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Nutrition Through The Ages: Infancy

Updated: May 24, 2023

As we know, the demand for specific nutrients adjusts throughout our lives. We've already discussed how pregnancy is a time when above-adequate nutrition is ideal. Infancy is second only to pregnancy regarding the heightened demand for some nutrients; and, this is also due to the rapid rate of growth and development that is occurring.

The first year of life is unmatched when it comes to growth. An infant will triple their weight and gain approximately 10 inches in length during this first year. It is the rapid rate of growth and development that makes an infant's nutrient needs so demanding. And, while it is important to be mindful of this rapid and intensive growth, it is also essential to understand that an infant's digestive tract and kidneys are not fully mature at this time. Additionally, their small size influences their ability to consume the nutrients they need.

"Weight, length, weight for height, and head circumference (HC) are the primarily used markers for measuring growth rates in infants and children. Trends in growth patterns over time provide more valuable information than a single measurement." - Patel; 2021

Infants should NOT be viewed as little adults when it comes to eating, and this is especially true for the first four to six months. Not only are their bodies not yet capable of consuming the types of foods adults eat, their bodies simply cannot maintain adult eating schedules. Also, due to the intensive growth and development, infants abilities are ever-changing which also adjusts how an infant feeds as well as how much an infant can consume at any given feed.


Growth Ages & Stages


General Infant Feeding Practices

While specific nutrients needs are the primary focus for this series, when it comes to infant eating behaviors there are some characteristics that should first be discussed as the provision of nutrition required by caregivers is at its absolute height. Although infants are not mini-adults, they do share one similarity in that they are all individuals, and every single suggestion - whether it be for feeding amounts, feed schedules, growth, etc., - is just that, a suggestion. Consider all this information to be a guide that is intended for individual adjustment.


How Much/Often Should Baby Eat?

The following feeding practices come from the American Academy of Pediatrics:

  • Newborns eat every 2 to 3 hours, or 8 to 12 times every 24 hours. Babies might only take in a half ounce per feeding for the first day or two of life, but after that will usually drink 1 to 2 ounces at each feeding. This amount increases to 2 to 3 ounces by 2 weeks of age.

  • At about 2 months of age, babies usually take 4 to 5 ounces per feeding every 3 to 4 hours.

  • At 4 months, babies usually take 4 to 6 ounces per feeding.

  • At 6 months, babies may be taking up to 8 ounces every 4 to 5 hours. The introduction of complementary, solid foods typically begins at this time for taste and texture development.

How Should Baby Eat?

Breastfeeding, bottle feeding, formula feeding, and solid foods are all potentially included in an infant's first year of life. This post will not focus on breastfeeding as the, Nutrition Through The Ages: Special Edition - Lactation covered breastfeeding extensively. The similarities between breastfeeding and bottle feeding, primarily concerns over is "my baby getting enough" as well as recognizing hunger/fullness cues, can be found in that post. Additionally, breastfeeding benefits are also covered there.


Formula Feeding

While breastfeeding is commonly described as the "gold standard" when it comes to early nutrition, due to its "in-house" grown benefits (anti-microbial, anti-inflammatory, enzymes, hormones, and growth factors) that readily transfer from mom to baby, it is not the only method available. Caregivers who cannot breastfeed or or who choose not to, should know that there are alternatives that adequately provide the nutrients babies need.


Two differences are important to note: formula is less digestible than breast milk which often means formula-fed babies need to eat less often than breastfed babies, and the chosen feeding route will also dictate specific nutrient needs.

"Commercial formulas attempt to duplicate mother's milk using a complex combination of proteins, sugars, fats, and vitamins that aren't possible to create at home. So if you don't breastfeed your baby, it's important to use only commercially prepared formula and not try to make your own." Ben-Joseph; 2018


Solid Food Readiness

The introduction of solid food is suggested around six months, and is considered to be complementary to either breastfeeding or bottle feeding. Baby's digestive tract is ready at this time and the incorporation of solid foods become major milestones alongside other behavioral developments. Solid food exposure is also critical for the introduction of different foods. This is not only when allergies are often first discovered, but there is so much eating behavior development centered on the inclusion of food variety/exposure that begins here.


So, how can we know an infant is ready for solid foods? The following readiness come from the American Academy of Pediatrics:

  • Holds Head Up High. Although some babies are able to lift their heads in a show of strength from the day they are born, it’s usually not until 3 or 4 months of age that the ability to hold one’s head up consistently higher and for longer periods sets in.

  • Sitting Pretty. Babies typically start sitting—albeit initially with a fair bit of propping—at about 6 months of age. Fortunately, several modern-day high chairs and feeding chairs come with convenient recline features that offer additional support for those not quite ready to sit fully upright on their own.

  • Big Enough. As a rough rule of thumb, babies are big enough to tackle solid foods right around the time when they double their birth weight and reach a minimum of about 13 pounds.

  • Can Watch & Respond. As babies become more aware of the world around them, they also tend to become more interested in food—often watching food intently and opening their mouths in eager anticipation when they see some headed their way.


 

Macronutrients

Macronutrients are the nutrients the body requires in large amounts. They are what makes up our total caloric intake. [Breastmilk and formula will adequately provide the macronutrients in the amount that are needed.]


Carbohydrates

  • NEEDED FOR: Carbohydrates are our brain’s primary choice for energy.

  • NOTE: Low-carb diets are NOT suggested for infants.

  • AMOUNT: 35 to 55% of total intake.

Fats

  • NEEDED FOR: Dietary fats are needed for all the new tissues and cells being built.

  • NOTE: Essential fatty acid deficiency (EFAD) can appear as soon as 7-10 days if not receiving adequate lipid intake. Docosahexaenoic Acid (DHA), an omega 3 fatty acid, is especially important for neurological development, eye development, and brain growth.

  • AMOUNT: 40 to 50% of total intake.

Protein

  • NEEDED FOR: Protein helps build structure in our bodies (skin, hair, nails, muscle, tissues, etc.) and it is needed for how our body functions in the form of hormones, transport proteins, and enzymes.

  • NOTE: There is high bioavailability of protein in breastmilk (meaning the absorption and retention of protein is high).

  • AMOUNT: 15 to 20% of total intake.

Calories

*Not a macronutrient, but worth including here.

  • NEEDED BECAUSE: Calories are the fuel our bodies require to survive. This is no different for infants.

  • NOTE: Caloric needs shift throughout the first year of life. Caloric need is highest in newborns (1-2 months).

Micronutrients

Micronutrients are the nutrients the body requires in small amounts. Although they are recommended in smaller amounts compared to macronutrients, they are equally essential. [Preterm infants are prone to vitamin deficiencies due to lower stores, increase requirements, and immature metabolic processes.]


Vitamin D

  • NEEDED FOR: Vitamin D is needed for bone growth, hormone production, calcium absorption, and nervous system function.

  • NOTE: There is a high need for Vitamin D during infancy, but breastmilk and most formula adequately provide for these needs without supplementation. However, it is worth noting that children with dark skin pigmentation and limited sun exposure are susceptible to deficiency (and are often prescribed a Vitamin D supplement).

  • NUTRITION TIP: Vitamin D is a fat soluble vitamin which means fat is required to enable absorption of the vitamin through the diet. Fortunately, both formula and breastmilk provide sufficient dietary fat.

Vitamin K

  • NEEDED FOR: Vitamin K is essential for blood coagulation.

  • NOTE: Vitamin K injections are now routine as it has been found that an infant's gut microbiome is not yet established enough to make Vitamin K. [Side note: During a micronutrient class, a student asked the professor what happened before Vitamin K injections were provided to infants. Their response was "many babies died".

Iron

  • NEEDED FOR: Iron is necessary for red blood cell formation and cognitive development.

  • BREASTFEEDING NOTE: A need for Iron during infancy develops at around four to six months of age due to depleted fetal stores and minimal amounts provided by breastmilk. Complementary food sources can be good options at this time (fortified infant cereals and pureed meats).

  • FORMULA FEEDING NOTE: Formula-fed infants do not require supplementation as infant formula is fortified with iron.

Zinc

  • NEEDED FOR: Zinc is needed for DNA, RNA, and protein synthesis. Zinc is considered to be essential for growth.

  • NOTE: Premature infants need higher doses of zinc due to their rapid growth.

Fluoride

  • NEEDED FOR: Fluoride is needed for tooth development.

  • NOTE: Fluoride supplementation may be needed after the first 6 months, but is dependent upon the local water supply.

Vitamin B12

  • NEEDED FOR: Vitamin B12 is needed to convert food into energy.

  • NOTE: There is an increased susceptibility for B12 deficiency if an infant is breastfeeding from a mom who is vegan.


 

Additional Considerations Impacting Nutrition


Colic

What & Why

  • Colic is when a healthy baby cries for a very long time (for no obvious reason).

  • It is most common during the first six weeks of life. Up to 1 in 4 newborn babies may experience colic.

  • Colic may occur as a symptom of GI distress.

  • Colic could occur after mom consumes certain foods, if infant is breastfed.

Tips

  • It usually goes away on its own by age 3 to 4 months, as the infant GI develops.

  • If breastfed: mom could try to eliminate certain foods from diet if possible causes are identified.

  • If formula fed: could try a different formula.

Regurgitation/Reflux

What & Why

  • Occurs when a baby spits up (baby can be completely healthy).

  • Often subsides as GI tract matures.

Tips

  • Avoid overfeeding.

  • Try small, frequent feedings.

  • Keep infant upright after each feeding.

  • Take time to burp baby.

  • Watch for gagging.

Allergies

What & Why

  • Show as the follow individually or in combination: GI distress, vomiting, diarrhea, runny nose, sneezing, and difficulty breathing in severe instances.

Tips

  • Delaying introducing of solid foods until 6 months

  • Introduce foods individually to assess allergic reactions.

  • Egg whites, peanuts, soy, and wheat are common triggers.

  • Breastfeeding reduces risk of allergy development.

 

Watch Companion Video Here!


Other Nutrition Through The Ages Posts!

Resources

1. Allen, L. H. “Vitamin B12 Metabolism and Status during Pregnancy, Lactation and Infancy.” Advances in Experimental Medicine and Biology, vol. 352, 1994, pp. 173–86. PubMed, https://doi.org/10.1007/978-1-4899-2575-6_14.


2. “Baby’s First Month: Feeding and Nutrition.” HealthyChildren.Org, https://healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/The-First-Month-Feeding-and-Nutrition.aspx. Accessed 18 Apr. 2022.


3. “Bite-Sized Milestones: Signs of Solid Food Readiness.” HealthyChildren.Org, https://healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Bite-Sized-Milestones-Signs-of-Solid-Food-Readiness-.aspx. Accessed 18 Apr. 2022.


4. “Bottle Feeding Basics.” HealthyChildren.Org, https://healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Bottle-Feeding-How-Its-Done.aspx. Accessed 18 Apr. 2022.


5. Breastfeeding vs. Formula Feeding (for Parents) - Nemours KidsHealth. https://kidshealth.org/en/parents/breast-bottle-feeding.html#:~:text=For%20moms%20who%20can’t,t%20bond%20with%20their%20baby. Accessed 18 Apr. 2022.


6. Bridge, Gemma. “Consider the Whole Picture When Discussing Infant Formula and Breast Milk.” The Journal of Nutrition, vol. 151, no. 6, June 2021, pp. 1375–77. DOI.org (Crossref), https://doi.org/10.1093/jn/nxab132.


7. Chaffee, Benjamin W., and Janet C. King. “Effect of Zinc Supplementation on Pregnancy and Infant Outcomes: A Systematic Review.” Paediatric and Perinatal Epidemiology, vol. 26, no. 0 1, July 2012, pp. 118–37. PubMed Central, https://doi.org/10.1111/j.1365-3016.2012.01289.x.


8. Growth Charts - WHO Child Growth Standards. 11 Jan. 2019, https://www.cdc.gov/growthcharts/who_charts.htm.


9. “How Often and How Much Should Your Baby Eat?” HealthyChildren.Org, https://healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/How-Often-and-How-Much-Should-Your-Baby-Eat.aspx. Accessed 18 Apr. 2022.


10. Interactive Nutrition Facts Label. https://www.accessdata.fda.gov/scripts/interactivenutritionfactslabel/vitamins.cfm. Accessed 29 Mar. 2022.


11. Lawrence, Ruth A. “Maternal Nutrition and Supplements for Mother and Infant.” Breastfeeding, Elsevier, 2022, pp. 247–77. DOI.org (Crossref), https://doi.org/10.1016/B978-0-323-68013-4.00008-0.



13. Moran-Lev, Hadar, et al. “Association of Socioeconomic Factors and Infant Nutrition Decisions: Breastfeeding and Type of Formula.” Breastfeeding Medicine, vol. 16, no. 7, July 2021, pp. 553–57. DOI.org (Crossref), https://doi.org/10.1089/bfm.2020.0398.


14. Mun, Jonathan G., et al. “Choline and DHA in Maternal and Infant Nutrition: Synergistic Implications in Brain and Eye Health.” Nutrients, vol. 11, no. 5, May 2019, p. 1125. DOI.org (Crossref), https://doi.org/10.3390/nu11051125.


15. Patel JK, Rouster AS. Infant Nutrition Requirements and Options. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2021. PMID: 32809593.


16. Robinson, Siân, and Caroline Fall. “Infant Nutrition and Later Health: A Review of Current Evidence.” Nutrients, vol. 4, no. 8, July 2012, pp. 859–74. DOI.org (Crossref), https://doi.org/10.3390/nu4080859.


17. Thompson, Janice, et al. The Science of Nutrition. 2nd ed., Student ed, Pearson Benjamin Cummings, 2011.

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