Table Of ContentHistoric, Archive Document
Do not assume content reflects current
scientific knowledge, policies, or practices.
5 3
2. ?
United States and
Infant Nutrition
Department of
II)
Agriculture
Feeding
Food and
Nutrition
Service
FNS-288 A Reference Handbook for
Nutrition and Health
Counselors the WIC and
in
CSF
Programs 3>
|1
i
>
op
i
\
est* T3 'a
>
-<
Q
<3
(3
5
2
4
C
•
'^^P' Infant Nutrition and Feeding
Note to the Reader on Using This Handbook
This handbook is for staffwho provide nutrition education and counseling to the
parents and guardians (termed "caregivers" inthe text) ofat-risk infants who par-
ticipate in the Special Supplemental Food Program for Women, Infants, and
Children (WIC) and the Commodity Supplemental Food Program (CSFP). This
publication provides an overview ofbasic subjects related to infant nutrition and
feeding and answers some common questions on the nutritional needs ofinfants,
the development offeeding skills, breastfeeding, formula feeding, the introduc-
tion offoods, infant feeding practices, food selection and sanitary food prepara-
tion and storage, oral health, vegetarian nutrition, and some common gastroin-
testinal problems.
Since this publication primarily focuses on nutrition forthe full-term infant
without medical conditions, the reader is advised to consult with other trained
health professionals ortextbooks on pediatrics and/or pediatric nutrition for
more detailed or advanced technical information on particular aspects ofinfant
nutrition, assessment ofan infant's nutritional status (including growth and
development), and nutrition care for preterm, low-birthweight, or special needs
infants orthose with medical conditions. Note that the term "health care
provider" in the text refers to the physician, dentist, nurse practitioner, regis-
tered nurse, or otherhealth professional providing medical or dental care to the
infant.
This handbook can assist staffin disseminating appropriate and accurate infor-
mation to clients and in planning individual counseling sessions, group classes,
and staffinservice training sessions. Chapter 7 summarizes key points taken
from the whole text. Reference citations throughout the text are cited in full at
the end ofeach chapter. A selectedbibliography is provided for additional refer-
ences on pediatric nutrition, nutrition care for childrenwith developmental dis-
abilities, lactation management, ethnic and cultural influences on infant nutri-
tion and feeding, and parenting skills. For quick reference to topics, referto the
detailed index at the end ofthis handbook.
Every effort has been made to ensure the accuracy ofthe information in this
handbook. The recommendations inthis handbook are not designed to serve as
an exclusive nutrition care plan or program for all infants. It is the responsibility
ofeach staffperson providing nutrition education to caregivers ofinfants to
evaluate the appropriateness ofnutrition recommendations in the context ofan
infant's nutritional and health status, lifestyle and other factors affecting that
status, and any new developments in infant nutrition. Ifyou have a question or
are unsure about the appropriateness ofa particularnutrition recommendation
for a particular infant, consult with the infant's health care provider and
someone with additional expertise in pediatric nutritionbefore makingthe
recommendation.
We are interested in your comments on this handbook. Please help us by com-
pleting the READER RESPONSE on the last page.
September 1993
Infant Nutrition and Feeding
Contents
Basic Background Information on
1: Nutritional Needs of Infants 1
Breastfeeding 36
Introduction 1 How the Breasts Function to
Nutrition Assessment 1 Produce Milk 36
Recommended Dietary Allowances and Breast Structure and Function 37
Other Estimated Nutrient Requirements 2 Hormonal Control ofLactation 37
Background Information on The Let-Down or Milk
Specific Nutrients 2 Ejection Reflex 37
Energy 2 Composition ofHuman Breast Milk 39
Carbohydrates 5 Colostrum 39
Protein 6 Mature Human Milk 39
Lipids 7 Practical Breastfeeding
VitaminD 8 Techniques and Tips 42
Vitamin A 9 Comfort During Nursing 42
Vitamin E 9 Feeding Positions 42
Vitamin K 10 Burping 47
Vitamin C 10 Frequency and Duration
Vitamin B 10 ofFeedings 47
12
Folate 11 Indicators ofWhether an Infant is
Vitamin Bg (Pyridoxine) 11 Consuming Enough Milk 49
Thiamin (Vitamin B 11 Supplementary or
1)
Riboflavin (Vitamin B 11 Complementary Bottles 50
2)
Niacin 12 Aids and Devices for
-J
Calcium 12 Breastfeeding 50
Iron 12 Breast Care 52
Zinc 14 Bowel Movements ofInfants 52
Fluoride 14 Expression ofMilk 53
Sodium 16 Planning for Time Away
Water 16 From the Infant 54
References 24 Common Concerns 56
Flat or Inverted Nipples 56
Table 1: Sore Nipples 56
Caloric Needs ofInfants 4 Engorgement 57
Plugged MilkDucts 57
2: Development of an Infant's Mastitis 57
Feeding Skills 29 Poor Suckling 58
Use ofCigarettes, Alcohol and Other
Stages ofMouth, Hand, and Body Drugs, and Certain Beverages
Skill Development in Infants 29 During Lactation 58
The Feeding Relationship 29
Cigarettes 58
References 32 Alcohol 59
Caffeine-Containing Products 59
Figure 1: Herbal Teas 60
Sequence ofInfant Development and Other Drugs 60
Feeding Skills in Normal, Healthy Contraindications to
Full-term Infants 31 Breastfeeding 60
Weaningthe Breastfed Baby 61
3: Breastfeeding 35 References 66
Benefits ofBreastfeeding 35
Methods to Support Nursing Figure 2:
Mothers in Your Program 35 Diagram ofStructures ofthe
Breast During Lactation 38
Infant Nutrition and Feeding
Figure 3: Figure 7b:
Common Breastfeeding Positions 43 Preparation Checklist for Standard
Figure 4: Milk- and Soy-BasedPowdered
Australian Hold orPosture Infant Formula 81
Feeding Position 45 Figure 7 c:
Figure 5: Preparation Checklist for Standard
Positionto Hold the Breast With the Hand Milk- and Soy-Based Ready-to-Feed
(C-Hold orPalmar Grasp) 46 Infant Formula 82
Figure 6:
Illustrations ofAids and Devices 5: Infant Foods 87
for Breastfeeding 62
Guidelines on Introducing New Foods 87
4: Formula Feeding 71 Developmental Readiness for
Solid Foods 87
Types ofCommercial Infant Developmental Delays Affect An Infant's
Formulas 71 Feeding Skills 88
Milk-Based Infant Formula 71 Problems With Introducing
Soy-Based Infant Formula 72 Solid Foods Early 88
OtherInfant Formulas 72 Problems With Introducing Solid Foods
Other Milks and OtherProducts 72 Very Late in Infancy 90
Whole Cow's Milk 72 Importance ofSlowly and Gradually
Low-Fat or Skim Cow's Milk 73 Introducing Each New Food 90
Evaporated Cow's Milk 74 Types ofFoods to Introduce 91
Sweetened Condensed Milk 74 Iron-Fortified InfantCereal 91
Goat's Milk 74 FruitJuice 91
Imitation Milks 74 Vegetables and Fruits 92
Recommended Amounts ofFormula Protein-rich foods 94
in the First Year 74 GrainProducts 97
Hunger and Satiety Cues 75 Finger Foods 97
Feeding Frequency and Amount 75 Sweetened Foods and Sweeteners 98
Sleepy orPlacid Infant 75 Beverages 98
Bottle Feeding: Tips on Feeding 76 General Tips on Food Purchasing and
Guidelines on Feeding a Bottle 76 Sanitary Food Preparation and Storage 99
Propping a Bottle Not Recommended 76 Home-Prepared Baby Food 99
Selection, Preparation, and Storage Commercially Prepared Baby Foods 102
ofInfant Formula 77 Food Safety Resources 103
Selecting Cans ofInfant Formula 77 Practical Aspects ofFeeding Solid
Sanitizing Bottles and Preparing Foods and Beverages 103
Infant Formula 77 Feeding Methods for Solid Foods 103
Sterilizing Water and Bottles 78 Recommended Amounts of
Storing Infant Formula 78 Solid Foods 104
Traveling with Infant Formula 78 Drinking from a Cup 105
Warming Infant Formula 78 Weaning from a Bottle 105
Guidelines for Infant Formula Use When Choking Prevention 105
There is Limited Access to Common References 110
Kitchen Appliances 79
References 83 Figure 8:
How the Recommended Sequence of
Figure 7 a: Introducing Foods Corresponds With
Preparation Checklist for Standard Milk- and Food Textures and Feeding Styles 89
Soy-Based Concentrated Infant Formula 80 Figure 9:
Guidelines for Feeding
Normal Infants, Birthto 1 Year Old 108
mm
Infant Nutrition and Feeding
^1
6: Special Concerns in Infant Table 3:
Feeding 113 Recommended Allowances of
Reference Protein and U.S.
Dietary Protein 159
Oral Health 113
Tooth Development 113 Table 4:
Estimated Safe and Adequate
Dental Caries (Tooth Decay) 113
Daily Dietary Intakes ofSelected
Nursing Bottle Caries (Baby Bottle
Vitamins and Minerals 160
ToothDecay) 114
Prevention ofDental Caries and Table 5:
Estimated Sodium, Chloride, and
Nursing Bottle Caries 114
Potassium Requirements of
Caring for an Infant's Mouth and
Healthy Persons 161
Teeth 116
C. Nutrient Chart: Function, Deficiency
Dental Care 116
and Toxicity Symptoms, and Major
Teething 116
Food Sources 162
Sources ofEducational Materials
on Oral Health for Infants and D. What CanYouDo When A Child Is
Choking? 167
Young Children 117
Vegetarian Diets 117
Selected Bibliography 169
Risks ofSome Vegetarian Diets 118
Guidelines for Nutrition Counseling ....118 Pediatric Nutrition 169
Common Gastrointestinal Problems 122 Nutrition Care for Children with
Spitting Up and Vomiting 122 Developmental Disabilities 169
Diarrhea 122 Breastfeeding Promotion 170
Constipation 123 Breastfeeding and Lactation
3 References 124 Management 171
Ethnic and Cultural Influences on
Figure 10: Infant Nutrition and Feeding 172
Illustration ofHealthy Teeth and Parenting ofInfants and Infant
ToothDecay Typical in Cases of Development 173
Nursing Bottle Caries 115 Selected Audiovisuals on
Infant Feeding 176
Figure 11:
Recommended Daily Food Servings Additional Resource Materials on Infant
Nutrition Topics 176
for a 6- to 12-Month-Old Vegan Infant 121
7: Summary of Key Points in Index 178
Previous Chapters 127
Acknowledgements 185
Appendix
Reader Response 191
A. National Center forHealth Statistics
(NCHS) Growth Charts:
Boys: Birth to 36 Months 148
Girls: Birth to 36 Months 152
B. Table 1:
Recommended Dietary
Allowances, 1989 156
Table 2:
Median Heights and Weights
and Recommended Energy Intake 158
