Infant and Toddler Nutrition

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Lets Eat!

• Infant and Toddler Nutrition

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Infant Nutrition

• Breast Feeding
• Formula Feeding

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Nutrition

• what to eat
• how much
• when
• special advice
• warning/preventing problems

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NewbornBreast Feeding

• What to eat moms
• how much ad lib
• when 10-12 times/24º
• specialoffer breast before baby gets upset/know
  signs of hunger

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NewbornBreast feeding

• Problems the sleepy baby- tickle toes, strip
  down, make less comfortable

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breast feeding

• A new mother comes to your office for her babys
  2 week check up
• She is exclusively breast feeding and wants to
  know how she can be sure that her infant is
  eating enough.

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intake

• weight gain
• breasts feel soft/empty after nursing, full/hard
  before
• voids 6 wet diapers/24 hrs
• stools soft, yellow, seedy, usually every feed

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Newborn Bottle Feeding

• whatcommercial formula- milk, soy, lactose free
  etc..
• how much2-4oz q 2-3 hrs
• specialdont force or encourage baby to finish
  bottle
• problems never prop bottles!/proper mixing of
  formula

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bottle feeding

• A new father comes to your office for his
  infants 2 week visit. The baby is exclusively
  formula fed and the father is concerned that he
  may be overfeeding the baby.

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overfeeding

• large volume spit up
• frequent, loose stools
• parents encourage baby to take one more sip

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The 2 month old

• remind parents not to start solids!
• Early intro of solids is assoc with unhealthy
  eating habits later-Peds 2008
• breast feeders should be nursing 10 times/24
  hours
• bottle feeders should be increasing intake 3-4 oz
  q 3-4 hours

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The two month old

• A mother comes to your office with her 2 month
  old. She is upset because the baby still wakes
  to feed in the middle of the night. Is this
  normal? When can she expect him to sleep through
  the night?

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2 months

• still need to eat every 3-4 hrs
• dont yet sleep through night
• knowing what to expect will help parents cope

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The 4 month old

• earliest time to start solids
• breast feeders still 8-10x/d
• bottle feeders 4-6oz q4-6 hrs
• begin to give up middle of night feed (at about
  12lbs) and sleep through the night5-6 hours

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4 monthsstarting solids

• Signs of readiness for solids
• head control(no head lag)
• loss of extrusion reflex
• still hungry after consuming 32oz of formula or
  nursing 10x/day
• do start solids by 6 months

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Starting Solids

• start with least allergenic and most nutrient
  rich food
• in USrice cereal
• in Scandanaviamashed potatoes
• in South/Central America avacado
  

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starting solids

• after baby is taking about 1/4 cup cereal BID, ok
  to try other single grain cereals or begin fruits
  and vegetables

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starting solidsbasics

• introduce new foods q3-4 days
• ok to start with fruits or veggies
• ensure baby is still getting majority of calories
  from milk 32oz/d or 6-8x/d

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4 months

• A mother comes to your office with her 4 month
  old. She is upset because you told her that he
  would likely be sleeping through the night by now
  and he only sleeps from midnight until 5AM.

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6 month old

• make sure they have started solids!

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6 months old

• A dad comes to your office with his 6 month old.
  Mom was breast feeding but has discontinued. Baby
  is now taking goats milk which they have heard
  is closest to human milk.

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Goats Milk

• Folate poor
• leads to megaloblastic anemia
• dont do it!

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9 month old

• still be taking 24-32 oz or nursing
  6-8x/day
• start yogurt/cottage cheese(full fat), egg yolks,
  tofu, mashed beans, finger foods esp. cheerios
• slowly introduce meats
• NEVER gt 4oz/day of juice

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9 months

• At the 9 month visit you notice that your patient
  has not gained weight since his 6 month visit.
  You question the family about his diet and they
  say that he eats table foods and no longer takes
  formula.

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formula intake

• until 12months of age, still need 24-32 oz of
  formula or breast milk daily!
• food is for practice, not nutrition

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No-Nos!

• honey- 12 months
• egg white-12 months
• strawberries/kiwis-18 months
• peanut butter- 3yrs
• sweets-limit!

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1 year old!

• begin to decrease milk intake from a max of
  32oz/d to a min of 12oz/day
• change to whole milk
• table foods- careful of choking esp whole peas,
  raw carrots, nuts, hard candies, hot dogs, grapes

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Got Milk?

• look for kids drinking too much milk---gt Fe
  deficiency
• do not restrict fat before 2yrs
• low fat (2) at 2 years old
• skim milk at 3 years old
• AAP is now rec skim milk earlier b/c of risk of
  hypercholesterolemia-I disagree except in extreme
  situations

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1 year old

• A mother comes to your office with her one year
  old. He is doing well and has transitioned to
  whole milk. She wants to know about the benefits
  of organic dairy products.

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Toddler Nutrition

• A mother comes to your office with her 18 month
  old. She is concerned because he only sits at
  the table for 5-10 minutes for each meal and is
  interested in eating some days and not on others.
  She wants him to eat three meals a day and feels
  snacking is bad for health and weight. In
  addition, he used to love peas and now throws
  them on the floor.

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Toddler Nutrition

• 6 small meals
• goal is a balanced day
• fruits and veggies at each meal and for snacks
• snacks should be nutrient rich
• keep iron rich foods as part of diet

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obesity

• 33 of all 2 year olds are not eating fruit
• 20 of all 2 year olds are not eating vegetables
• french fries are 1 veg eaten by all 15-18 month
  olds
• Pediatrics 2003

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obesity-no wonder!
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obesity

• of all 19-24 month olds, 1/10 eat candy, 23
  drink soda/sugary drinks, 27 eating fried snacks

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obesity

• nutritional and flavor programing begins early in
  life-encourage good habits now!
• Rule of 9s

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obesity

• school age kids intake of fruit and vegetables
  depends on
• mothers preference
• food related experiences early in life
• breast feeding duration

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obesity and breast feeding
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obesitybottle v breast