Pediatric nutrition considers the dietary needs of infants to support growth and development, including changes in organ function and body composition.
Purpose
Decisions parents make about nutrition and feeding their infants have short- and long-term effects on the babies' subsequent growth and development. Infectious disease and chronic digestive disease can be reduced with good nutrition choices such as breastfeeding. Breastfed infants have better overall health, so choices about pediatric nutrition are important considerations.
Precautions
Infants consume small amounts of food at a time, but they should not be fed directly from the jar because bacteria is introduced into a jar from the babies' mouth. If uneaten food is then put into the refrigerator, bacteria will likely grow and may cause diarrhea, vomiting, or other signs of food-borne illness. In order to prevent food sensitivities, some foods such as wheat, eggs, and chocolate should be avoided until the child is one year of age.
Ensuring adequate water intake, which can be derived solely through milk, is critical to maintain electrolyte balance and therefore the overall health of infants and young children.
Breastfeeding for optimum health
There are several advantages that breastfeeding provides compared to bottle-feeding. Breast milk imparts superior nutritional, immunological, and psychological benefits to infants. Breastfeeding is also much more economical, and no preparation is required. The American Dietetic Association advocates breastfeeding exclusively for four to six months, and breastfeeding with weaning foods for at least 12 months. The American Academy of Pediatrics also advocates breastfeeding, stating, "Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth…It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired."
Breast milk's nutritional advantages are:
It provides infants with most of the nutrients they need for growth and is a readily available energy source.
It contains large amounts of vitamin E, which may help prevent anemia. Additionally, vitamin E is an important antioxidant.
Unlike cow's milk, it has an optimum calcium to phosphorus ratio of 2:1.
Breastfeeding transfers antibodies from mothers to infants.
All infectious diseases occur less frequently in infants who are breastfed rather than bottle fed.
It favorably changes the pH of stools and the intestinal flora, thus protecting against bacterial diarrheas.
Formula feeding
There are a number of commercially prepared infant formulas on the market available in powder, concentrated liquid, and pre-diluted liquid forms. The American Academy of Pediatrics advises that whole cow's milk should not be given to a child during the first year of life. It also recommends iron-fortified formula for all infants on formula. Infant formula has more protein and more iron than human milk, but lacks antibodies.
Introduction of solid foods
The age to start solid foods depends on infants' needs and readiness, but they do not need solid food before six months of age, particularly breastfed infants. Tongue and mouth movement is usually adequate by four months. If infants are force-fed early, some will 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. When the infant is about seven months old, breast-feeding once a day should be replaced by a bottle or cup of modified formula or fruit juice. By 10 months, the infant may be weaned to a cup. Thereafter, one or two feedings daily can be continued until age 18 to 24 months. A full diet of solid foods and fluids by cup should be given to infants who are nursed even longer.
To determine an infant's tolerance, solid foods should be offered by spoon and introduced one flavor at a time. Many commercial baby foods (desserts and soup mixtures, in particular) are high in starch, calories, have no or little vitamin or mineral value, and are high in cellulose, which is poorly digested by infants. Commercial baby foods with high sodium content, more than 200 mg/jar, should be avoided. The daily sodium requirement is 17.6 mg/kilogram. Pureed home foods will suffice.
KEY TERMS
Anemia—A decrease in the number of red blood cells in the bloodstream, characterized by pallor, loss of energy, and generalized weakness.
Cystic fibrosis—A hereditary genetic disorder that occurs most often in Caucasians. Thick, sticky secretions from mucus-producing glands cause blockages in the pancreatic ducts and the airways.
Dietary reference intakes (DRI)—This standard recommends the daily amounts of energy, protein, minerals, and fat-soluble and water-soluble vitamins needed by healthy males and females, from infancy to old age.
Electrolytes—Any of the various ions such as sodium, potassium, or chloride required by cells to regulate the electric charge and flow of water molecules across the cell membrane.
Gluten enteropathy—A hereditary malabsorption disorder caused by sensitivity to gluten, a protein found in wheat, rye, barley, and oats. Also called non-tropical sprue or celiac disease.
Meat should be preferentially introduced to high-carbo-hydrate foods; however, because infants often reject meat, it must be introduced patiently and carefully.
To ensure infants eat enough fat when weaning from breast milk or formula, choose whole milk up to two years of age. Two good sources of protein and fat that infants enjoy are peanut butter and cheese. If there are concerns about obesity, lean protein choices provide the fat and protein. Adequate intakes of grains, fruits, and vegetables will ensure that infants receive all the necessary vitamins and minerals.
Preparation
In order to make appropriate choices about pediatric nutrition, it is important to be aware of the nutritional needs of infants. The following are the recommended vitamin and mineral intakes for infants and young children:
Vitamin A for infants 0–6 months: 400 micrograms/day (mcg/d); 7–12 months: 500 mcg/d; children 1–3 years: 300 mcg/d.
Thiamine (vitamin B1) for infants 0–6 months: 0.2 milligrams/day (mg/d); 7–12 months: 0.3 mg/d; children 1–3 years: 0.5 mg/d.
Riboflavin (vitamin B2) for infants 0–6 months: 0.3 mg/d; 7–12 months: 0.4 mg/d; children 1–3 years: 0.5 mg/d.
Niacin for infants 0–6 months: 2 mg/d; 7–12 months: 4 mg/d; children 1–3 years: 6 mg/d.
Vitamin B6 for infants 0–6 months: 0.1 mg/d; 7–12 months: 0.3 mg/d; children 1–3 years: 0.5 mg/d.
Vitamin B12 for infants 0–6 months: 0.4 mcg/d; 7–12 months: 0.5 mcg/d; children 1–3 years: 0.9 mcg/d.
Pantothenic acid for infants 0–6 months: 1.7 mg/d; 7–12 months: 1.8 mg/d; children 1–3 years: 2.0 mg/d.
Biotin for infants 0–6 months: 5 mcg/d; 7–12 months: 6 mcg/d; children 1–3 years: 8 mcg/d.
Folate for infants 0–6 months: 65 mcg/d; 7–12 months: 80 mcg/d; children 1–3 years: 150 mcg/d.
Vitamin C (ascorbic acid) for infants 0–6 months: 40 mg/d; 7–12 months: 50 mg/d; children 1–3 years: 15 mg/d.
Vitamin D (in the absence of adequate sunlight) for infants 0–6 months: 5 mg/d; 7–12 months: 5 mg/d; children 1–3 years: 5 mg/d.
Vitamin E for infants 0–6 months: 4 mg/d; 7–12 months: 5 mg/d; children 1–3 years: 6 mg/d.
Vitamin K for infants 0–6 months: 2.0 mcg/d; 7–12 months: 2.5 mcg/d; children 1–3 years: 30 mcg/d.
Calcium for infants 0–6 months: 210 mg/d; 7–12 months: 270 mg/d; children 1–3 years: 500 mg/d.
Phosphorus for infants 0–6 months: 100 mg/d; 7–12 months: 275 mg/d; children 1–3 years: 460 mg/d.
Magnesium for infants 0–6 months: 30 mg/d; 7–12 months: 75 mg/d; children 1–3 years: 80 mg/d.
Selenium for infants 0–6 months: 15 mcg/d; 7–12 months: 20 mcg/d; children 1–3 years: 20 mcg/d.
Zinc for infants 0–6 months: 2 mg/d; 7–12 months: 3 mg/d; children 1–3 years: 3 mg/d.
Iron for infants 0–6 months: 0.27 mg/d; 7–12 months: 11 mg/d; children 1–3 years: 7 mg/d.
Energy (calories) for infants 0–6 months, with a weight of approximately 6 kg (13 lb): 650 kilocalories per day (kcal/d); 6–12 months with a weight of approximately 9 kg (20 lb): 850 kcal/d; children 1–3 years with a weight of approximately 13 kg (28 lb): 1300 kcal/d.
Protein for infants 0–6 months: 13 grams per day (g/d); 6–12 months: 14 g/d; children 1–3 years: 16 g/d.
Breastfed infants need 400 international units (IU) of vitamin D and 0.25 mg of fluoride daily.
Breastfeeding does not require any preparation, but bottle feeding requires some preparation such as ensuring the milk is the right temperature and the nipples are sterilized, if sterilized disposable nipples are not used.
Complications
Obesity may start with excessive eating in infancy. If an infant has two obese parents, it is particularly important to monitor and control weight gain. With two obese parents, an infant has an 80% chance of becoming obese.
Infants should be closely monitored for proper weight gain to ensure they are receiving adequate nutrition. Resources such as the National Center for Health Statistics growth charts can be used as a guide.
Health care team roles
Breastfeeding education efforts are important steps for health care teams. They should encourage a longer duration of breastfeeding to achieve maximum nutritional benefits for infants. A dietitian can assist in providing advice regarding pediatric nutrition feeding decisions.
BOOKS
Baker Jr., Robert D. Pediatric Parental Nutrition, 1st ed. Gaithersburg, MD: Aspen Publishers, Inc., 2001.
Hendricks, Kristy M., et al. Manual of Pediatric Nutrition, 3rd ed. Hamilton, Canada: B. C. Decker Inc., 2000.
Institute of Medicine. Dietary Reference Intakes: Applications in Dietary Assessment. Washington, D.C.: National Academy Press, 2001.
Mindell, Earl, and Hester Mundis. Earl Mindell's Vitamin Bible for the 21st Century. London, UK: Warner Books, 1999.
Rodwell-Williams, Sue. Essentials of Nutrition and Diet Therapy. London: Mosby-Year Book, 1999.
Samour, Patricia Q., et al. Handbook of Pediatric Nutrition, 2nd ed. Gaithersburg, MD: Aspen Publishers, Inc., 1999.
PERIODICALS
Azais-Braesco, V., and G. Pascal. "Vitamin A in Pregnancy: Requirements and Safety Limits." American Journal of Clinical Nutrition 71 (2000): 1325S-33.
Mills, J. L. "Fortification of Foods with Folic Acid—How Much is Enough?" New England Journal of Medicine 342 (2000): 1442-45.
Traber, Maret G. "Vitamin E: Too Much or Not Enough?" American Journal of Clinical Nutrition 73 (2001): 997-98.
ORGANIZATIONS
American Dietetic Association. 216 W. Jackson Blvd., Chicago, IL 60606-6995. (312) 899-0040. <http://www.eatright.org/>.
Food and Nutrition Information Center Agricultural Research Service, USDA. National Agricultural Library, Room 304, 10301 Baltimore Avenue, Beltsville, MD 20705-2351. (301) 504-5719. (301) 504-6409. <http://www.nal.usda.gov/fnic/>. fnic@nal.usda.gov.
Food and Nutrition Professionals Network. <http://nutrition.cos.com/>.
La Leche League International. 1400 N. Meacham Road, Schaumburg, IL 60168-4079. (847) 519-7730. <http://www.lalecheleague.org/>.
OTHER
Women, Infants, and Children. The Food and Nutrition Service Headquarters. 3101 Park Center Drive, Alexandria, VA 22302. (703) 305-2746.
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