perspective. It provides the essential energy and nourishment infants need to grow and develop. But food should not be a substitute for a reassuring hug or used as a bribe or reward for good behavior. Even an infant quickly learns how to use food as a manipulative tool, which can set the stage for later eating problems.

In the Beginning, They Are What You Eat
Good infant nutrition actually begins before birth, because what the mother eats during pregnancy goes a long way toward determining her baby’s initial nutritional health. A well-nourished mother provides plenty of nutrients her baby can use for proper growth and development in the uterus, as well as to store for later use. Skimping on food to avoid gaining excessive weight while pregnant can produce a low-birth-weight baby who has special nutritional needs or serious medical problems. An anemic woman is likely to have a baby with low iron reserves. A woman who does not consume adequate folate may have a baby with serious neurological problems. High doses of vitamin A before and during early pregnancy can cause birth defects. All pregnant women are strongly advised to have regular prenatal checkups and to eat a varied and balanced diet.

Breast Milk — Babies‘ First Food
Physicians are in agreement that breast milk provides the best and most complete food to achieve optimal health, growth, and development for full-term infants. In fact, the recommendation of the World Health Organization is that a full-term, healthy infant should be exclusively breast-fed up to 6 months of age (premature and low-birth-weight babies may need specialized formula and breast milk). An adequate alternative to breast milk is commercial infant formula, which provides comparable nutrition but lacks some of the unique benefits of breast milk.

Although breast-feeding for 6 months may not be possible for every mother, a baby can benefit from any amount of breast milk — even a few feedings. Colostrum, the breast fluid that is secreted for the first few days after birth, is higher in protein and lower in sugar and fat than later breast milk. It has a laxative effect that activates the baby’s bowels. Colostrum is also rich in antibodies, which increase the baby’s resistance to infection. Hormones released in response to the baby’s suckling increase the flow of breast milk, and within a few days women produce enough mature milk for their infants. Mature breast milk is easy to digest and provides just about all the nutrients a baby normally needs for the first 4 to 6 months. This milk has two parts — the beginning of the feed is foremilk, which is high in sugar and water and a real thirst quencher for the baby. As the baby continues to feed, the breast decreases in size and the milk becomes a fat and calorie-rich milk, known as hindmilk.

A breast-fed baby can remain on breast milk exclusively until the introduction of age-appropriate foods at 4 to 6 months of life. In addition, a daily supplement of vitamin D (400 IU) is recommended in the United States and Canada for breast-fed babies and should be continued until an adequate amount of vitamin D is consumed through diet. Beginning at 4 to 6 months of age, these babies usually require additional iron, which is typically provided by an iron-fortified cereal. Fluoride supplementation may be required for some infants after 6 months. Babies of vegan mothers may require a B12 supplement.

How to Tell If Your Baby Is Getting Enough
Many new nursing mothers often worry that their babies are not getting enough to eat. Mothers should answer the following questions:

1. How many wet diapers and stools does my baby have each day?

2. Is my baby growing?

3. Does my baby appear hungry?

A baby who has regular stools and produces six or more wet diapers a day is most likely getting plenty of food. Although this varies, breast-fed babies generally nurse every 2 to 4 hours for the first month or so. Experts promote “on demand” feeding; in other words, babies should be fed whenever they are hungry for the first 4 or 5 months. Some babies may be sleepy or disinterested in food; a baby who is not feeding at least six to eight times a day may need to be stimulated to consume more.

Growth is an important indicator of whether or not a baby is getting enough to eat. Remember, however, that babies tend to grow in spurts. During a growth spurt, an infant will want to nurse more often and longer than usual, which may empty the reserve of breast milk. This will signal the mother’s body to increase milk production. But the mother should not be concerned if, a week or two later, her baby is less interested in eating.

Finally, hungry babies send out plenty of signals that they are hungry. Common cues are fussing, crying, and irritability as well as a variety of lip and tongue movements — such as lip smacking and fists in mouths.

Bottle-Feeding
Although more than half of all North American women breast-feed for at least the first few weeks, many mothers elect to bottle-feed. They should be assured that commercial formulas provide all the essential nutrients and, when used according to the manufacturers’ instructions, babies thrive on them. Choosing an iron-fortified formula is recommended. Babies under one year of age should not be given regular cow’s milk because it is difficult for them to digest and may provoke an allergic reaction. The cow’s milk in most infant formulas is modified to make it easier to digest. Despite this precaution, some babies may require a soy or rice formula.

Generally, bottle-fed babies consume more than breast-fed infants do; they may gain weight more rapidly, although the breast-fed babies will eventually catch up with them. On average, most babies double their birth weight in 4 to 5 months, and triple it by the time of their first birthday.

Bottle-feeding requires more work than nursing; bottles, nipples, and other equipment must be sterilized. Some formulas are premixed; others are concentrated or powdered, and must be mixed with sterile water. Formula mixed in advance should be refrigerated, but not longer than 24 hours; after that, it should be discarded. Any formula that is left in the baby’s bottle after a feeding should be discarded; if not, there is a possibility of its being contaminated by microorganisms entering through the nipple opening.

Introducing Foods
There is no specific age at which to start solid foods, but for most babies, 4 to 6 months is about right. Starting too early can be harmful because the digestive system may not be able to handle solid foods yet; also, the early introduction of solid foods may increase the risk of developing food allergies. An infant who is thriving solely on breast milk can generally wait until he is 5 or 6 months old; after that, nursing alone may not provide adequate calories and the nutrients that a baby needs for normal growth.

The first solid food must be easy to digest and unlikely to provoke an allergic reaction — infant rice cereal is a good choice. For the first few feedings, put a very small amount on the spoon, gently touch the baby’s lips to encourage him to open his mouth, and place the cereal at the back of the tongue. Don’t expect these feedings to go smoothly; a baby usually does a lot of spitting, sputtering, and protesting.

The baby should be hungry, but not ravenous. Some experts suggest starting the feeding with a few minutes of nursing or bottle-feeding, then offering a small amount of the moistened cereal — no more than a teaspoon or two — and finishing with the milk. After a few sessions, you can start with the cereal, then gradually increase the amount of solid foods as you reduce the amount of milk.

Beginning slowly, introducing only one or two new items a week. If you use home-cooked foods, make sure that they’re thoroughly pureed. In addition to rice cereal, try oatmeal and barley cereals; strained vegetables and fruits; and pureed chicken and beef. At about 5 months, fruit juice can be added to the diet, starting with apple juice. Hold off on orange juice and other citrus products for at least 6 months; these may provoke an allergic reaction. Other potentially allergenic foods should be delayed until the baby is 6 to 9 months old, or even later if there is a family history of allergies. Withdraw any food that provokes a rash, runny nose, unusual fussiness, diarrhea, or any other sign of a possible allergic reaction or food intolerance.

Self-Feeding
When they are about 7 or 8 months old, most babies have developed enough eye-hand coordination to pick up finger food and maneuver it into their mouths. The teeth are also beginning to come in at this age; giving a baby a teething biscuit, or cracker to chew on can ease gum soreness as well as provide practice in self-feeding. Other good starters are finger foods, which could include bite-size dry cereals, bananas, slices of apples and pears, peas, and cooked carrots, and small pieces of soft-cooked boiled or roasted chicken. The pieces should be large enough to hold but small enough so that they don’t lodge in the throat and cause choking.

As soon as the baby can sit in a high chair, he should be included at family meals and start eating many of the same foods, even though they may need mashing or cutting into small pieces. Give the child a spoon, but don’t be disappointed if he prefers using his hands. At this stage it’s more important for the baby to become integrated into family activities and master self-feeding than to learn proper table manners. These will come eventually, especially if the parents and older siblings set a good example.

Weaning
Giving up the breast or bottle is a major milestone in a baby’s development, but not one that should be rushed. When a woman stops nursing is largely a matter of personal preference. Some mothers wean their babies from the breast to a bottle after only a few weeks or months; others continue nursing for longer, even though the child is eating solid food. Similarly, some babies decide to give up their bottles themselves at 9 or 10 months; yet others will still want it — especially at nap or bedtime. If a baby under a year old drinks milk from a cup, it should still be a formula.

From : Foods That Harm, Foods That Heal

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