NUTRITION DURING INFANCY

An infants birth weight should:

Double by 4 to 6 months of age
Triple by 1 year
The infants length changes more slowly than weight, increasing about 10 inches from
birth to 1 year
Energy and Nutrient Needs during Infancy
Energy
Infants should not have a restricted fat intake
Human milk, in fact, is high in cholesterol and fat content. Omega-3 fatty acids are
plentiful in human milk, particularly if the mother includes fish in her diet on a regular
basis. These fatty acids have been found to be essential for proper brain and nervous
system development
The rapid growth and metabolism of the infant demand an ample supply of all the
nutrients.
Heart rate (beats/minute)
Respiration rate
(breaths/minute)
Energy needs (kcal/body
weight)

Infants
120 to 160
20 to 40

Adults
60 to 100
12 to 20

45/lb (100/kg)

<18/lb (<40/kg)

Protein
Protein requirement is highest during the first 4 months of life when growth is the most
rapid.
It is suggested infants receive 2.2 g/kg/day from birth to 6 months of age and 1.6 g/
kg/day for the second half of the first year
Protein has a significant influence on renal solute load. Renal solute load (RSL) refers to all
solutes of endogenous or dietary origin that require excretion by the kidneys.
The infant kidney is immature and unable to handle the large renal solute loads of an
adult. Therefore, increasing a normal infants protein intake above the recommended
amount should be avoided.
Vitamins and Mineral Supplementation
During the third trimester of pregnancy, the fetus stores iron in its liver to be used during
the postnatal period. By 4 months of age, this supply of iron is usually depleted.
It is recommended that all breastfed infants receive a daily oral supplement of vitamin D,
unless they receive substantial sunlight exposure. Vitamin D can be toxic, so the
recommended dosage should not be exceeded. Because vitamin D is present in
commercial infant formula, formula fed infants need not receive a supplement.
Newborns are vulnerable to vitamin K deficiency (and thus hemorrhaging) in part because
they lack intestinal bacteria to synthesize the vitamin
RECOMMENDED SUPPLEMENTATION OF INFANT DIETS
TYPE OF
IRON
VITAMIN D
FLUORIDE
VITAMIN K
FEEDING
Human milk
1 mg/kg/day
10 mcg/day
0.25 mg/day
Single IM dose
of 0.5 to 1 mg
or oral
dose of 1 to 2
mg
Formula
Iron-fortified
0.25 mg/day
Single IM dose
formula
of 0.5 to 1 mg
or oral
dose of 1 to 2
mg

Water
The infants body is about 75% water. By 3 years of age, the body has developed so it has
the adult proportion of about 60% water
Breast milk or infant formula normally provides enough water to replace fluid losses in a
healthy infant. If the environmental temperature is extremely high, however, infants need
supplemental water.
Food for Infants
The ideal food for the first 4 to 6 months of life is exclusive use of breast milk, which has
the correct balance of all the essential nutrients as well as immunologic factors that
protect the infant from acute and chronic diseases
The breast should be offered at least 10 to 12 times per 24 hours in the first several
weeks.
Although there is no specified time the infant should stay on the breast, between 10 and
15 minutes per breast (offering both breasts per session) is a good recommendation.
If a mother chooses not to breastfeed or if she has a medical condition contraindicating
breastfeeding, a variety of formulas made from either cows milk or soy are available.
The fat in cows milk is less digestible than the fat in breast milk or formula and contains
less iron and more sodium and protein. These higher levels of solutes may lead to
dehydration caused by increased urine volume to reduce solute levels in the body.
Cows milk may be introduced after 1 year of age when at least two-thirds of energy needs
are fulfilled by foods other than milk. The delay in cows milk consumption reduces the risk
of developing a milk allergy.
Introduction of solid foods
Solid foods may be added to the infants diet between the ages of 4 and 6 months. Infants
who are introduced to solid foods before this time may be prone to excessive kcal intake,
food allergies, and GI upset
How to introduce solid foods
The infant should be able to sit with some support; move the jaw, lips, and tongue
independently; be able to roll the tongue to the back of the mouth to facilitate a food bolus
entering the esophagus; and show interest in what the rest of the family is eating.
To indicate fullness the infant may turn the head to the side, refuse to open the mouth, or
grimace when the spoon comes close to the mouth
The infant should never be force-fed. If the infant is overtired or is not interested in food,
he or she ought to be removed from the high chair and the foods offered again later.
At the age of 9 to 12 months, an infant may enjoy self-feeding. Although this may be a
messy process, caregivers should encourage the development of these skills through food
exploration
Appropriate solid foods during the first year of life
Breast milk or formula is still the primary food, and the solid foods are complementary.
Solid foods should be introduced gradually and one at a time with a 4- to 5-day interval
between new foods. This timing is suggested because if the infant has any type of allergic
reaction such as GI upset, upper respiratory distress, or skin reactions (e.g., eczema,
hives), the offending food can be easily identified.
SOLID FOODS DURING THE FIRST YEAR OF LIFE
AGE
4-5 months

DFOOD
Iron-fortified infant cereal

5-6 months

Strained fruits and vegetables

6-8 months

Mashed or chopped fruits and vegetables

Juice from a cup
Crackers, toast, cottage cheese, plain
meats, egg yolk, finger foods

9-12 months

FOODS TO AVOID IN THE

FIRST YEAR OF LIFE
Honey (may cause infantile
Clostridium botulinum
poisoning);
hot dogs, grapes, hard
candies, raw carrots,
popcorn, nuts, peanut
butter (choking hazards);
skim milk (insufficient
calories); cows milk
(potential allergen, may
replace breast milk or
formula);

egg whites (potential

allergen)
Beverages during the first year of life
Fruit juice can make an important contribution to the diet as a source of vitamin C, water,
and possibly calcium (if fortified)
From age 6 to 12 months, no more than 4 to 6 fluid ounces per day should be offered
Excess fruit juice (more than 12 fluid ounces per day) may lead to diarrhea from
carbohydrate malabsorption, growth failure, or, in some children, obesity caused by
excess calories
All fruit juices given to infants (and children) should be pasteurized.
Baby Bottle Tooth Decay
also known as nursing bottle caries, nursing bottle mouth, and nursing bottle syndrome
It most commonly affects the maxillary incisors, although other teeth may be affected as
well.
For BBTD to develop, the mouth requires the presence of fermentable carbohydrate and a
pathogenic organism.
BBTD commonly occurs in infants who are allowed to sleep with a bottle of milk, juice, or
other sweetened liquid.
Infants should never be put to bed with a bottle of milk, formula, juice, or other sweetened
liquid. If a bottle is needed at bedtime, it should be plain water only.
Special Nutritional Needs
The Premature and Low Birth Weight Infant
An infant is considered premature if born before 37 weeks gestation. Low birth weight
infants may be full term or premature but weigh 2500 g or less at birth.
Because the coordinated suck-swallow reflex is not fully developed until an infant reaches
34 weeks gestation, initial feeding of the premature infant may need to be via total
parenteral nutrition, tube feeding, or gavage feeding.
The best feeding choice for a premature infant is mothers milk with the addition of
human milk fortifier, which adds additional minerals and protein needed by the
premature infant.
The nurse can play a key role in helping the mother pump and store her milk in the
neonatal nursery. The milk may then be given by gavage even when the mother is not
present.
Cystic Fibrosis
is an autosomal recessive disorder and is the most common genetic disorder among white
populations, affecting roughly 1 in 2000 live births.
Clinical features of the disease include chronic pulmonary disease, pancreatic exocrine
insufficiency, and increased sweat chloride
Failure to Thrive
is a weight-for-length measurement less than the fifth percentile or weight for age below
the third percentile
FTT may have organic causes, such as an underlying metabolic disorder. Congenital heart
disease or HIV infection may cause such an increased energy requirement that oral intake
is not able to keep up with metabolic need.
Nonorganic FTT may be diagnosed when no medical reason for poor growth can be
recognized. There may be psychosocial causes of the FTT such as either extreme of
parental attention (neglect or excessive attentiveness)
Treatment for nonorganic FTT must include nutrition intervention to promote weight gain
and therapy to correct developmental delays and any psychosocial problems in the home
environment
Inborn Errors of Metabolism
1. Phenylketonuria
Treatment consists of a low-phenylalanine diet to be followed throughout the individuals
life. In infancy the use of a special formula such as Lofenalac is recommended. Partial
breastfeeding is permitted, but phenylalanine levels in the infants blood must be
monitored carefully.14 As PKU children are introduced to solid foods and make the
transition to table foods, meals require careful planning. The use of low-protein breads and

pastas is advised. This condition requires close monitoring of dietary intake by specialized
dietitians.
2. Galactosemia
is another rare, autosomal recessive disorder caused by an enzyme deficiency.
Absence of the enzyme galactose-1-phosphate uridylyltransferase results in an
inability to metabolize galactose.
Because the milk sugar lactose is a disaccharide of glucose and galactose, these
infants are unable to tolerate any milk products containing lactose.
Manifestations include diarrhea, growth retardation, and mental retardation
Treatment is dietary therapy excluding all milk products, including human milk. Soy
formulas and casein hydrolysate formulas are acceptable. Even with lifelong diet
therapy, there may be long-term health consequences such as nervous system or
ovarian dysfunction