Let’s Eat!

1. Let’s Eat! • Infant and Toddler Nutrition

2. Infant Nutrition • Breast Feeding • Formula Feeding

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

4. Newborn:Breast Feeding • What to eat: mom’s • how much: ad lib • when: 10-12 times/24º • special:offer breast before baby gets upset/know signs of hunger

5. Newborn:Breast feeding • Problems: the sleepy baby- tickle toes, strip down, make less comfortable

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

7. 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

8. Newborn: Bottle Feeding • what:commercial formula- milk, soy, lactose free etc.. • how much:2-4oz q 2-3 hrs • special:don’t force or encourage baby to finish bottle • problems: never prop bottles!/proper mixing of formula

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

10. overfeeding • large volume spit up • frequent, loose stools • parents encourage baby to take “one more sip”

11. 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

12. 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?

13. 2 months • still need to eat every 3-4 hrs • don’t yet sleep through night • knowing what to expect will help parents cope

14. 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 night”=5-6 hours

15. 4 months:starting 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

16. Starting Solids • start with least allergenic and most nutrient rich food • in US=rice cereal • in Scandanavia=mashed potatoes • in South/Central America = avacado

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

18. starting solids:basics • 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

19. 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.

20. 6 month old • make sure they have started solids!

21. 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 goat’s milk which they have heard is closest to human milk.

22. Goat’s Milk • Folate poor • leads to megaloblastic anemia • don’t do it!

23. 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 > 4oz/day of juice

24. 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.

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

26. No-No’s! • honey- 12 months • egg white-12 months • strawberries/kiwis-18 months • peanut butter- 3yrs • sweets-limit!

27. 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

28. Got Milk? • look for kids drinking too much milk---> 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

29. 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.

30. 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.

31. 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

32. 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

33. obesity-no wonder!

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

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

36. obesity • school age kids intake of fruit and vegetables depends on: • mother’s preference • food related experiences early in life • breast feeding duration

37. obesity and breast feeding

38. obesity:bottle v breast