Nutrition in the First Year

The first years of life have been long recognized as being a critical time for providing the nutrients required for optimum growth and development. Decisions about breast or formula feeding and the introduction of solid foods are made by parents but these decisions impact your care of the baby when in your childcare program. Knowing about the different types of foods available for infants and when solid foods can be introduced may help you and your staff at feeding time.

Breast Feeding

Breast milk is uniquely superior because it is custom designed for each baby. No two mothers make the same milk. Studies have shown that breast milk protects the baby against disease. Colostrum, the milk the baby receives at the beginning of breast feeding, contains antibodies that boost the baby's immune system. There are lower incidences of acute and chronic diseases, such as infections of the lung, ear, and intestine in the breast-fed baby. Breast milk also contains nutrients that promote brain growth and may even enhance IQ. Another advantage is that breast feeding encourages proper facial and dental development. There are psychological, social, economic and environmental benefits as well.

Probably the most frequent question new mothers who breast feed ask is how to be sure the baby is getting enough to eat. The best way to tell is to count the number of soiled diapers; a baby should have at least six wet diapers a day. Most doctors recommend that breast-fed newborns nurse every 2-3 hours (even if they have to be wakened to nurse). Depending on the baby, nursing can take as little as 10 minutes or up to 30 minutes on each breast. Mothers who express their milk for later use should store the breast milk in sterilized bottles. Label each container with the date and time the milk was pumped. Fresh milk should be refrigerated and used within two days; frozen milk should be used within two weeks. If a bottle is sent with the baby to childcare, it must be kept cold and labeled with the date, contents, and the baby's name.

Formula Feeding

Formula-fed babies should be fed on demand as well, usually 4-6 times per day. For the first month, newborns usually consume 18-24 ounces every 24 hours, increasing to as much as 32 ounces by the fourth month. Discard prepared bottles with formula after 24 hours. Open containers of ready-to-feed or concentrated formula should be discarded after 48 hours.

To warm bottles of breast milk or formula properly, place them in hot (not boiling) water for five minutes. Shake well and test milk temperature to make sure it is not too hot before feeding. NEVER MICROWAVE BABY BOTTLES! Microwaves heat unevenly, resulting in "hot spots" that could scald the baby's mouth and throat.

Whether breast milk or formula is used, bottles should be used only once and then cleaned thoroughly before using again; any leftover milk or residue in the bottle will be contaminated with bacteria from the baby's mouth. If bottles, bottle caps, and nipples are washed by hand instead of in a dishwasher, rinse and boil these items for five minutes or more just before refilling.

Solid Food

When should a baby start eating solid food? The baby should be able to sit up with support, hold his or her neck steady and move the head from side to side. This usually happens between 4-6 months. It is important to start solids when the baby is ready because the baby's stores of iron begin to run out about this time. Rice cereal is best to start with because it is the cereal that is least likely to cause an allergic reaction. The baby should be fed very small amounts of cereal at first, about one teaspoon of cereal mixed with several teaspoons of breast-milk or formula. It is difficult for a baby to manipulate cereal that is too thick and choking may result. Use a small, soft-tipped spoon that fits the baby's mouth and allow the cereal to flow off the spoon into the mouth. Some of the cereal may run out of the mouth because the baby is not accustomed to moving food to the back of the mouth and swallowing it. The baby may only eat a few bites at first.

Cereals containing oats, barley, and wheat can be introduced at six months, vegetables and fruits between 6-8 months. In order to identify possible food allergies, new foods should be introduced one at a time with an interval of at least three days before introducing another new food. Foods most likely to cause an allergic reaction are wheat, peanuts, citrus fruit or juice, cow's milk, fish, and egg whites. Symptoms of an allergic reaction are diarrhea, rashes, vomiting, and colic. Pediatricians and nutritionists recommend introducing vegetables before fruits because humans are born with a preference for the "sweet" taste of fruit. If the baby learns to eat fruit first, she or he may be less likely to want to eat vegetables, which are less sweet. Fruit juice should be diluted--half juice, half water--and limited to 4-6 ounces per day. Too much may cause diarrhea.

Commercially prepared baby foods (without added sugar, fat or salt) are recommended over homemade because of the risk of food contamination. It is hard to maintain temperatures that will keep bacteria from growing when preparing and reheating homemade baby food. To avoid the risk of contaminating homemade or commercial baby food, take the amount of food needed from the jar with a clean spoon and place the food on a clean plate then immediately refrigerate the jar with the unused baby food. Use it for the next feeding or discard the unused portion after 24 hours.

Feeding with a spoon is a new experience for babies, so do not be alarmed if the first bites are spit out. The baby needs to get used to the spoon and the food that is on it. Start with a small amount and gradually increase to two tablespoons twice a day to give the baby the additional iron and protein she needs. About the seventh month, increase the texture to lumpy foods such as cooked chopped vegetables, small amounts of soft fruits, and strips of toast. From 7-10 months, 3-5 breast feedings per day or 24-32 ounces of formula are recommended, while introducing pureed meats mixed with baby's favorite vegetable. The time to begin letting a baby feed herself or himself is 10-12 months of age. Finger foods and foods that stick to the spoon are best. This stage of development, although a messy one, is a developmental milestone for the baby.

The recommended serving size at age one is two servings of protein foods (1/4 cup or 1 oz. per serving of chopped meat, fish or chicken); 2-4 servings of vegetables and fruits (1/4 cup per serving); 2-4 servings of fruits (1/4 cup); six servings of grains (1/4 cup cereal, 1/2 slice of bread, two crackers), and three cups of whole or breast milk.

It is important to remember that a baby's attitudes toward food are being formed during the first year of life. The goals should be to meet the baby's nutritional needs, introduce variety into the diet without contributing to overeating, establish good dietary habits, and promote the enjoyment of food without placing undue emphasis on its role in the baby's life.

Pam David, RD
Nutrition Consultants, Birmingham, AL

RESOURCES

The American Academy of Pediatrics (AAP) has information available on breast and bottle feeding, and infant feeding. AAP, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098; 847-434-4000; www.medem.com/MedLB/articleslb.cfm?sub_cat=20

INTERNET RESOURCES

Nutramed, www.nutramed.com/children/infant.htm

University of Nebraska-Lincoln, www.ianrpubs.unl.edu, type in ‘food for babies’ in the search window

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