Nutrition & Your Baby

1. Nutrition & Your Baby www.healthychildren.org www.aap.org www.zerotothree.org

2. Food Allergies • Food allergies in children are relatively rare. In 2007, about four in 100 children younger than 18 had a food allergy. • Most children outgrow food allergies, especially to milk, eggs, and soy. Food allergies are much less common in adults than in children. • Eight foods cause 90% of food allergies in children: milk, eggs, peanuts, tree nuts (pecans, walnuts), fish, shellfish, soy and wheat.

3. Delaying & PreventingFood Allergies • Breastfeeding at least 6 months; 1 year is best • Mom’s should limit eggs & cow’s milk • Low allergy formulas, no soy protein or cow’s milk • Restrict solid foods until 4-6 months • No cow’s milk before 1 year

4. Amount & Schedule of Formula Feedings www.healthychildren.org • Few days – few weeks • 2 to 3 oz, every three to four hours • Breast fed infants usually take smaller, more frequent feedings than formula fed infants • During the first month, if your baby is sleeping more than 4-5 hrs, wake her up to feed • End of first month • At least 4 oz, every four hours

5. Amount & Schedule of Formula Feedings www.healthychildren.org • Two-four months, or more than 12 lbs, most formula fed babies no longer need middle of the night feedings • Consuming more during the day • Sleep patterns become more regular • Stomach capacity has increased, can go longer between feedings, up to 4-5 hours • By six months, • 6 to 8 oz each feeding • Four to five feedings in 24 hours • On average, 2.5 oz of formula per day, per pound of body weight, but let your baby tell you when he has had enough • Fidgety or easily distracted, he is likely full • If he drains the bottle & is still smacking his lips, he is likely still hungry

6. Amount & Schedule of Formula Feedings www.healthychildren.org • Should not have more than 32 oz in 24 hours, consult your pediatrician if your baby consistently wants more or less • Some babies have higher needs for sucking and may just want to suck on a pacifier after feeding. • Whether breastfed or bottle fed, your baby’s feeding needs are unique. You will discover how to meet his needs as you & your baby get to know one another.

7. Ensuring safe water www.healthychildren.org • Have well water tested for nitrates and fluoride before giving it to infants under one year of age. • Check your water quality by contacting: • the county health department, or • Environmental Protection Agency’s Safe Drinking Water Hotline (1-800-426-4791) • If you are concerned about the quality of the plumbing, run the faucet for two minutes each morning prior to using the water to cook or drink. This will flush the pipes and lower the likelihood of consuming contaminants. • Drinking water that may be contaminated with germs should be boiled for one minute and then allowed to cool before drinking. Do not boil for longer than one minute.

8. Fluoride www.healthychildren.org • Babies should not receive fluoride supplementation during the six months of life. • If your home is supplied by a well, have it tested to determine the amount of natural fluoride. • If your baby consumes bottled water or your home has a municipal water supply, check to see if the water is fluorinated. • If you have questions or concerns, check with your pediatrician about your baby’s fluoride needs.

9. Introducing Solid Foods • Iron fortified cereal is introduced first • Rice cereal is suggested, easily digestible, low allergenic • Infant cereal may be mixed with formula or breast milk until whole milk is given. • After 6 months of age, fruit juice may be used to mix cereal • Vitamin C in fruit juice helps with iron absorption from cereal • Infant cereals should be continued until 18 months of age due to benefit as a source of iron Wong’s Nursing Care of Infants and Children, p.528

10. Fruit Juices • No juice prior to 6 months • No more than 4-6 oz per day • White grape juice is recommended • Better absorbed, safe for infants this age without causing stomach distress • Other juices have high fructose and may cause abdominal pain and diarrhea • Should be refrigerated, warming destroys vitamin C • Provide in a cup, not a bottle, to prevent dental caries. Wong’s Nursing Care for Infants and Children, p. 529 www.aap.org

11. Other foods • Add vegetables before fruits, then meats • Introduce one solid food every 5-7 days, to determine any reaction • By 8-9 months, finger foods can be offered • Avoid choking hazards such as grapes and hotdogs • After one year, egg whites may be introduced in small quantities to detect an allergy • Avoid honey and corn syrup due to bacteria risk • By 1 year, well cooked table food may be served Wong’s Nursing Care for Infants and Children, p. 529

12. How Much is Enough? • ½ to ¾ tablespoon 6 months - 1 year • In general, 1 tablespoon per year of age • More may be served, because infant’s focus is on texture and feel less will be consumed. • As the quantity of solid food increases, the quantity of milk is decreased to prevent overfeeding. • Caloric requirement for infants to 1 year is approximately 50 kcal/lb. • Early feeding of smaller portions may help prevent the “clean your plate” concept which contributes to overeating later in life. Wong’s Nursing Care for Infants and Children, p. 529

13. Toddler Nutrition & Beyond • Eating habits established in the first 2-3 years of life have lasting effects into adulthood • Milk intake should average 2-3 cups/day, more limits the intake of solid foods • After age 2, children may be given skim or low fat milk to reduce intake of calories, fat and cholesterol • Visit choosemyplate.gov for additional information Wong’s Nursing Care for Infants and Children, p. 624