Infant Nutrition

Definition

Children between the ages of birth and one year are considered infants. Infants grow very rapidly and have special nutritional requirements that are different from other age groups.

Purpose

Infant nutrition is designed to meet the special needs of very young children and to give them a healthy start in life. Children under one year old do not have fully mature organ systems. They need nutrition that is easy to digest and contains enough calories, vitamins, minerals, and other nutrients to allow them to grow and develop normally. Infants also need to receive the proper amount of fluids for their immature kidneys to process wastes. In addition, infant nutrition involves avoiding exposing infants to substances that are harmful to their growth and development.

Description

Infancy is a time of incredibly rapid growth and development. Ensuring that infants get the right kinds of nutrients in the right quantities and avoid the wrong kinds of substances gives them their best chance at a healthy start to life. Parents and caregivers are responsible for seeing that their infant's nutritional needs are met. Infant nutrition is so important that the U.S. Department of Agriculture (USDA) has developed the Women, Infants, and Children (WIC) program. This program provides free health and social service referrals, nutrition counseling, and vouchers for healthy foods to supplement the diet of pregnant and breastfeeding women, infants, and children up to the age of five who live in low-income households and are considered nutritionally at risk. In 2016, WIC served about 7.7 million people, including 1.88 million infants, 3.98 million children, and 1.84 million pregnant and nursing women.

Breastfeeding

Human milk is uniquely suited to meet the nutritional needs of newborns. Many health organizations, including the American Academy of Pediatrics (AAP), the American Medical Association (AMA), the Centers for Disease Control and Prevention (CDC), the Academy of Nutrition and Dietetics (formerly the American Dietetic Association), and the World Health Organization (WHO), support the position that breast milk is the best and most complete form of nutrition for infants. These organizations recommend that infants be exclusively breastfed for the first 6 months of life and that breastfeeding continue for at least 12 months.

Breastfeeding in the United States was increasingly accepted in the last decade of the twentieth century. In 1998, 64% of American mothers breastfed their babies for a short time after birth, but only 29% were still breastfeeding by the time their baby was six months old. One of the goals of Healthy People 2020, a set of health goals for the nation developed by the U.S. Department of Health and Human Services, was for 75% of American women to breastfeed their babies for a period immediately after birth and for 50% to breastfeed for the first 6 months of their infant's life. Women were divided into groups based on ethnicity, but none of the groups met the target. More recent initiatives, such as Healthy People 2020, have eliminated the ethnic categories, with the addition of a third target: 82% to breastfeed for a period after birth, 61% to breastfeed for 6 months, and 34% to breastfeed for a full year.

Required nutrients for infant formula

Nutrient

Minimum per 100 calories

Maximum per 100 calories

Protein (g)1

1.8 g

4.5 g

Fat

3.3 g

6 g

30% calories

54% calories

Essential fatty acids (linoleate)

300 mg

2.7% calories

Vitamins

A

250 IU (75 mcg)

750 IU (225 mcg)

D

40 IU

100 IU

K2

4 mcg

E3

0.7 IU

C (ascorbic acid)

8 mg

B1 (thiamine)

40 mcg

B2 (riboflavin)

60 mcg

B6 (pyridoxine)4

35 mcg

B12

0.15 mcg

Niacin5

250 mcg

Folic acid

4 mcg

Pantothenic acid

300 mcg

Biotin6

1.5 mcg

Choline6

7 mg

Inositol6

4 mg

Minerals

Calcium7

60 mg

Phosphorus7

30 mg

Magnesium

6 mg

Iron

0.15 mg

3 mg

Iodine

5 mcg

75 mcg

Zinc

0.5 mg

Copper

60 mcg

Manganese

5 mcg

Sodium

20 mcg

60 mcg

Potassium

80 mg

200 mg

Chloride

55 mg

150 mg

1Amounts apply to proteins with a biological quality equivalent to or better than that of casein. If the quality is less than that of casein, the minimum amount must be increased—e.g., formula containing protein with a biological quality of 75% of casein will need at least 2.4 grams of protein (1.8/0.75). All formulas must use a protein with a biological quality of at least 70% of casein's.

2Added vitamin K must be in the form of phylloquinone.

3Must be 0.7 IU per gram of linoleic acid.

4At least 15 mcg for each gram of protein (past the required 1.8 g).

5Includes niacin (nicotinic acid) and niacinamide (nicotinamide).

6Required only for non-milk-based infant formulas.

7The ratio of calcium to phosphorus in infant formula must be no less than

1.1 but not more than 2.0.

SOURCE: U.S. Food and Drug Administration. Code of Federal Regulations Title 21, no. 2, Sec. 107.100: Nutrient specifications. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=107&showFR=1 (accessed April 4, 2018).

Infants are born with immature immune systems that do not become fully functional for about two years. Because immune system cells make antibodies to fight infection, having incompletely developed immune systems leaves infants vulnerable to many bacterial and viral infections. Nursing mothers have fully developed immune systems, and many of the antibodies and other components of the immune system are passed into breast milk. Nursing infants take in their mother's antibodies along with the other nutrients when they nurse. These antibodies survive passage through the infant's digestive system and are absorbed into the infant's blood, where they help protect against infection. Well-designed studies have repeatedly documented the fact that breastfed babies have fewer ear infections, bouts of diarrhea, respiratory infections, and cases of meningitis than formula-fed babies. Overall, the death rate of breastfed babies during the first year of life is lower than the death rate of formula-fed babies.

Another way that breastfeeding protects against infection is by helping prevent exposure to waterborne contaminants. In developing countries, water supplies are often contaminated with bacteria and chemicals. Using this water to mix formula increases the risk of the baby ingesting these pathogens and toxins. Breastfed babies are not exposed to this type of contamination.

Another advantage of breastfeeding is that infants are unlikely to gain excess weight. Childhood obesity is a major concern in the United States. Because mothers are unable to measure how much breast milk their baby consumes, they are less likely to encourage overfeeding. Research suggests that breastfed babies have a lower risk of developing type 2 diabetes. Other research suggests that the rate of other chronic diseases such as asthma, celiac disease, inflammatory bowel disease, and various allergies appears to be lower in breastfed babies than in babies fed with formula. Premature babies especially appear to benefit from reduced chronic disease as a result of breastfeeding.

Breastfeeding also provides benefits to the nursing mother. Breastfeeding is more economical than buying formula, even taking into account the extra food— about 500 calories daily—that the mother needs to eat when she is nursing. Because breastfed babies on average get sick less than formula-fed babies, the family is also likely to save money on doctor visits, medicine, and time off from work to care for a sick child.

Select recommended dietary allowances (RDA) and adequate intakes (AI) for infants

0-6 months

6-12 months

Vitamins

Folate (folic acid)*

65 ng

80 ng

Niacin*

2 mg

4 mg

Riboflavin (vitamin B2)*

0.3 mg

0.4 mg

Thiamin (vitamin B1)*

0.2 mg

0.3 mg

Vitamin A*

400 ng

500 ng

Vitamin B6*

0.1 mg

0.3 mg

Vitamin B12*

0.4 ng

0.5 ng

Vitamin C*

40 mg

50 mg

Vitamin D

10 ng

10 ng

Vitamin E*

4 mg

5 mg

Vitamin K*

2 ng

2.5 ng

Elements

Calcium*

200 mg

260 mg

Fluoride*

0.01 mg

0.5 mg

Iron

0.27 mg*

11 mg

Magnesium*

30 mg

75 mg

Potassium*

0.4 g

0.7 g

Selenium*

15 ng

20 ng

Sodium*

0.12 g

0.37 g

Zinc

2 mg*

3 mg

Macronutrients

Carbohydrates*

60 g

95 g

Fat*

31 g

30 g

Protein

9.1 g*

11 g

Water*

0.7 L

0.8 L

*Indicates Adequate Intake (no RDA has been established).

μg = microgram (mcg)

SOURCE: U.S. Department of Agriculture, National Agricultural Library, Food and Nutrition Information Center.

DISADVANTAGES OF BREASTFEEDING. Although breast milk is the best food for an infant, breastfeeding does have some disadvantages for the mother. Initially, babies breastfeed about every two to three hours. Some women find it exhausting to be available to the baby so frequently. When the infant is older, the mother may need to pump breast milk for her child to have while she is away or at work. Fathers sometimes feel shut out during the early weeks of breastfeeding because of the close bond between mother and child. In addition, women who are breastfeeding must watch their diet carefully. Some foods or substances, such as caffeine, can pass into breast milk and cause the baby to be restless and irritable. Finally, some women simply find the idea of breastfeeding messy and distasteful, and resent the fact that they need to be available much of the time for feeding. For women who cannot or do not want to breastfeed, infant formula provides an adequate alternative.

Formula feeding

Although infant formula is not as perfect a food as breast milk for infants (it is harder for them to digest and is not a chemical replica of human milk), formula does provide all of the nutrients that babies need to grow up healthy. The U.S. Food and Drug Administration (FDA) regulates infant formula under the Federal Food, Drug, and Cosmetic Act (FFDCA). The FDA sets the minimum amounts of nutrients (29) that must be present in infant formula and sets maximum amounts for nine other nutrients. Some of these nutrients include vitamins A, D, E, and K, and calcium. Some formulas contain iron, while others do not.

Substances used in infant formulas must be foods on the FDA-approved “Generally Recognized as Safe” (GRAS) list. Facilities that manufacture infant formula are regularly inspected by the FDA and are required to keep process and distribution records for each batch of formula. Every container of formula must show an expiration or use-by date. The FDA must be informed of any changes made to the formula.

Infant formulas are either cow's milk based or soy based. Infants who show signs of lactose intolerance (colicky, restless, gassy, spitting up) usually do well on lactose-free cow's milk formula. Formula comes in three styles: ready-to-feed, concentrated liquid, and powder. Ready-to-feed formulas are the easiest to use and can be poured straight from the can into a bottle; however, they are also the most expensive. Concentrated liquids need to be mixed with an equal portion of water. Powder formulas, which also need to be mixed with water, are the least expensive and keep longer than the liquid varieties.

REASONS TO FORMULA FEED. Not every woman wants or is able to breastfeed. Aside from personal preference, women should use formula feed if they:




A nurse injects vitamins into the feeding tube of a premature baby.





A nurse injects vitamins into the feeding tube of a premature baby.
(BSIP/AMELIE-BENOIST/Medical Image)

A few babies are born with a genetic inborn error in metabolism that prevents them from digesting any mammalian milk. These babies must be fed soy-based formula to survive.

PROS AND CONS OF FORMULA FEEDING. Formula feeding has some definite advantages. Anyone, not just the mother, can feed the infant. This gives the mother more flexibility in her schedule and allows the father or other relatives to enjoy a special closeness with the baby that comes with feeding. Also, the mother does not need to be concerned about how her diet affects her baby, and she does not need to worry about breast milk leakage. Because formula is digested more slowly than breast milk, feedings are less frequent. Some women feel uncomfortable nursing in front of other people or find it difficult to locate places to nurse in private. Formula feeding eliminates this problem.

Formula feeding also has some disadvantages. Aside from the fact that formula is not an exact duplicate of breast milk and is harder to digest, it also costs more and requires more advance preparation. Bottles need to be washed, and the water used to mix formula, at least in the early months, needs to be boiled or be special bottled water suitable for infants. The Academy of General Dentistry warns that some public water supplies are fluoridated at levels too high for infants, and that fluorodosis of the primary (baby) teeth may result. Finally, formula must be refrigerated once it is mixed or a can is opened. It can only be kept for about a day in the refrigerator, so waste is more likely to occur. Likewise, when traveling, bottles need to be refrigerated. Although most babies do not mind cold formula, many parents like to heat their child's bottles to body temperature, another inconvenience when traveling.

Transitioning to solid foods

When an infant is between four and six months old, most pediatricians recommend introducing the infant to some baby foods, but not before 17 weeks of age. Infants do not need solid food before six months of age, particularly if breastfed. By this age, infants begin to have the muscle coordination to swallow stage one, or pureed, baby foods. If infants are force-fed early, some may rebel and develop feeding problems. Weaning of a breastfed infant depends on the preferences and needs of the mother and infant. Weaning gradually over weeks or months is easiest. As weaning progresses and the infant takes more solid food, feeds can be dropped, particularly daytime feeds. As the infant becomes more coordinated, drinks can be offered from a cup. Early morning and night time feeds are often the last feeds to remain until the mother and infant are ready to stop completely.

To determine an infant's tolerance, solid foods should be offered by spoon and introduced one food at a time. This allows any reaction to a certain food to be easily identified. This food can then be avoided for a while and reintroduced at a later stage as better tolerance develops. Weaning usually starts with foods mashed or pureed into thick liquids, using the infant's usual milk to make the right consistency. As weaning progresses thicker, lumpier food can be offered along with finger foods for the infant to hold and self feed. Commercial baby foods with high sodium content, more than 200 mg/jar, should be avoided. If there is a family history of food allergies, previous advice recommended waiting until six months or older to start additional foods. Some recent evidence suggests that, for high-risk children, earlier introductions may reduce the risk of allergies (such as peanut allergy). Hence, early exposure may be better. Concerned parents are advised to speak to their health-care practitioner.

Popular first foods include mashed banana or avocado, mixed with a little of the infant's usual milk or a small amount of iron-fortified rice cereal or an other single-grain cereal mixed into a slurry the consistency of thin gravy with formula or breast milk. This should be offered from a spoon and not from a bottle. It may take many attempts before the infant will eat the new food. When the child eats this with ease, parents can begin introducing new foods and offering lightly mashed mixed meals. It is important to offer savory as well as sweet foods. Commercial baby food is available in jars or frozen. Baby food can also be made at home using a blender or food processor. Portions can be frozen in an ice cube tray and thawed as needed.

KEY TERMS
Atopy—
An inherited tendency toward strong and immediate hypersensitivity reactions to substances in the environment. Examples include severe food allergies, allergic skin reactions, and bronchial asthma.
Colic—
Excessive crying in an otherwise healthy infant.
Fluorodosis—
A cosmetic dental problem that can be caused by the presence of too much fluoride in drinking water. Fluorodosis causes brown spots on the teeth but does not weaken them in any way.
Obesity—
Excessive weight due to accumulation of fat, usually defined as a body mass index of 30 or above or body weight greater than 30% above normal on standard height-weight tables.
Pathogens—
Microorganisms that can cause disease.

Beverages such as fruit juices, squashes, or soft drinks should be limited or avoided. Well-diluted sips of juices such as apple, grape, or pear juice (but not citrus juices) can be taken from a cup. Juice should not be served in a bottle. Tea and coffee should be avoided as they contain caffeine and may reduce iron absorption. By the end of the first year, infants can eat a variety of ground or chopped soft foods that the rest of the family eats.

Foods that should not be fed to infants

Some foods are not appropriate for children during their first year. These include:

QUESTIONS TO ASK YOUR DOCTOR

Precautions

Mothers with certain health conditions or using certain drugs should not breastfeed. Women with chronic diseases should consult with their healthcare providers before breastfeeding.

Parents using concentrated liquid and powdered formulas must measure and mix formula accurately. Inaccurate measuring can harm the infant's growth and development. Water used in mixing formula must be free of pathogens, contaminants, and excessive levels of fluoride.

Interactions

Street drugs, many prescription and over-the-counter drugs, and alcohol can all pass into breast milk and have the potential to permanently harm an infant's growth and development. Pregnant or breastfeeding women should consult their healthcare providers before taking any drug or supplement. Caffeine also passes into breast milk. Some women find that even moderate amounts of coffee or caffeinated sodas cause their infants to become restless and irritable, whereas others find little effect. Breastfeeding women should monitor their caffeine intake and try to keep it to a minimum.

Complications

Many women have trouble getting newborn infants to latch on and begin breastfeeding. This can usually be overcome with the help of a lactation consultant or pediatric nurse. Breastfeeding can cause the mother to develop sore, infected nipples. This is usually a temporary condition and should not be a reason to stop breastfeeding.

Complications from bottle feeding tend to be related to the infant's difficulty with digesting formula. Some infants become gassy and colicky and may fuss, cry for long periods, and spit up cow's milk–based formula. Parents are advised to speak to their healthcare professional to see whether switching to an alternative formula may relieve this problem. Other complications with formula feeding are generally related to improper mixing of formula.

Parental concerns

Breastfeeding parents often are concerned about whether their baby is getting enough milk, because there is no way to directly measure how much milk a baby consumes when nursing. Newborns should have a minimum of six to eight wet diapers and four bowel movements per day during the first two weeks of life. As the child grows, these numbers will gradually decrease. In addition, a woman's breasts should feel hard and full (sometimes even painful) before nursing, and softer after nursing. Newborns nurse every two to three hours, and they should seem satisfied after nursing. The most definite sign that the baby is getting enough food is that he or she is gaining weight.

Infants grow in irregular spurts. They may eat hungrily for a few days and then eat little a few days later. Parents often worry about this, but it is a normal pattern.

The transition to solid food is often a slow process. Infants eat very small amounts and often must be exposed to a new food multiple times before they will eat it willingly. Parents should avoid feeding infants only foods that they themselves like, as infants should be allowed to form their own taste preferences. Because childhood obesity is a major problem in the United States, parents and caregivers should avoid encouraging the infant to overeat.

See also Academy of Nutrition and Dietetics ; Breastfeeding ; Calcium ; Childhood nutrition ; Childhood obesity ; Fluoride ; Gestational diabetes ; Insulin ; Iron .

Resources

BOOKS

Behan, Eileen. The Baby Food Bible: A Complete Guide to Feeding Your Child, from Infancy On. New York: Ballantine, 2008.

Dietz, William H., and Loraine Stern, editors. “What's Best for my Newborn?” In Nutrition: What Every Parent Needs to Know, 1–30. 2nd ed. Elk Grove Village, IL: American Academy of Pediatrics, 2012.

Meek, Joan Younger, ed. The American Academy of Pediatrics New Mother's Guide to Breastfeeding. 2nd ed. New York: Bantam, 2017.

Samour, Patricia Queen, and Kathy King, editors. Pediatric Nutrition. 4th ed. Sudbury, MA: Jones and Bartlett Learning, 2010.

Shelov, Steven P., editor. Your Baby's First Year. 5th ed. New York: Bantam, 2015.

PERIODICALS

American Academy of Pediatrics. “Breastfeeding and the Use of Human Milk (Policy Statement).” Pediatrics 129, no. 3 (2012): e827–41.

WEBSITES

American Academy of Pediatricians. “Breastfeeding Initiatives.” AAP.org . (accessed May 5, 2018).

BabyCenter. “Solid Feeding Basics.” https://www.babycenter.com/baby-solid-feeding-basics (accessed May 5, 2018).

March of Dimes. “Feeding Your Baby.” March of dimes.org . https://www.marchofdimes.org/baby/feedingyour-baby.aspx (accessed May 5, 2018).

Matthews, Jania, International Food Information Council. “Questions and Answers about the Nutritional Content of Processed Baby Food.” FoodInsight.org . http://www.foodinsight.org/Questions_and_Answers_About_the_Nutritional_Content_of_Processed_Baby_Food_ (accessed May 5, 2018).

MedlinePlus. “Infant and Toddler Nutrition.” U.S. National Library of Medicine, National Institutes of Health. https://medlineplus.gov/toddlernutrition.html

Office of Disease Prevention and Health Promotion. “Healthy People 2020 Objectives for the Nation.” CDC.gov . https://www.cdc.gov/breastfeeding/policy/hp2020.htm (accessed May 5, 2018).

ORGANIZATIONS

American Academy of Pediatrics (AAP), 345 Park Blvd., Itasca, IL, 60143, (847) 434-4000, (800) 433-9016, Fax: (847) 434-8000, http://www.aap.org .

La Leche League International, 110 Horizon Dr., Ste. 210., Raleigh, NC, 27615, (919) 459-2167, (800) 525-3243, Fax: (919) 459-2075, http://www.llli.org .

March of Dimes, 1275 Mamaroneck Ave., White Plains, NY, 10605, (914) 997-4488, http://www.marchofdimes.org .

Women, Infants, and Children, Supplemental Food Programs Division, Food and Nutrition Service, USDA, 3101 Park Center Dr., Rm. 520, Alexandria, VA, 22302, (202) 305-2746, Fax: (703) 305-2196, http://www.fns.usda.gov .

Tish Davidson, AM
Revised by Anne P. Nugent, PhD

  This information is not a tool for self-diagnosis or a substitute for professional care.