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Normal Nutrition, Growth and Development
Birth - Twelve Months
Growth and Development:
- The first year of life is characterized by rapid growth. Right after birth, infants lose weight; birth weight is usually regained by the seventh to tenth day after birth. Thereafter, rapid growth occurs with most infants doubling their birth weight by 4 months and tripling it by 12 months of age.
- Nutrient needs are met by breast milk or iron-fortified formula for the first 4 - 6 months of life. Breastmilk is recommended for the first twelve months; however, women unable to breastfeed should be supported and not made to feel inadequate. Breastfeeding may be contraindicated in some cases (e.g., women taking certain medications or women infected with HIV or hepatitis C) Breastfed infants may need fluoride or vitamin D supplements; these needs should be discussed with the infant's pediatrician.
- Hydration is crucial for infants. Dehydration can occur quickly in heat or with diarrhea or vomiting. Fluid needs are met by breastmilk or formula in most circumstances; however, if extra fluids are needed, the pediatrician should be consulted. Water intoxication can occur if young infants are given too much plain water.
- Introducing Solid Foods - Infants transition from exclusive breast milk/formula feedings by starting solid foods between 4-6 months of age. Iron-fortified infant rice cereal is usually introduced first as it is hypoallergenic, provides needed iron, and can be altered in consistency as the infant adjusts from liquid to thicker textures. Foods should be added to the diet one at a time with several days in between introduction of each food. This will allow time to observe food tolerance and screen for allergic symptoms. First foods should be the least allergenic, easiest to digest, and thinnest texture. As food tolerance becomes established, foods are advanced until by age one year the baby is meeting most of its nutrient needs from table-foods.
- Energy needs are extremely high with newborns - the first twelve months an average calorie need is about 100 - 120 kcal /kg/d (about 45-50 kcals/lb/d) In contrast, a typical adult requires only 30 kcals/kg/d (10-15 calories per pound of body weight) Evidence of high metabolic needs is an infants rapid heart and respiration rate.
- Protein needs are greater for infants to support their rapid growth a newborn may require about 2.5 - 3.0 grams of protein /kg/d compared to adult protein needs of about 0.8g/kg/d
- Cow's milk is not recommended for the first twelve months. Cow's milk has too much protein, is hard for infants to digest, can cause gi bleeding. It does not have the appropriate balance of nutrients for infants and is hard on their kidneys. Regular whole cow's milk should not be included into a child's diet until after one year of age.
- Fat is not restricted in an infants diet - breast milk has a high fat content
- Honey should never be given to babies under one year of age; there is a risk of botulism
- Foods that are hard (nuts, raw carrots), sticky (peanut butter) or the right size to block the babies airway (hot dogs or foods cut in circles) should not be given to children under three years of age secondary to choking risk
- Microwaves can heat food too hot and unevenly. It's better to err on the side of giving baby cold foods. Warming bottles under warm running tap water is safer than microwave warming
- Parents/caregivers decide what the baby will eat - for the first six months it is a simple choice between breast milk or infant formula - babies should decide when and how much to eat. It is important to pay attention to infant satiety cues and not overfeed (e.g. push the baby to "finish" the bottle). Babies are not necessarily hungry every time they cry, if alternative comfort measures don't work, however, the baby should be fed even if little time has elapsed since the last feeding. Feeding patterns may vary greatly from one day to the next with increased frequency of feedings during "growth spurts."
- Babies have a small stomach capacity and need to eat often - they should be fed on demand, not by a schedule - even if this means little sleep for the adults! Responding quickly to baby's hunger cues starts the feeding relationship off on the right foot by making the infant feel that it can communicate its needs effectively.
- Babies spit up a lot - if weight is increasing adequately, this is generally not a concern.
- Avoid early introduction of allergenic foods such as egg-white, wheat, citrus, chocolate and nut butters
- Fruit juice should not be given by bottle. By age 6-8 months, a small amount of diluted fruit juice can be given by cup. Babies should not have more than 3-4 ounces of juice per day. Excess juice has been linked to poor growth in babies (in older children, excess fruit juice consumption carries a risk of obesity).
- Bottles are for breast milk, formula, and for older babies, water. Cereal should not be added to bottles
- Colic - the infant has an immature digestive tract and GI upset is common. Also, gas can result from air swallowed during feedings, especially for newborns mastering suck and swallow coordination. Burping, proper latch on and holding baby in appropriate position during feeding can all be helpful. For severe symptoms, there are infant anti-gas drops. Pediatricians should be consulted if GI symptoms are severe, persistent, or if there is any blood in the stool.
- Poor weight gain - some babies sleep too long or fall asleep during feedings and don't gain weight adequately as newborns. These infants may need to be wakened every 3-4 hours to be fed. For babies that fall asleep during feedings, unwrapping them or tickling their feet may help them stay awake during feedings.
- Teething - One of the hardest things about parenting is watching your baby or child suffer. When babies are cutting teeth, parents often want to try anything to ease the process. Here are some cautions to keep in mind:
- Use only specially designed "teething" rings when you give your baby something to chew on. Choking or injury to the mouth and gums are possible when you give your baby other items to chew on.
- Don't give infants age-inappropriate foods to use for teething. If your baby isn't ready to eat a food, it shouldn't be used for teething. A baby, even one without teeth, can break off pieces of food that could pose a choking risk. Ironically, people often use hard-to-chew foods as teething objects; these may be the very foods that pose the greatest choking risk! Also, hard foods can cause cuts or other injury to an infant's mouth or gums. Besides the choking hazard, salt-cured foods such as jerky and those foods with sodium nitrates contain carcinogens which are associated with cancer. Infants have a higher risk for cancer development with exposures because of rapid cell division.
- Over-the-counter numbing agents can provide some temporary relief for teething babies. However, a baby with a numb mouth may have some difficulty chewing and swallowing. Be sure and watch your baby closely during meals if you are using mouth-numbing teething medication.
- Don't use alcohol (brandy, whiskey, etc.) on a baby's gums. Even a small amount of alcohol ingestion can be very dangerous for an infant. Alcohol is toxic and should never be given to babies or children.
Some babies may sail through the teething process with few symptoms while other infants are visibly uncomfortable and difficult to console with each new tooth's arrival. If you think your baby is suffering from painful teething, check with your pediatrician about pain-reducing strategies.
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