Newborns, Infants, and Toddlers (age 0 to 2 years old)
PILLAR TWO: Nutrition
The American Academy of Pediatrics (AAP) and the World Health Organization both recommend breastfeeding for the first six months of life. The health gains from breastfeeding can lower the risk of obesity later in life.
Promoting and supporting breastfeeding should be the standard of care for all prenatal and routine pediatrician visits.
The AAP notes that breastfeeding cessation often occurs during the transition from hospital to home, at ages 6 to 8 weeks, and when the mother returns to work.
When breastfeeding is not feasible, the alternative is bottle-feeding infant formula. At 2 months of age, an infant will consume 4 to 5 ounces per feeding, every three to four hours, for a total of about six feedings within 24 hours.
This amount of formula volume per feeding gradually increases while the number of meals per day decreases until a peak at 6 months of age. Here, the infant will consume 7 to 8 ounces of formula per feeding, every four to five hours during the day, with no nighttime feedings.
Complementary foods should be introduced at 6 months of age and not before. Introducing solids before 4 months of age is associated with excessive weight gain in infancy as well as childhood obesity.
The initial foods should be high in iron and zinc. Pureed meats and iron-fortified infant cereals best meet the nutritional needs at this age.
Share with parents the Infant Feed Chart, which shows the types and amounts of solid foods required in the first year of life.
Why excessive weight gain occurs
Discuss with the parents the possible reasons for excessive weight gain and how to avoid it:
- Introducing complementary foods too early (it should begin after six months).
- Formula feeding greater than 45 ounces a day if there are no solid foods or 32 ounces a day with solid foods. (Suggest they limit formula to 24 ounces a day if the infant is higher than 85 percentile weight for length and takes solid foods.)
- Review with parents the appropriate intake of complementary foods after 6 months of age, including food selections and portion sizes. (Also, stress the need to maintain regular vegetable and fruit intake and encourage adding a fruit or vegetable to at least one daily snack.)
- Share the handouts, Introduction to Solids and Spoon Feeding and How to Start Feeding Solids.
Evidence shows that overfeeding is the most common factor for excessive infant weight gain. Parents need to recognize the signs of hunger and satiety. These include:
SIGNS OF HUNGER
Breast- or bottle-feeding
- Hand-to-mouth activity
- Facial grimaces before crying
- Fussing sounds
- Waking and tossing
- Crying (a late sign of hunger)
- Watching food being opened
- Making a tight fist or anxiously reaching for the spoon
- Showing irritation if the feeding pace is too slow or temporarily stops
SIGNS OF SATIETY
Breast- or bottle-feeding
- Turning the head away from the nipple
- Lack of interest in eating
- Closing the mouth
- Sealing the lips
- Sucking that slows or stops and starts
- Spitting out the nipple or falling asleep
- Playing with the spoon or other food
- Eating slower or turning away from the food
- Spitting out the food
Wellness tip: Healthier bottle-feeding
Make sure parents follow these healthy bottle-feeding habits:
- Only use expressed breast milk or formula
- Do not give juice or sweetened beverages like soda or sports drinks
- Do not prop the bottle during feedings and let babies feed alone (this takes away from parent-baby bonding and may increase the risk of choking) Additionally, propping the bottle may lead to overfeeding.
- Do not add cereal or other foods to the bottle
- Learn their infant’s hunger and satiety signs to avoid overfeeding
Transition to Toddlerhood
Parents should introduce a variety of foods by the end of the child's first year, which can teach the child healthful food habits and reduce the risk of obesity later in life. Here are some strategies to help parents make a successful food transition.
- As an infant moves from puree foods to more textured table foods, a lower intake of vegetables and fruit is common. Parents should make sure to offer softer, chopped vegetables and fruits to the infant’s diet.
- By 9 months of age, an infant should have two snacks a day and can include easy-to-eat finger foods, such as cereal, crackers, and cookies.
- If the infant/toddler refuses food, try again. It can take 10 to 20 attempts before food is accepted. Also, offer new meals prepared in different ways. For example, vegetables can be served fresh, steamed, roasted, or mashed.
- Share the handout Infant Feed Chart for portion sizes and recommended daily servings.
The AAP recommends no fruit juice for children younger than 1 year old because it does not provide the necessary nutrients like breast milk, formula, or fruits and vegetables. Excessive juice intake also may contribute to weight gain. Juice can be introduced after 1 year of age but should be limited to no more than four ounces a day. Parents should also avoid sodas, sports drinks, and sugar-sweetened beverages like lemonade, fruit punch, sweet tea, and portable kids drinks, such as Sunny D and Capri Sun.
Other practices also are associated with increased weight gain among infants. Parents should NEVER do the following:
- Offer food as a reward. Instead offer age-appropriate non-food related treats, such as reading a favorite book together, visiting the park, or taking a walk.
- Force feed. Never force a child to eat during designated mealtimes. Allow the child to self-regulate when he or she is hungry and full.
- Insist on finishing the plate. Again, let the child eat until he or she feels full and not until the dish is clean. Serving appropriate portion sizes can help.
Wellness Tip: Reduce excessive caloric intake
Here are some other tips to share with parents about managing their child’s calories:
- Create a structured daily meal and snack times, such as three meals and one to two snacks a day. This approach encourages regulation of appetite.
- Provide meals and snacks at the table or in a highchair versus eating on the go.
- Use smaller, age-appropriate plate sizes.
- Avoid feeding during non-meal and snack times; for example, waiting for appointments, in the grocery store, and when driving.
- Introduce a spoon at 8 to 9 months of age, and transition to a cup by 1 year of age. A spoon promotes self-feeding behavior. Also, share the handout Transitions to Cup and Table Food.