Nutrition for the Infant and Toddler

The foundation for healthful eating should be laid before the baby is born. Will you breast-feed or bottle-feed? How will you sup­plement and then replace  breast milk or formula when the time comes? Children can breast-feed through the first year of life, but it's still a good idea to prepare a nutritional plan for infancy and toddler hood.

You can get good nutritional advice from the doctor's office, clinic, hospital seminars, local health departments, or even some breast-feeding or childbirth groups. In recent years, experts have learned a lot about nutrition, which has led to changes in some dietary rec­ommendations. Try to follow their guidelines, but know that you'll be tailoring any diet to fulfill your own baby's needs. Plus, your child's needs will change as he or she grows. To make sure your child doesn't get mal­nourished, your nutritional plan should be well balanced. The diet should be varied.

And, it should supply both nutrients and energy, to help ensure good growth and good health. Too little food will lead to slow growth. Foods have to supply enough calo­ries (energy) to keep the body working and bones and muscles growing, in addition to those calories needed to provide energy to move around and play. But don't overdo it on the calories, either! When planning your child's diet, remember that babies need lots of fluids (liquids), too.

PROTEINS

can be a burden on a baby's kidneys, espe­cially if the baby isn't getting enough fluids. Formulas and cow's milk contain more pro­teins than mother's milk.

SUGARS

It's easy to forget that many foods contain "hidden sugars," especially in juice drinks, jellies, sweetened cereals, and some milk products. These sugars are "empty calories" that give a burst of energy but not much more. Eating a lot of sugar interferes with the absorption of iron and can damage the teeth.

FATS

Polyunsaturated fats and fatty acids help the brain develop and function. Using cod-liver oil (which also contains vitamins A and D) and vegetable oils will supply most of the crucial fatty acids. The omega-3 fatty acids are especially important. They aren't found in formulas, but can be found in mother's milk, oily fish (like tuna, sardines, herring, mackerel, salmon), and some oils. Ask the doctor's office about vitamin D supplements.

Even after weaning, your baby will need more fats than you do, relatively speaking. Whole milk, some food oils, and vegetable margarine can help you give your baby nutrition without resorting to "junk food."

FIBER

Plants — such as raw vegetables and corn —are the most important source of dietary fiber. Fiber helps prevent and treat constipa­tion, by "moving things through" the diges­tive system. It's ^good to include some fiber-rich foods in your baby's diet, but not too much. If there's too much fiber, the baby will get full before he or she has received enough nutrients. Balance and moderation are key.

VITAMINS

Babies need a lot of vitamins during infancy to sta^y healthy, especially vitamins A, C, and D. Even mother's milk doesn't contain enough vitamin D for most babies. And, our bodies can store onl^y small amounts of vita­min D. Children need to ^get enough vitamin D durin^g the first ^year of life, and all through childhood. This is especially important in the winter, in cold climates. Fortunately, most cow's milk and many cereals have been "for­tified" with extra vitamin D. This helps pre­vent vitamin D deficiency, or rickets.

Vitamin A is found in most types of milk. Foods hi^gh in vitamin D probably also contain vitamin A. Carrots and tomatoes are impor­tant sources of vitamin A. Getting enough vit­amin A helps prevent eye problems. The B vitamins are a group of vitamins that are important for the body's metabolism.

We receive vitamin B through milk, grain products, and fortified cereals. Vitamin C improves the absorption of iron from formula and grain products, among other things. Breast milk supplies enough vitamin C, if the mother maintains a health­ful diet. Adding extra vitamin C to your diet won't add much vitamin C to your breast milk, but it won't hurt, either. Citrus fruit juices (orange, grapefruit, lemon, lime) are good sources of vitamin C.

IRON

Iron is used in the making of red blood cells and in some metabolic processes. The red blood cells help oxygen get to all of the tissues in our bodies. During the last part of preg­nancy, your baby built up a "reserve" of iron from you. This stored iron is used until the baby starts receiving iron from other sources.

About half of the iron in the breast milk is absorbed. When weaning has begun, the baby's ability to absorb iron from the moth­er's milk will decrease. This is one of the good reasons to wait to introduce solid foods until the baby is 6 months old. Citrus fruits and baby cereal enriched with iron and vita­min C are important sources of iron from the second year of life on. Iron from table food will provide only about 10% of a child's daily need, but iron-enriched cereal will pro­vide around 90%.

FLUORIDE

Fluoride is built into the enamel, or hard outer part, of the teeth when they are form­ing. So, children need to get fluoride to get strong teeth. Fluorinated water (found in many water supply systems), fluoride tooth­paste, or fluoride supplements reduce the danger of tooth decay, slow the development of cavities, and even help repair minor tooth damage. Beware of giving your child too much fluoride in his or her diet, though.

DIETARY ADVICE FOR GOOD WEIGHT GAIN

The diet of infants and toddlers has to be adjusted to the child's age. During the early period, breast milk or formula provides all the nutrition. During the second half of the first year, grain-based baby cereal becomes important. Then what should follow is a mixed balanced diet. Good, steady weight gain and a happy baby are the best indictor healthful development and well-being. Weight gain is largest during the first year of life.

"Normal" weight gain

(approximate weights):

0-3 months: 7 ounces a week

(in the range of 5 to 8 ounces)

3-6 months: 5 ounces a week

(3-1/2 to 6 ounces)

6-9 months: 3-1/2 ounces a week

(2-1/2 to 4-1/2 ounces)

9-12 months: 1-1 /2 to 2-1/2 ounces a week

1-2 years: 4-1/2 to 5-1/2 pounds a year 2-5 years: 4-1/2 pounds a year

As the child grows and develops, there will be different demands and expectations about food. Learning healthful habits is important. However, children have different personalities and tastes, just like grown-ups. Infants may have periods of slow weight gain, even if they are eating well and acting happy. Know that this is normal.

OVERWEIGHT?

Weight should always be measured relative to height. As long as a baby's diet mainly con­sists of breast milk, he or she is not thought of as overweight, even if the weight is at the top of the weight charts. Infants who are being breast-fed shouldn't go on weight-reduction diets.

If your doctor says your child is over­weight, it's important to look at what's being eaten. Try making a detailed "daily intake" list of exactly what your child is eat­ing — the types of foods, quantities (by volume or weight), and times of the day or night when they are eaten. Until you do that, it might seem as though your child is not eating enough. Then you can look at what can be change.

UNDERWEIGHT?

Remember that it's important to measure weight compared to height. A child is consid­ered underweight if his or her weight is less than the weight of three-quarters of the other children his or her age and height.

Sometimes, a breast-fed or bottle-fed child is getting too little nutrition, even when he or she seems satisfied. If the child is being given additional food, do an accurate analy­sis of the diet, to see whether he or she is receiving enough nutrients. At the same time, you have to look at how often the child has bowel movements, and what they look and smell like.

GENERAL GUIDELINES FOR INFANT NUTRITION

( Younger than 6 months)

Breast milk (or formula) is the most important source of nutrition for young infants. As long as your baby is happy and healthy, gains enough weight, and has a normal sleep pattern, there's no reason to introduce other types of food.

If, however, the baby seems extremely hungry, sleeps only a little, and demands several meals during the night, you may need to supplement the breast milk or formula before he or she reaches 6 months of age. But first, try to increase your pro­duction of breast-milk, if you're breast-feeding.

It's important to remember that crying does not always mean hunger. One study of healthy babies showed that the children under 3 months of age cried for an hour and a half each day, and those between 3 and 5 months of age cried for an hour and 20 minutes! The children in the study had 5 periods a day with prolonged spells of crying!

You can start "mixed nutrition" by giving a few tea­spoons of baby cereal at an evening feeding. Prepare the dry cereal with water or expressed breast milk.

FROM 6 TO 12 MONTHS OLD

When your child turns 5 or 6 months old, breast milk or formula alone may not provide enough nutrients or calories anymore. At that point, it's time to start supplementing the diet with solid foods, in the form of baby cereal and dinners. You'll probably start with cereals, then gradually add breads, fruits, vegetables, and other foods. As soon as the child has been introduced to solid foods, be sure to limit the amount of formula to 20 ounces a day! He or she can be given water for extra fluid.

The child should learn that foods have different tastes and consistencies. Meals at this stage are educational experiences. Hold off on foods that most often trigger allergies (such as fish, eggs, pies, beans, tomatoes, strawberries, and citrus fruits). This is especially important in families who already suffer from allergies. Prepared baby food is convenient but expensive. You can mash ^your own food or use a blender.

OLDER THAN 1 YEAR

-Now's the time to build on the habits your child learned in the first year. Your child is being weaned and is getting more sociable. It is impor­tant to have at least one meal where the family is gathered together at a specific time. The meal should also be planned so that everyone is eating at least some of the same foods. Generally, you shouldn't try to force a child to eat. You can decide what the baby eats, but he or she should decide how much.

A child's stomach capacity is limited. If the food isn't nutritious enough, or if it has too much fiber, the^y can't eat enough to meet their large energy (calorie) needs.

If your child drinks a lot of cow's milk, it may be at the expense of other types of food, and the diet won't be varied enough. Whole milk gives a lot of energy from animal fat, but few nutritional sub­stances like iron and vitamins A and D. If the iron is gotten from cereal and bread, and you use veg­etable margarine or vegetable oils ⁱⁿ meals that also contain some fat, low-fat milk can be substi­tuted for whole milk. (Skim milk should not be

WEANING

There is no set time for when a child should be weaned from breast milk or for­mula. Each mother will have to decide when she and her baby are ready. It's recommend­ed that most children breast-feed for at least 1 year, or longer if possible.

WHOLE, LOW-FAT, AND SKIM MILK

Even when babies are fully weaned from breast milk, they shouldn't get too much cow's milk. Drinking too much cow's milk makes them feel full, but they probably won't be able to absorb enough iron.

The use of whole milk and other cow's milk products becomes an alternative at around 1 year of age, or later if you're still breast-feeding. Cow's milk should not be introduced until then. Recent studies indicate that early use of cow's milk can cause minor bleeding in the stomach and gut, and can lead to loss of iron (anemia). Cow's milk can also provide too-high levels of proteins and salts. And, some children are allergic to cow's milk. It's better to use a formula that is not based on cow's milk.

After 1 year, it's okay to gradually add whole milk. Fats are important for the development of the brain, and low-fat milk (1% or 2% fat) or skim milk (no fat) alone probably won't provide enough fat in the first 2 years. By using vegetable oils

and vegetable margarine as substitutes for the fat in whole milk  on whole-grain foods and vegetables the child will receive more of the "good" polyunsaturat­ed fats in the diet.

Grain Products

Grain products have a high calorie content. With breast milk or formula, single-grain cereals such as rice, oatmeal and barley forma complete and balanced diet for the infant. Try starting with rice cereal which most babies tolerate the best. After three to five days of successful feeding, you can introduce oatmeal cereal, then barley. Be prepared if your baby refuses and try again in a few days. Infant grain cereals taste different and have a different texture than breast milk or formula.

MEAL-TIME

Having the family gather to eat meals together is a nice way to bond, to get to know each other's habits, and to introduce new foods to the baby. If schedules permit, try getting everyone together for one or more meals a day.

You don't need to buy ready-made baby food when your child is ready for foods other than breast milk or formula. If your own dinner is very spicy, chewy, or other‑wise unsuitable, it may be fine to give the baby potatoes or vegetables mashed with a little sauce, margarine, or broth. Or, the baby can be given baby cereal or a slice of bread with a topping.

How MANY MEALS?

Babies will usuall^y decide for them­selves how many meals they should have. During the first few weeks, they'll usually adjust to 7 or 8 meals a day (every 3 hours), and later the^y'll want 5 or 6 meals (every 4 hours). Four meals a day are prob­ably fine if the older baby is contented and eats well.

WHEN BABY IS SICK

Mother's milk is best for ill infants. But because infants are nose breathers, it may be hard for them to suck well when their nose is blocked. If that happens, you can try puttin^g a few drops of salty water or special nose drops into your baby's nose before the feeding. If the baby can't suck, you should express milk from your breasts and give it with a bottle or a teaspoon. If he or she loses the appetite enough that your breasts start to over-fill, you'll have to express milk by hand or with a breast pump. That way, you'll keep producing milk and ^you'll have extra breast milk in store for later use. Mother's milk can last for 2 to 3 days in the refrigerator, or about 6 months in the freezer. If your child has diarrhea (loose bowel movements), he or she should stop drink­ing cow's milk. This does not apply to mother's milk; the child should continue to breast-feed. Mother's milk contains agents that protect the baby against infections and diarrhea. It's very important to give extra fluids, in the form of clear fluids, to chil­dren with diarrhea.

WHEN YOU ARE SICK

Good news... You don't have to stop breast-feeding if you aren't very ill. If you get a cold or mild virus, you should continue breast-feeding. Mother's milk contains antibodies that help protect the baby against infections.

If you get a fever, the amount of breast milk you produce might go down. In that case, try to breast-feed more frequently, even if you're tired. It's more important to spend your energy breast-feeding than doing chores. But if your own nutrition is suffering, be sure to call your doctor for advice. It's comforting to know that even if you're in the hospital, you may be able to breast-feed.

Be very cautious about taking medicines when you're sick. Ask your doctor, breast-feeding advisor, or pharmacist about which medicines will pass into your milk.

If you can't breast-feed for a few days, you can increase the milk production again by putting your baby to the breast more fre­quently, or try to maintain production by expressing the milk.