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Additional Slides Feeding Healthy Babies - C.Richards, RD, Interior Health

Tongue Tie – about 4 % of babies Feeding Healthy Babies - C.Richards, RD, Interior Health

Milk enters around teeth • V-Shaped Palate • Malocclusions common • Smaller nasal cavity • Mouth breathing more common in childhood/ adults • Milk enters close to throat • U-Shaped Palate Illustration from: F Weber, M Woolridge, J Baum, An ultrasonographic study of the organisation of sucking and swallowing by newborn infants, Dev Med Child Neuro, 1986,19-24. Sourced from http://www.brianpalmerdds.com Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Mother’s Diet & Breastfeeding • Not affected by mother’s diet: • Quantity: -extra water does not make extra breastmilk -a poor diet does not make less • Lactose content: -lactose is made by the breasts • Affected by mother’s diet: • Lipids: -avoid trans fats, include healthy fat sources • Proteins: -“innoculate” baby to family foods • Flavours: -garlic, bitter, spices etc help baby learn tastes • Alcohol: -passive permeability, no need to pump & dump • Medications & Mother’s Milk, by Thomas Hale (IH Online Library) Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

http://www.healthyfamiliesbc.ca/home/articles/breastfeeding-buddyhttp://www.healthyfamiliesbc.ca/home/articles/breastfeeding-buddy Feeding Healthy Babies - C.Richards, RD, Interior Health

Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Baby’s First Foods, HealthLink BC File #69c, September 2009 : Your baby sits and holds her head up; AND She watches and opens her mouth for the spoon; AND When you try solids she does not push food out with her tongue. Signs of Readiness to Start Solids Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Myths about readiness for solids • Reaching for foods/showing interest • Baby has doubled its birth weight • Baby doesn’t sleep through the night • Baby is no longer satisfied with breast (or with formula or combo) Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

In exclusively breastfed babies (<6 months), water is not needed before solids are introduced, even in hot or humid temperatures At 6-9 months – sips of water may be offered in an open cup simply learning how to drink, not for hydration 9-12 months offer water freely in a cup at meal times or snack times or in between when thirsty Water Feeding Healthy Babies - C.Richards, RD, Interior Health

Not needed, no nutritional benefit If parent decides to offer: limit to ¼ to ½ cup per day do not put in bottle or sippy-cup No rationale for dilution could promote longer exposure/sipping and therefore tooth decay Juice must be pasteurized Fruit Juice Feeding Healthy Babies - C.Richards, RD, Interior Health

Introduce first in small amounts in cooking Cheese (grated or chopped) and plain whole fat yogurt can complement a varied diet Milk to drink can be introduced at meals whole cow’s milk (3.25%), pasteurized, fortified small amounts in small open cup at meals avoid putting cow’s milk in a bottle or sippy-cup should not replace breastfeeding (or formula) until at least 9 months old Milk Alternates: Fortified soy drinks are too low in fat for toddlers under 2 years Fortified rice drinks are too low in protein and fat Toddler drinks = milk + sugar + oil Milk Feeding Healthy Babies - C.Richards, RD, Interior Health

Gagging: Normal reflex as baby learns to eat Choking is different Honey: Wait until over 12 months due to risk of infant botulism 70-100 cases in US each year (?rarer in Canada) 5% due to honey, 95% due to natural environment Pasteurization: Milk, juice, soft cheese such as brie, camembert and feta should be pasteurized Mercury: Avoid offering fish high in mercury Food Safety Feeding Healthy Babies - C.Richards, RD, Interior Health

http://www.healthyfamiliesbc.ca/home/articles/feeding-jobs-parents-and-toddlershttp://www.healthyfamiliesbc.ca/home/articles/feeding-jobs-parents-and-toddlers Feeding Healthy Babies - C.Richards, RD, Interior Health

Non-Responsive Feeding Styles & Weight • Restrictive feeding associated with: • Perception that infants could not recognize their own hunger or satiety • Concern that the infant would become overweight • Pressuring feeding associated with: • Perception that their baby’s appetite is less than other babies • Concern that infant would become underweight in the future. Maternal Controlling Feeding Styles During Early Infancy, Gross et al, Clinical Pediatrics 2011 Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Regular Meal & Snack Times Snacks: MostlyFamiliar foods Meals: Whatever you’re making -- with at least one familiar food you can introduce new foods Feeding Healthy Babies - C.Richards, RD, Interior Health

Big or Small • Young Babies • grow best • when: • …they are fed when they seem hungry • …it’s okay if they eat fast or slow • …they decide when they stop eating • …they have wet diapers regularly • …they get lots of love and attention between feeding times • …their parents don’t worry about their size Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Big or Small • Toddlers are • healthiest when: • …they play actively every day • …they have routine meal times and snack times • …they rarely eat between meal or snack times • …they feel good about themselves • …their parents don’t worry about their size Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Children who eat with family at least once a day: • Eat more nutritious foods • Perform and behave better at school • Enjoy greater vocabulary • Observe their parents modeling healthy eating • Understand their family’s values and traditions • Deepen their sense of belonging and security • Are less likely to smoke, use drugs, drink or attempt suicide Family Meals Focus # 9, Feb 2006 https://ellynsatter.com/newsletters.jsp & The National Center on Addiction and Substance Use at Columbia University Feeding Healthy Babies - C.Richards, RD, Interior Health

Family Meals • Calm, Pleasant • Slow Down • Small portions • Child decides how much • Routine meals & snacks • Healthy Food Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

BCMJ, 2011 Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

http://www.youtube.com/user/EllynSatterInstitute Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Growth is Shifting, Plus Feeding Concerns • “Many children naturally shift by one or two percentiles, but it sounds like feeding is a bit of a struggle. Let’s see if we can explore some ways to help reduce that struggle.” Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Growth is Shifting, Plus Feeding Concerns • “See how her growth chart shows that her weight gain is speeding up a bit? This might be normal for her.” • “It sounds like it’s hard to tell when she is hungry, versus when she just needs to be held, comforted or wants to play. Let’s talk about how to tell the difference.” Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Big. Hungry. Consistent pattern. • “Your baby’s predictable growth pattern is very normal and reassuring. She is bigger than other babies her age which is logical considering her family genetics – but there’s nothing concerning about her growth.” • “From what you tell me, you are worried that she might be eating too much. This is unlikely. Babies rarely eat more or less than they need and its important that we follow their hunger and fullness cues.” Feeding Healthy Babies, CRichards, BC Dietetic Intern Rounds

Fact Sheet Generator Feeding Healthy Babies - C.Richards, RD, Interior Health

Feeding Healthy Babies - C.Richards, RD, Interior Health

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