A Basic Approach to Feeding and Care

1. A Basic Approach to Feeding and Care • Chapter 3 • Infant Feeding Successful Solutions Professional Development LLC

2. A Basic Approach to Feeding and Care Chapter Topics The food program in a child care center serves many purposes. Proper food handling, food preparation, and serving children nutritious meals are extremely important. Eating meals together can help children to develop social skills and good eating habits.

3. A Basic Approach to Feeding and Care Chapter 3 Infant Feeding Some infants (often those born prematurely) do not give cues that are very easy to read. If you have difficulty understanding an infant's signals, talk with the parents about ways their baby communicates with them, or consult with a public health nurse.

4. A Basic Approach to Feeding and Care Chapter 3 Infant Feeding • Tips on Infant Feeding • Young infants do not have good head control and will need a hand behind the head for extra support. • Hold infants so that their head is higher than their hips. This helps babies swallow and prevents choking. • Hold the bottle or, when infants are old enough, let them hold it. NEVER prop a bottle. • Stroke infants gently and give affectionate pats when you feed them. Touch is one of the most important ways of communicating and interacting with infants.

5. A Basic Approach to Feeding and Care Chapter 3 Infant Feeding • Tips on Infant Feeding • Rock and gently move them. A rocking chair with arms is helpful for movement and to help you support an infant's position. Occasionally change an infant's position; this helps with burping. Talk and sing to them. • To prevent tooth decay, do not give a bottle to a reclining infant unless the bottle contains only water, and offer juice only from a cup.

6. A Basic Approach to Feeding and Care Infant Bottle Feeding Chapter 3 Infant Feeding Bottle Labeling and Cleaning 3. Bottles will not be washed and re-used at the center. The family will provide a sufficient number of bottles to meet the daily needs of the infant. If bottles must be re-used, our center will wash, rinse and sanitize bottles or place them in a dishwasher with a sanitizing cycle. Used bottles cannot be cleaned in a food sink. They will be placed in a tub to be cleaned in the kitchen. • 1. Hands will be washed at the hand-washing sink before handling bottles. 4. Nipples needing to be re-used will be washed, rinsed, and boiled for 1 minute and then allowed to air dry. 2. All bottles will be labeled with the child's full name, date prepared and time feeding begins (discard within one hour if not consumed). 5. All bottle nipples should be covered at all times (to reduce the risk of contamination and exposure). WAC 170-295-4060 requires child care programs to incorporate policies on infant feeding. Above are suggested policies as recommended in the Child Care Licensing Guidebook in order to meet minimum licensing guidelines and best practices.

7. A Basic Approach to Feeding and Care Infant Bottle Feeding Chapter 3 Infant Feeding Refrigeration 2. Bottles that babies have fed from will not be placed back in the refrigerator or re-warmed. Bacteria from baby's mouth is introduced into milk and begin to multiply once bottles are taken from the refrigerator and warmed. 1. Filled bottles will be capped and refrigerated immediately upon arrival at the center or after mixing, unless being fed to an infant immediately. 3. Bottles will be stored in the coldest part of the refrigerator, not in the refrigerator door. 5. Frozen breast milk will be stored at 10 degrees F. or less and for no longer than 2 weeks. 4. A thermometer will be kept in the warmest part of the refrigerator (usually the door) and will be between 35 degrees F. and 44 degrees F. at all times. It is recommended that the refrigerator be adjusted between 35 degrees F. and 41 degrees F. to allow for a slight rise when opening and closing the door. WAC 170-295-4060 requires child care programs to incorporate policies on infant feeding. Above are suggested policies as recommended in the Child Care Licensing Guidebook in order to meet minimum licensing guidelines and best practices.

8. A Basic Approach to Feeding and Care Infant Bottle Feeding Chapter 3 Infant Feeding Bottle/Food Preparation Area 6. Microwave ovens will not be used to heat formula, breast milk or baby food. 8. If a crockpot is used the water temperature must be monitored and held below 120 degrees F., and contain no more than 1 1/2 inches of water (crockpots pose a risk of scalding). The crockpot must be secured to the counter for earthquake safety. Crockpots will be cleaned and sanitized daily. Consider replacing the crockpot with a bottle warmer, which heats with steam and has an automatic turn-off or heat bottles by holding the bottle under warm running tap water until the fluid is no longer cold. All unused formula and non-frozen breast milk will be returned to the parent when they pick up their child at the end of each day. 1. Before preparing bottles or food, staff will wash their hands in the hand washing sink. The food preparation sink and area will not be used for hand washing or general cleaning. 2. A minimum of eight feet will be maintained between the food preparation area and the diapering area. If this is not possible, a moisture-proof, transparent 24-inch high barrier of 1/4-inch Plexiglas or safety glass will be installed. 4. Used bottles and dishes will not be stored within eight feet of the diapering area or placed in the diapering sink. 7. Bottles will be warmed no longer than 5 minutes. 5. Preparation surfaces will be cleaned, rinsed and sanitized before preparing formula or food. 3. Centers with only one sink in the infant room must obtain a clean source of water for preparing bottles (i.e., water from the kitchen kept in an airtight container).

9. A Basic Approach to Feeding and Care Infant Bottle Feeding Chapter 3 Infant Feeding Contents of Bottle 1. Infants will be fed breast milk or iron-fortified infant formula until they are one year of age. 4. No honey, or products made with honey, will be given to infants less than 12 months of age, because of the risk of botulism. 5. Bottles will only contain formula or breast milk. Juice will be given only in a cup. 2. Written permission from the child's licensed health care provider will be required if an infant is to be fed Pedialyte or a special diet formula. 3. No medication will be added to breast milk or formula. WAC 170-295-4060 requires child care programs to incorporate policies on infant feeding. Above are suggested policies as recommended in the Child Care Licensing Guidebook in order to meet minimum licensing guidelines and best practices.

10. A Basic Approach to Feeding and Care Infant Bottle Feeding Chapter 3 Infant Feeding Formula 2. Formula will be mixed as directed on the can. The water will be from the food preparation sink or bottled water. Water from the hand washing sink may NOT be used for bottle preparation. 1. Powdered formula in cans will be dated when opened and stored in a cool, dark place. Unused portions will be discarded or sent home 1 month after opening. WAC 170-295-4060 requires child care programs to incorporate policies on infant feeding. Above are suggested policies as recommended in the Child Care Licensing Guidebook in order to meet minimum licensing guidelines and best practices.

11. A Basic Approach to Feeding and Care Infant Bottle Feeding Chapter 3 Infant Feeding Breast Milk 2. Frozen breast milk will be thawed in the refrigerator or in warm water (under 120-176 degrees F.) and then warmed as needed before feeding. Thawed breast milk will not be refrozen. 1. Frozen breast milk will be stored at 10 degrees F. or less and for no longer than 2 weeks. The container will be labeled with the child's full name and date. 3. Unused thawed breast milk will be returned to the family at the end of the day. WAC 170-295-4060 requires child care programs to incorporate policies on infant feeding. Above are suggested policies as recommended in the Child Care Licensing Guidebook in order to meet minimum licensing guidelines and best practices.

12. Starting Solid Foods A Basic Approach to Feeding and Care Chapter 3 Infant Feeding Although parents choose most food for their own babies, your understanding of nutrition and feeding is important so you can be a resource when they have questions. The choice of foods for babies should come from their nutritional and developmental needs. For most babies, breast milk or formula is the best source of nutrients throughout the first year of life. At four or five months of age, however, most babies are becoming interested in semi-solid foods.

13. Starting Solid Foods A Basic Approach to Feeding and Care Chapter 3 Infant Feeding Babies may be ready to start infant cereal when they can sit without support, hold their head and neck steady, and keep food in their mouth to swallow. These developmental signs of readiness usually appear between 4-6 months of age. If there is a family history of food allergies it is a good idea to delay starting solid foods until six months of age. With parent's instruction, caregivers should feed infants semi-solid food, such as cereal with a spoon, not through a bottle.

14. Starting Solid Foods A Basic Approach to Feeding and Care Chapter 3 Infant Feeding Chewing, gumming and swallowing skills are necessary for infants' language development. Sucking food from a bottle does not allow infants the opportunity to gain tongue skills for language.

15. Starting Solid Foods A Basic Approach to Feeding and Care Chapter 3 Infant Feeding Ask the parents what foods they are starting at home and follow that plan at the center. Introducing only one new food per week is a good idea. If an infant has an allergic reaction, it is easier to pinpoint which food is causing the problem. Intolerance of a food or an allergic reaction should show up in that time period. If symptoms of intolerance such as a rash or diarrhea occur, stop giving the recently added food. Try again in a few months if the reaction is a mild one.

16. Starting Solid Foods A Basic Approach to Feeding and Care Chapter 3 Infant Feeding It is time to offer other foods when infants are older and can sit without support and can sip from a cup. These include mashed soft fruits and vegetables and sips of water from a cup. This phase is typically seen at around 6-8 months of age. When infants have mastered picking up items between their thumb and forefinger and bringing them to their mouths, it is time to offer safe "finger foods" to promote self-feeding skills.

17. Starting Solid Foods A Basic Approach to Feeding and Care Chapter 3 Infant Feeding Finger foods may include soft pieces of cooked vegetable or peeled soft fruit, toast squares, unsalted crackers, bite-size cereal, small pieces of chicken, fish, tofu or ground meat, grated cheese, cooked plain rice or noodles. At this stage, infants may also try to hold their own spoons and try to feed themselves. It is a good idea to offer a small hard plastic spoon with a short handle for infants to "practice" with.

18. Starting Solid Foods A Basic Approach to Feeding and Care Chapter 3 Infant Feeding The finger food stage usually develops around 10-12 months of age. As infants get more skilled at using their fingers, you can add more foods such as cooked kidney beans, cooked egg yolks and other foods that are more challenging to pick up. By 10-12 months of age infants can start eating three meals a day plus snacks and use a cup for beverages with meals. Soon infants will be eating foods the rest of the children in care are enjoying. Special attention needs to be given to foods that pose a choking risk.

19. Starting Solid Foods A Basic Approach to Feeding and Care Chapter 3 Infant Feeding Baby food in jars can quickly spoil once opened. Use a clean spoon to put the portion you plan to use in a bowl or cup. Never feed directly from the jar unless you are planning to throw the jar away when done. Use another clean spoon, not the one you have been using to feed the baby, to get more food from the jar. Throw away the unused portion in the bowl or cup. Always refrigerate opened jars of baby food and discard or send home after 48 hours.

20. A Basic Approach to Feeding and Care Chapter 3 Infant Feeding Click here to launch Chapter 3 Assessment 2