Part 1 Infant Nutrition.1Sorry for the delay in posting this week, I caught a legit real cold for the first time in about 2.5 years and luckily it came on a Friday, which meant Jeff was able to let me off the hook for baby duties. However, this also meant that I wasn’t going to be able to publish a Sproutings Saturday post. The sinus pressure was way too uncomfortable (along with feeling like my head was unattached from my body) for me to write a real post and it wasn’t nearly at the point where I was comfortable publishing it. 

(Quick Jump Links)

Part 2: Nutrition in a Nutshell – Toddler and Pre-Schooler

Part 3: Nutrition in a Nutshell – Children 5 years and Older

About this Post

As a little intro, I wanted to write this post because 1) it was a topic that a couple of my readers suggested, and 2) it really makes me cringe to read all of the bad advice some moms give to other moms on the topic of infant nutrition. I feel like I can justifiably say that this is “bad advice,” because I got my Bachelor’s in Science in Dietetics (nutrition, to the rest of the population) and focused a lot of my undergraduate projects on Maternal, Infant, and Child Nutrition (heck, I even chose my Master’s focus on Maternal and Child Nutrition when I started at UCLA). I’m not saying that I remember everything I learned in college about every phase of infant and child nutrition, but it’s the basis from which I stem off and do my own investigating and writing. 

This series of posts will be divided into: Infancy, Toddler & Pre-School Age, and Child Nutrition 5 & Up because: 1) It’ll take me a substantial amount of time to cover nutrition for infancy through 5 and up – there is an overwhelming amount of information on nutrition for each group; and 2) It’ll be easier for you guys to click to whichever post is more relevant for you when you read it. 

Getting to it… Why “Nutrition in a Nutshell”?

My good college friend Staci (a Dietitian) is a new mom like me and has seen some pretty horrifying photos of babies being fed really BAD food, littered throughout her social media feed. I’ve also heard of parents who are friends with my friend who have fed their premature 1-month old (age-adjusted 1 month old, has been out of the uterus for 2 months but was born 4 weeks early) some really bad foods. Now, usually us folks in the world of nutrition are taught not to use the term “bad food,” because really there aren’t supposed to be “bad foods.” However, I strongly disagree, when it comes to infant feeding. There are foods that are bad. Very bad. Like, your 4-month old (let alone an infant of any age or even a toddler) doesn’t need to be drinking sweet tea from a sippy cup, eating chips and salsa at a Mexican restaurant, or chowing down on cheesecake. 

As a parent (or even a non-parent), we’ve grown accustomed to this culture of not interfering, not passing judgment, not speaking up, etc on other parenting styles or things that should be corrected for the safety of the child. This topic isn’t quite the same as the debate between cloth- and disposable- diapering, this is about what foods are going into your baby’s body. This should be a SPEAK UP! type of topic! (I know, I know. Even I wouldn’t have the guts to say “oh hey ma’am, you really shouldn’t be feeding your 1-month old that cake”)

Nutrition is just as important as the topic of breastfeeding versus choosing to formula-feed when you are fully capable of breastfeeding (i.e., not having complications, supply is not an issue, etc).  It is paramount in the development in your baby’s cognitive and physical development. I really can’t stand to hear when parents turn a deaf ear to hearing the importance of forming good nutritious habits and taste preferences early, for they have a substantial impact on food preferences, quality of health, and longevity.

So in this topic (like vaccinations and breastfeeding) I AM judgmental of parents who know better but choose not to do better.

Quick and dirty, I want to keep this easy-to-read and uncomplicated. I want to post some important pointers with references listed so that it’ll be clear what is good and what should be avoided. Additional references for your specific situation are at the end of this post, should you need them.

Infant Nutrition (Newborn to 4-6 Months)

  • NOTHING BUT BREASTMILK OR FORMULA. Make sure formula is properly mixed, because concentrated infant formula will damage even full-term baby kidneys because they are not developed enough to tolerate that high of a solute load (of metabolized formula). 
  • No water.
    • You do not need to give baby water if it is hot outside or if they are “thirsty.”
    • What you do need to do is increase YOUR water intake if you are breastfeeding and it is hot outside.
    • Unless otherwise RECOMMENDED BY YOUR BABY’S PEDIATRICIAN. This does not mean people on Facebook or your mom or whoever tell you to give your baby water. This is usually if your baby appears dehydrated, is febrile, or has other indications for additional water. STERILIZED water is usually directed by physician, as well. 
  • No juice. I don’t care what you think the 100% Gerber Juice bottle says (it says for a “supported sitter” AND for 6 months and older ONLY!!!!!)
  • No solids.
  • No honey. This is beating the dead horse of “nothing but breastmilk and formula,” but it seems like parents left and right still want to suggest giving young babies things they shouldn’t. Seriously. Even if your baby is teething, seems uncomfortable, do not give honey. The risk of botulism from spores present in honey (even pasteurized honey) is all too real, so do not expose your baby’s underdeveloped gastrointestinal tract to spores it cannot defend itself. 
  • That also means (I wish I didn’t have to write this): No wine, no bourbon chocolate sauce, no flourless chocolate cake, no cheez-itz, no sweet tea. (Crazy, right?)
  • Unless at the urgency of your pediatrician, nothing in a bottle except breastmilk or formula!
  • Vitamin D3 supplementation at 400 IU per day. This is to ensure proper bone development since Vitamin D is necessary for mineralization of bones in everyone, but especially infants who have growing and quickly mineralizing bones. Nearly the entire United States population does not get the required amount of Vitamin D synthesized by the skin naturally from the sun, so unless you live someone near the equator, your baby needs to get some dietary Vitamin D3! In addition, babies have very sensitive skin and would need to be shaded from the sun’s harsh rays under 6 months of age. Read more about Vitamin D supplementation (and the evidence-based research to go with it) in the post “Does Vitamin D3 Do a Sprout Good?”
  • Breastmilk provides all the protein, carbohydrate, and fat that is needed for an infant’s development. Formula contains a higher amount of protein than breastmilk; however, the protein is not as efficiently absorbed and utilized by the body.¹ Babies need to consume about 9 grams of protein per day. If you’re breastfeeding you don’t need to worry about protein intake since your milk is species-specific and all nutrients are absorbed efficiently. Breastmilk also contains a higher content of essential fatty acids and cholesterol that is preferred for baby’s eye and brain development. See more info below.

Why? Babies need all of their nutrition in the form of breastmilk (or formula). All of their vitamins, minerals, essential macronutrients (protein, carbohydrates, and fat) need to come from highly specialized sources that are made specifically for babies. Anything else added to their diet will take place of their caloric intake, meaning they will be missing out on the important calories that positively impact infant growth, body functions, tissue growth, and activity. (To read more about CDC growth charts, click here)

Age              Estimated Calorie Requirement¹

                              Boys               Girls 

1 Month                     472                     438 

2 Month                     567                     500 

3 Month                     572                     521 

4 Month                     548                     508 

5 Month                     596                     553 

6 Month                     645                     593 

Breastmilk consists of, on average, 22 calories per ounce.² (Enfamil Newborn Formula is 20 calories per ounce) After about 10 days and up to 6 weeks, a baby’s stomach volume is about 60-80 mL (about 2-2.6 ounces, which means about 44-57 calories per feeding). Babies this young feeds about 8-12 times a day in the first six weeks (8 feedings is equal to about 352-458 calories, and 12 feedings is about 528-686 calories).³ 

After 6 weeks and up to 6 months, baby may eat fewer feedings but consume the same overall volume in a day, due to a growing stomach. (This is one reason – among many others – why it’s much easier to breastfeed. You feed your baby what s/he needs and wants at a feeding, you don’t need to estimate or worry if you’re preparing enough appropriately-mixed formula in each bottle, for each feeding). So that means that baby can drink more in one sitting and take a longer time between feedings, with fewer feedings overall. See how there’s not really any room for anything besides breastmilk (or formula)? 

The USDA¹, AAP 5, American Academy of Family Practice7, and World Health Organization8 all unanimously agree that breast milk is the recommended nutrition for all healthy full-term newborns and infants, and that babies should be exclusively breastfed for 6 months, then breastfed along with the introduction of complementary solid foods, and continued breastfeeding up to 12 months.

Infant Nutrition (4/6 – 12 Months)

At 4 months old, the American Academy of Pediatrics says it’s OK to start solid feeding if you are formula feeding. This is because babies’ diets will need to be supplemented with solid foods to get iron stores restored with meats or iron-fortified infant cereals. There is a higher risk of obesity when solid foods are started before 4 months of age.4 The AAP says that for breastfed infants, they do just fine with breastmilk until 6 months old.5 Also:

  • Formula-Fed + 4 Months = start solids.
  • Breastfed + 4 Months = keep breastfeeding. 
  • Breastfed + 6 Months = start solids. 
  • As mentioned above, by the time your baby is 6 months old, their stomach has gotten larger.  However, baby still needs as much milk at 6 months as she did at 6 weeks, just in fewer (but larger and quicker) feedings. Babies at this age eat between 14 and 25 ounces of breastmilk per day (I spoke with a La Leche League International Rep), with the number of feedings depending on if your baby is eating at night. That is a wide range, but it varies depending on how much solids they are eating. (More here at KellyMom)
  • Tips on how to balance introducing solids and breastfeeding at KellyMom here. She recommends before 12 months, to nurse before feeding solid meals, to ensure baby is taking in the maximum amount of breastmilk for that feeding, and helps to maintain your milk supply. This is so s/he gets the best source of protein, fat, and carbohydrates and doesn’t fill up on solids. (For more on maintaining your milk supply read “Boobie-nomics: Nature’s Supply & Demand”
  • The importance of solid food introduction is to expose babies to textures and flavors, a broader range of vitamin and mineral sources, in addition to more bioavailable iron sources, especially for formula-fed babies. Iron is in its most bioavailable form in breastmilk, however, after 6 months baby’s iron stores start to deplete and s/he requires iron from foods.
  • Breastmilk provides 50% of calories to baby in the form of healthy and well-absorbed fats that are very important for brain and eye development and function. It’s recommended to continue breastfeeding or providing breastmilk until at least 12 months and continued as long as mutually (baby and parent) desired.¹ Remember, donor or expressed milk is just as important as breastfeeding, since it still provides its long list of benefits!
  • Juice is allowed AFTER baby has reached 6 months of age.
    • This is BECAUSE sorbitol and fructose sugars that are primary sugars in juices are not absorbed well and are then fermented in the gut. This results in diarrhea, bloating (gas pain), abdominal pain, and indigestion.¹
    • No more than 4-6 ounces of pasteurized 100% juice only.
    • Juice in cups only, NOT bottles! The sugars in juice lead to tooth decay as they ferment.
  • NO HONEY. As stated above, the botulism spores present in honey (raw and pasteurized) will colonize in your baby’s gut and their gut cannot defend against them. Do not risk exposing your baby’s young gastrointestinal system to botulism spores. (I am adding this in on 3/5/15 because of a post I saw on a mom’s group on Facebook where a mom suggested another mom of a teething 5-month old to give him honey. DO NOT DO THIS!!!!!)
  • Whole grains, legumes, and green vegetables are important sources of fiber for an infant’s diet.
  • At 7-12 months, 11 grams of daily protein should come from sources such as meat, legumes, egg yolks, poultry, fish, cheese, yogurt, and cereals.¹ To get an idea: about 2.7 g of protein are in 1 egg yolk (6.3 g protein in an entire egg, but egg whites can lead to an allergic reaction in some babies, start with the yolk first), 1 ounce of cheese (about 4 dice) has 6.82 g protein, a 2.5 oz jar of store-bought baby food strained chicken/beef/fish has 9.73 g protein, 1 tablespoon of boiled lentils has 1.11 grams protein,1/2 c whole milk cow’s yogurt has 4 g protein.  
    • If your baby is fed a vegetarian diet, animal sources or high-quality protein plant sources should be combined with other plant sources to ensure that all of the necessary amino acids are being absorbed.
    • Vegan diets need to be carefully adjusted so that high-quality protein (and iron) needs are met.
    • Here’s a link to a Baby Centre article that has some insight about mixing different high-protein vegetarian foods to get a variety of amino acids. 
  • Essential Fatty Acids (EFAs) from fats are very important nutrients in infant diets due to their role in preventing body heat loss, helps absorption of fat-soluble vitamins (vitamins A, D, E, K), 50% of energy needs from fat are obtained through breastmilk, and are required for normal brain, eye, and skin/hair development. EFAs are important in fighting infection and disease as well.¹ The proportion of healthy EFAs in breastmilk are much higher than in infant formula.¹
  • Cholesterol is a good thing! The AAP states “no restriction of fat or cholesterol is recommended for infants <2 years when rapid growth and development require high energy intakes.”6 Infants need this higher proportion of fat in their diets! Studies suggest that the significant cholesterol content in breastmilk compared to infant formula (none) is actually protective in infancy and helps the baby’s body to later metabolize cholesterol later in life.
  • No cow’s milk! 
    • Cow’s milk is not made specifically for humans, human milk is. Now that the obvious has been stated, the protein and mineral content in cow’s milk is so high that it can often lead to kidney problems. This is because developing infant kidneys are not mature enough to tolerate the solute load of these nutrients and can lead to kidney damage. (This can also happen with highly concentrated infant formula) 
  • As mentioned in Newborn-4/6 Months, Vitamin D3 (400 IU) supplementation is still needed. After 6 months of age, when your baby is in the sun, they still should be protected with a physical sunscreen (vs chemical) to protect their skin from harmful rays. This blocks out the UV rays that help synthesize Vitamin D through the skin, so dietary supplementation is a must. Again, read more at “Does Vitamin D3 Do a Sprout Good?” for the evidence-based recommendation. 
  • Water can now be given, usually about 4-8 ounces per day, when solid foods are given.¹ This can also be given at night feedings when trying to wean from breastfeeding or formula at night. For more on weaning from night feedings or help with sleep training, see “Sleep Training Part 1: Weaning from Night Feedings.”

Age              Estimated Calorie Requirement¹ 

                              Boys               Girls 

7 Month                     668                     608 

8 Month                     710                     643 

9 Month                     746                     678 

10 Month                    793                     717 

11 Month                    817                     742 

12 Month                    844                     768 

In a Nutshell

Not exactly the shortest post, but hopefully it was easy-to-read and understand! Of course there are many other important details that should be investigated if your child has an insufficiency or special dietary concern, as discussed with your pediatrician. Information regarding vitamin and mineral supplementation is provided in the USDA’s Calorie and Nutrient Needs of Infants guide below (reference 1) should you need it!

I hope you enjoyed reading this, hopefully it’ll serve as a reference tool when someone you know asks about calorie needs and what exactly to give that little baby!

Sources:

¹United States Department of Agriculture, Calorie and Nutrient Needs of Infants: http://www.nal.usda.gov/wicworks/Topics/FG/Chapter1_NutritionalNeeds.pdf

²http://kellymom.com/nutrition/milk/change-milkfat/

³http://www.ameda.com/breastfeeding/the-first-12-months

4http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/Starting-Solids-Too-Early-May-Increase-Obesity-Risk.aspx

5http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Switching-To-Solid-Foods.aspx

6Committee on Nutrition, American Academy of Pediatrics. Cholesterol in children. Pediatrics 1998; 101(1):141-147.

7http://www.nhlbi.nih.gov/files/docs/guidelines/peds_guidelines_full.pdf

8http://www.who.int/topics/breastfeeding/en/

For other info on infant feeding (like vitamin and mineral supplementation), please refer to the USDA Infant Feeding Guide: http://wicworks.nal.usda.gov/infants/infant-feeding-guide

To look up the nutrient content of foods, check out the USDAs Nutrient Database: http://ndb.nal.usda.gov/ndb/search

Solid Foods: KellyMom Resources http://kellymom.com/category/nutrition/starting-solids/

Coming Soon: Toddler Nutrition! (with Pre-school and Child Nutrition 5 & Up shortly after!)