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The Informed Parent

Infant Nutrition Update

by Lori A. Livingston, M.D., F.A.A.P.
Published on Apr. 24, 2011

Good nutrition is absolutely vital to a growing infant and child. Normal growth and development (motor skills, verbal skills, social skills and cognitive development) depend on an adequate balance of food groups, vitamins and minerals, as well as sufficient calorie intake. A poor diet can lead to poor growth (both height and weight), a weak immune system, learning disabilities, and even death as the heart and other organs are unable to function normally. We see the worst cases of malnutrition in third world countries where adequate food is scarce. However, malnutrition is common in every country and every city. Children of all ages, ethnicities and socioeconomic backgrounds can have a diet that is lacking in necessary protein, fat, vitamins and minerals, which can lead to serious medical problems.

What, then, is a “typical” and healthy diet for your infant and toddler? Your pediatrician and the AAP have guidelines to make sure that your child gets proper nutrition for his growth and development. We will discuss these guidelines from birth through nine months of age. Recommendation for nine months to twelve months and up will follow in May.

Birth to Four Months

  • Breastfeeding exclusively is recommended, if possible. Breast milk is known to protect infants from many infections, is easiest to digest, and is the most natural infant food. It is also free!
  • Infant formulas today are also a good choice, if necessary. A traditional milk based formula is closest to breast milk. All infant formulas have iron added which is very important. Soy formulas should be avoided except in rare situations if recommended by your pediatrician.
  • DO NOT try to buy a formula that is low in iron. DO NOT try to make formula from a home recipe: these are lacking in many essential vitamins and minerals and can be very dangerous. DO NOT mix formula different than the instructions on the container. This can be life threatening. DO NOT give an infant at this age water, tea, or any other liquids or foods. DO NOT prop the bottle in the baby’s mouth or give the baby a bottle in bed as this can lead to choking, tooth decay and ear infections.
  • If you are not sure breastfeeding is going well or which formula is best for your baby, ask your pediatrician.
  • Give a multivitamin with iron, such as Poly-visol, found over-the-counter, to all exclusively breast fed infants starting at two months of age. Breast milk is often low in iron and can cause anemia.
  • NEW RECOMMENDATION: Give a vitamin D supplement, such as Di-visol found over-the-counter, to all exclusively breastfed infants starting at two months of age. Breast milk is often low in vitamin D and most infants will not get enough sun exposure to make vitamin D.

Four Months to Six Months

  • Start first complementary solid food: usually iron fortified single grain infant rice cereal.  NEW RECOMMENDATION: pureed meat is an excellent first food since it is much higher in iron and necessary mineral for growth.
  • An iron rich first food, like rice cereal or meat, is important for breastfed infants who are at highest risk for iron deficiency. These first foods are also very unlikely to cause any allergic reaction.
  • Usually a small amount fed 1 to 2 times per day with a spoon is adequate to start. Try spoon feeding before a bottle so your infant is hungry. Let your infant guide you on the amount. Some babies eat very little and some eat a lot--both are okay.
  • Continue breastfeeding or formula. Most infants at this age will drink 28 to 32 ounces per day.
  • DO NOT start other mixed grain cereals or oatmeal yet, as these can cause allergic reactions.

Six Months to Nine Months

  • Start solid foods like pureed vegetables, fruits and/or meat. Homemade foods are great, as well as Stage 1 store bought infant foods.
  • Look for foods in glass containers or BPA free plastic. DO NOT heat baby food in plastic containers.
  • Give one new food every 3 to 4 days to see if any allergic reaction occurs such as rash, vomiting or diarrhea.
  • If your infant doesn’t like the taste of certain foods, try 10 to 15 times before giving up. Research shows infants need repeated exposure to new tastes and textures before they will accept them.
  • Okay to change to infant oatmeal or mixed grain cereal if desired. But also watch for allergic reactions.
  • Okay to advance to Stage 2 foods or mixed purees once you know there are no allergies to individual foods.
  • Feedings should increase to 2 to 3 times per day, and continue to let your infant guide you on the amount to feed. Most infants will turn their head or spit out food when they are done.
  • Continue breastfeeding or formula feeding as usual. Most infants will drink 24 to 32 ounces per day. Many infants will drink less milk when they are eating more solid food. Breast milk and formula alone are inadequate for proper nutrition at this stage.
  • Try to balance the amount of fruit, vegetable, whole grain (cereal), and meat/protein each day.
  • Introduce a beginner sippy cup, with WATER ONLY. Do not give your baby juice or other liquids unless recommended by your pediatrician.

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