Infant nutrition

Infant nutrition is the description of the dietary needs of infants. A diet lacking essential calories, minerals, vitamins, or fluids is considered inadequate. Breast milk provides the best nutrition for these vital first months of growth when compared to infant formula. For example, breastfeeding aids in preventing anemia, obesity, and sudden infant death syndrome; and it promotes digestive health, immunity, intelligence, and dental development. The American Academy of Pediatrics recommends exclusively feeding an infant breast milk, or iron fortified formula, for the first six months of life and continuing for one year or longer as desired by infant and mother. Infants are usually not introduced to solid foods until four to six months of age.[1] Historically, breastfeeding infants was the only option for nutrition otherwise the infant would perish. Breastfeeding is rarely contraindicated, but is not recommended for mothers being treated for cancer, those with active tuberculosis, HIV, substance abuse, or leukemia.[2] Clinicians can be consulted to determine what the best source of infant nutrition is for each baby.

Infant nutrition requirements

Formula (left bottle) and pumped breastmilk (right bottle)

Proper infant nutrition demands providing essential substances that support normal growth, functioning, development, and resistance to infections and diseases. Optimal nutrition can be achieved by the expectant mother making the decision to breastfeed or bottle-feed the infant before birth and preparing for chosen decision.[2]

Birth to six months

The World Health Organization (WHO) and the Pan American Health Organization currently recommend feeding infants only breast milk for the first six months of life.[3] If the infant is being fed infant formula, it must be iron-enriched. An infant that receives exclusively breast milk for the first six months rarely needs additional vitamins or minerals. However, vitamins D and B12 may be needed if the breastfeeding mother does not have a proper intake of these vitamins. In fact, the American Academy of Pediatrics suggests all infants, breastfed or not, take a vitamin D supplement within the first days of life to prevent vitamin D deficiency or rickets. Exclusively breastfed infants will also require an iron supplement after four months, because the iron is not enough at this point from the breast milk.[2]

Using formula

This form of nutrition may be used instead of breast milk due to lifestyle choices or the fact that women cannot breastfeed. Formula provides all the nutrition needed for a baby to thrive and grow.[4] Every child is different and may need different nutrition to help them grow and be comfortable. Babies may also have an allergy, may be premature, or may have a reason to not consume breast milk. There are formulas specifically for an each type of baby. If a child has a lactose intolerance, they may turn to soy based formulas or lactose free formulas.[5] Some babies may have bad colic and need a formula that will be extremely gentle but still provide all the nutrients needed to thrive and grow.

It is important to know that some foods are restricted for infants. For example, whether breast- or bottle-fed, infants do not need additional fluids during the first four months of life.[2] Excessive intake of extra fluids or supplements can have harmful effects. Fluids besides human breast milk or iron-enriched infant formula are not recommended. These substitutes, such as milk, juice, and water do not possess what the infant needs to grow and develop, cannot be digested correctly, and have a high risk of being contaminated. Water is acceptable only for mixing infant formula. Honey also must be avoided because there is a high risk of botulism.[2] Breast milk is the safest thing to give, unless the mother is advised against it by a health care professional.

The frequency of breastfeeding varies amongst each mother-infant pair. Contributing factors are the age, weight, maturity, stomach capacity, and gastric emptying of the infant; as well as the storage capacity the mother has of breast milk. Typically, feedings occur eight to twelve times per day for breastfed infants. Early on, infants may not signal when they are hungry, so parents are taught to feed the infant every three hours during the day and every four hours during the night, even if waking the infant is required. The feedings will last 30–40 minutes in the beginning, or 15–20 minutes per breast if breastfeeding. As the infant matures, the feeding times shorten.[1] Feeding often is important to promote normal growth and development, and maintain milk production in mothers who are breastfeeding.

Solid foods should not be introduced until four to six months of age. This is delayed because the infant is not able to digest solid foods properly. Infants are born with a reflex to suck milk in, they do not have the ability to push food away. So, if solids are given, it is considered forced feeding.[2] Giving solid foods prematurely can lead to weight gain and obesity, this is why breast milk or infant formula is preferred.

Newborn

Newborns typically consume half an ounce for the first 2 days after birth but will gradually increase to 1 or 3 ounces until 2 weeks after birth. They will begin to drink 2 to 3 ounces. You should expect to feed the baby every 8 to 12 times per day in a 24 hours span. Newborns will need to be fed throughout the night until their stomach can hold in more liquid and nutrition.[6]

2 months

Babies at 2 months of age will begin to drink 4 to 5 ounces every 3 to 4 hours.[6]

4 months

A 4 month old baby should drink 4-6 ounces every 4 hours.[6]

6 months

A 6 month old should drink 6-8 ounces every 4–5 hours.[6]

Six to twelve months

Starting solids

Baby girl getting her first spoonful of rice

Solid foods should be introduced from six months onward. Salt, sugar, processed meat, juices, and canned foods should be avoided. Breast milk or infant formula continues to be the primary source of nutrition during these months, in addition to solid foods.[3] Solid food can be introduced during this age because the gastrointestinal tract has matured. Solids can be digested more easily, and allergic responses are less likely. The infant has begun teething by now, which will aid in chewing of solid food. Another milestone that the infant may have reached by now is properly supporting and turning their head. They may do this to express a dislike in certain foods. The infant has also developed enough to participate in feedings by grasping bottles and pieces of food to feed themselves.[2]

When beginning solids it is important that the infant starts consuming solids with iron. Infants store iron from the womb and by 6 months of age it has depleted from their body.[7] Iron-fortified infant cereal has traditionally been the first solid introduced due to its high iron content. Cereals can be made of rice, barley, or oatmeal. However, there is increasing suggestion that iron-rich whole foods, such as meat and legumes, might be a better choice than iron-fortified processed foods such as manufactured rice cereals.[8]

Health benefits of breast milk

Foremilk (left) has a higher water content and a lower fat content to satisfy thirst. Hindmilk (right) has a lower water content and a higher fat content to satisfy hunger.

Each year in the U.S. roughly 27% of infants and children are affected by disease.[9] Breastfeeding can lower the risk of respiratory, gastrointestinal, and other potentially life-threatening diseases. It offers protection against obesity and diabetes later in life, too.[3] Breast milk is proven to be chemically different for each mother and infant pair. For example, a premature infant's mother will have different milk than a mature infant's mother. Breast milk can also change if an infection is detected in the infant.[10] This natural prevention is tailored toward each infant.

Preventing anemia

Breastfed infants are at a lower risk for acquiring iron-deficiency anemia. Infants that only consume cow's milk become deficient in iron and are 50% more likely to lose blood in their stool. If the infant is allergic to cow's milk, it causes inflammation of the digestive system, resulting in chronic blood loss and decreased absorption of iron. This is why infant formula must be iron-enriched if breastfeeding is not possible.[2] Breast milk naturally contains lactoferrin, an iron binding protein that allows better iron absorption and digestion.[11] Allowing the baby to absorb more iron leads to a better gut health of the infant.

Preventing obesity

Breastfed infants tend to have lower incidence of obesity later in life. Breast milk leads to a slower weight gain in early infancy, and is protective against child obesity and development of type 2 diabetes.[2] Diabetes is a serious health problem where the body does not use insulin correctly. This diagnosis can cause many complications of the skin, eyes, feet, nervous system, heart, and kidneys.[12] Therefore, it is important to prevent diabetes when possible, because it goes hand-in-hand with obesity.

When an infant is breastfed, they are exposed to a variety of flavors due to the mother's changing diet and breast milk.[13] A study showed that later in life breastfed children are more likely to eat a variety of healthy foods; this happens because food preferences are ingrained early in life. So, when an infant is exposed to a variety of flavors early on, they are less likely to be picky eaters later. Another study confirmed a decrease in obesity at ages two years and four years if the infant is exclusively breastfed for at least the first four months.[14] Therefore, breast milk is proven again to be the best nutrition without causing obesity.

Preventing sudden infant death syndrome (SIDS)

Infant sleeping

SIDS (crib death) is an unexplained death occurring in an infant who is one year of age or younger. Most deaths occur when the infant is sleeping.[15] Breastfeeding helps reduce the risk of SIDS when done exclusively for any length of time.[2] It is recommended to breastfeed the infant from birth to 6 months exclusively to decrease the risk of SIDS by 50%.[16] Diarrhea and upper respiratory illnesses, both linked to a higher risk of SIDS, occur less frequently for infants who are breastfed when compared to babies that are not breastfed, thus reducing the risk. Also, breast milk provides necessary nutrition for the infant's brain to develop. This allows the brain of the baby to mature quickly enough so that he or she will have the response to gasp for air when needed. Lastly, breastfed babies tend to sleep for shorter periods at a time and awaken more easily. Research has shown that babies who sleep shorter and awaken from their sleep easily tend to have a lower risk of SIDS.[17] Conclusively, most incidences happen when the infant is asleep, so it is important to exclusively breastfeed in order to reduce the incidence of SIDS.

Promoting digestive health

Breast milk is important for the infant's digestive system. It is the best substance to give, especially over cow's milk. Infants cannot properly digest fats, which cow's milk is full of. Breast milk contains a lot of fat, too, but it also contains lipase, a substance to help break down the fat to aid in digestion. This leads to infants passing softer stools, so constipation is rare in breastfed infants.[2] Human milk also allows beneficial bacteria to grow in the infant's intestines, which protects the mucosal barrier of the infant's stomach. This prevents harmful pathogens from harming the infant's intestinal lining. The infant's digestive mucosa is unable to produce antibodies until they are about four to six months old, which makes the infant susceptible to many infections. However, breast milk provides the antibodies needed for the infant to stay protected until they are able to produce their own antibodies.[11] Breast milk also stimulates a microbiota, which results in the production of IgA. IgA is an immunoglobulin that is a first line of defense to protect the digestive tract of the infant. This immunoglobulin is much higher in infants that are breastfed than in infants that were infant formula-fed.[11]

Promoting immunity

From Colostrum to Breastmilk. (Days after birth)

Colostrum is a great source of nutrition for a newborn baby, it is a thick yellow fluid that the mother produces first after birth. It has valuable nutrition that aids the baby with building immunity because it helps destroy disease-causing viruses. Other benefits of colostrum include: prevention of jaundice, aiding the baby in passing their first stool, building a strong immune system, providing a great number of vitamins and protein, and prevents low blood sugar in babies.[18] Overall, the sticky, thick, yellow liquid called colostrum has many benefits for a newborn baby which can be only provided to the baby through breastfeeding.

Breast milk also contains much more protein than cow's milk. It contains 60% protein whereas cow's milk contains only 40% protein.[11] Protein is very important for infants because they need more protein per pound than adults do. For the first few months of their life, this protein must come from breast milk or infant formula, it cannot come from cow's milk.[19] One specific protein that breast milk has is lactoferrin, which is bacteriostatic,[11] meaning it prevents the growth of harmful bacteria. Without this protein, the baby cannot produce the immunity that its body desperately needs, resulting in a higher risk of disease and malnutrition. Breast milk provides the best source of protein for an infant.

Another immunoglobulin breast milk provides to the infant is known as IgG. IgG provides passive immunity from the mother to the infant. This means that antibodies for common childhood diseases like diphtheria, measles, poliomyelitis, and rubella are passed onto the infant naturally, if the mother was immunized for these diseases in her lifetime. The infant is then protected for about 3 months, just enough time to protect them until they receive their first immunizations at 2 months.[2]

Promoting intelligence

Parents generally want their child to be as smart as possible and to excel in school. Breastfeeding an infant can increase their intelligence throughout life. Mothers who exclusively breastfed their child have a higher chance of increasing their child's intelligence. Studies have shown that infants that are breastfed for six months versus infants who were only breast fed for one month have a higher intelligence score. Those children tend to have a higher intelligence score in the third and fifth grades. Their intelligence scores are also higher at the age of 15 years.[20] Breastfeeding aids in the development of cognitive maturity which leads to a higher intelligence. However, this only correlated to those children who were exclusively breastfed by their mothers as infants.[20]

Promoting oral health

Dental caries (more commonly known as tooth decay or cavities) is the most common chronic childhood disease.[21] The transition from breastfeeding or bottle feeding can be a challenging time for both parent and infant. Importantly, it represents a time where the risk for development of dental caries begins with the eruption of the first baby teeth. Transition from breastfeeding/bottle-feeding usually coincides with the introduction of solid foods that may contain substances (i.e. sugars & other carbohydrates) that can cause dental caries. The consumption of cow’s milk and other non-breast milk beverages (i.e. juices) at 6 weeks to 12 months of age significantly contributes to dental caries at 5 years.[22] There is a relationship between prolonged and inappropriate bottle use and increase in dental caries and as such, it is recommended that infants be encouraged to drink from a cup by their first birthday and be weaned from the bottle by 12–14 months of age. Breastfeeding cessation is dependent upon the infant and mother. Pacifier may be used as a means of soothing or distracting the infant. Due to the risk for dental caries, dipping pacifiers in sweetened liquids (i.e. sugar water, juice etc.) is discouraged.[21]

History of breastfeeding

Louis-Roland Trinquesse Young woman breastfeeding her child 1777

Breastfeeding, prehistorically, was the only way infants were nourished, there was no acceptable substitute for human milk for a long time. In 1 AD, philosophers were discovering the importance of breast milk versus any substitute. It was concluded that breastfeeding helped the mother and infant establish an emotional connection.[3] The nutritional value was still not fully understood, but it was believed that through suckling, the infant gained not only energy, but also the characteristics and personality of whoever they fed from. It was suggested that infants be breastfed as long as possible, and many were until two to three years of age.

It was not until 16 centuries later that the importance of breast milk was truly understood. In 1748, in the book “An Essay upon Nursing, and the Management of Children, from Their Birth to Three Years of Age” by Cadogan, colostrum was recognized as a substance responsible for the elimination of meconium, and prevention of illnesses of mothers and children. Also, it was believed that a bond was established if the mother breastfed her child from the hour it was born. Wet-nurses and introducing solid food before the baby turned six months were now opposed, and mortality rates decreased once accepting the value of breastfeeding. Those that continued to feed their infants substitutes like cereals, cow's milk, and broths too early, led to the infant's development of scurvy, rickets, gastrointestinal problems, and kidney stones.[3]

Continuing on into the 19th century, scientists were relating high rates of mortality and undernourishment to the lack of infants being breastfed. At last, breastfeeding was seen as the best and only option for infant nutrition before six months. However, in 1847, when the first commercial formula was made, it promoted the use of bottles, partly due to breasts receiving a sexual connotation during this time. With the promotion of formula, the long fight for breastfeeding took a dive. Organizations that took notice came together to promote breastfeeding once again, they included Natural Childbirth Movement, Baby Friendly Hospital Initiative launched by WHO, and United Nations International Children's Emergency Fund (UNICEF). In 1990, these organizations pushed to protect and promote “breast milk is the best food for infants.[3]” This value still holds true today. Factors leading to increased breastfeeding rates recently include facilities encouraging mothers to have skin-to-skin contact with the infant after birth, cultivating the initiation of breastfeeding; and facilities encouraging rooming-in, where the mother can watch for feeding cues with the infant staying in her room.[1]

There are different beliefs and misconceptions pertaining to infant nutrition specifically the topic of breastfeeding among young people and different tribal groups. Studies have been done to inform people with more factual evidence related to the pros and cons of infant nutrition. For instance, mothers surveyed from Massai with children ranging in age from newborn to six months believe a mixture of both breast milk and other semi-solid supplements can be a more beneficial, nutritious meal for the child. A deeper study was further conducted proving the above statement to not be in the best interest of the child. Comparing the mortality and morbidity rates from Massai and other places, Massai has higher statistics for both. This could be the result of the lack of information on the WHO recommendations for infant and child feeding.[23] However, another study was done in Zimbabwe related to infant breastfeeding as well. This study has shown the factors that weigh against the idea of exclusive breastfeeding. Zimbabwe has fecal conduction due to bad living conditions such as poor water sanitation, and hydration. The Sanitation of Hygiene Nutrition Efficiency conducted two base trials in two districts to optimize the nutritional values of infants and to improve these conditions for child feeding. They observed household characteristics and social interactions which they then compared to how the child responds.[24] These trials will help to hypothesize and explain the public health problems of the children. Overall, there has been a spark of interest and enthusiasm on the topic of infant nutrition, that will hopefully result in change. A change for more support towards infant nutrition and the nutritional will benefit children.[25]

See also

• Infant formula

References

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