INFANT NUTRITION 101

Amanda McMurray
Registered Dietitian
Pediatrics
 Growth Curves

World Health Organization (WHO)

 Included children from a diverse set of countries: Brazil, Ghana, India, Norway, Oman
and the USA
 0-24 months are based on the growth of infants who were:
› Exclusively/predominately breastfed for > 4 months
› Breastfed for a total of > 12 months
› Started on complementary foods between 4-6 months of age

A key characteristic of the new standards is that they

explicitly identify breastfeeding as the biological norm
and establish the breastfed child as the normative model
for growth and development
Example 1
Example 2
 Diet History: Infants

 Food records, 24 hr recall

 Daily routine
 Breastfeeding/formula (preparation)
 Introduction of solids
 Iron/Vitamin D supplements
 Other fluids consumed
 Inappropriate foods/fluids
 Feeding milestones
Additional Considerations
 Appetite and taste changes
 Feeding aids or assistance
 Chewing/swallowing
concerns
 Access to food
 Community resources used
 Food preparation
 Caregivers involved
 Role of food/meals in the
family
 Frequency, amount and
type of fluids consumed
 Allergies/intolerances
 Texture tolerance and
progression
 Nutrition and food
knowledge
 Vitamin and mineral
supplementation
 Alternative therapies, herbs
 GI symptoms, nausea,
vomiting, stooling, GER
 Ways to Feed an Infant
 Breastfeed – every 2-3 hours to start around the
clock then increase time between feeds
 EBM – expressed breastmilk (pumped) – 20
kcals/oz – can fortify with formula and fed by
bottle *donor milk in NICU
 NG – nasogastric tube
 Gtube - bolus
 GJ tube – continuous
 Failure to Thrive (FTT)

 One of the most common pediatric problems

 Most prevalent during the first three years of life
 1-5% of all hospital admissions for children < 2 years
 More frequently seen in lower socioeconomic families
 No universally accepted definition
 Wt less than the 3rd % percentile
 Wt less than 85% of expected wt for age (IBW)
 A deceleration of growth velocity across 2 major
percentile lines
 Risk Factors for FTT

Organic Factors Non-organic Factors

Is associated with an Occurs in the absence of an
identifiable disease identifiable disease
 Inability to take in  Inability to provide
adequate calories adequate calories
 Inability to retain/use  Psychosocial issues
adequate calories  Lack of knowledge or
 Increased caloric misinformation
requirements regarding feeding
 Altered growth potential practices
 Infant Formula

 3 Forms:
 Ready to feed - most expensive, does not
require water.

 Concentrate – a liquid that requires mixing

with water in equal parts.

 Powder - requires mixing with water. Not

sterile

*important to know the correct way to mix

formula
Composition of Standard Infant Formula
 Caloric density: standard formulas contain
20 calories/oz (0.678calories/ml).
 Protein content: ratio of whey to casein
varies-
most are 60:40 similar to human milk.
 Fat: most provide ~50% of calories from fat .
 Micronutrients: Higher vitamin and
mineral content than human milk to cover
97% of the population.
Similac Advance, Enfamil A+
 Special Formulas
 Hydrolyzed whey - lower osmolality, ?
improved gastric emptying
 Nestle Goodstart
 Soy: used for vegetarians, lactase deficiency,
galactosemia.
 Isomil, Enfamil Soy
 Lactose free: cow’s milk-based formula.
 Similac Sensitive, Enfamil Gentlease
 Protein hydrolysate: infants who can not
digest or are allergic to intact protein, fat
malabsorption.
 Nutramigen A+ *
 Alimentum* or Pregestimil A+ (MCT)*
 *increased cost
 Speciality formulas con’t
 Free amino acids – severe allergies, short bowel syndrome,
malabsorption $$
 Puramino A+
 High MCT oil - Severe steatorrhea, Chylothorax
 Portagen (87% MCT oil)

 OHIP + now covers many of the special formulas

 Vitamins and Minerals

< 37 weeks : > 37 weeks:

EBM: EBM:
 Fer-in-sol until 1 year  400 IU Vitamin D/day

corrected age (1.0 mL D-vi-sol/day)

 Poly-vi-sol 1.0 mL Formula:
 < 500 mL/day: 400 IU
Formula:
 If BW less than 1 kg,
Vitamin D/day
 500-1000 mL/day: 200
Fer-in-sol
 Poly-vi-sol or D-vi-sol
IU Vitamin D/day
 >1000 mL/day: No
additional supplement
 Expected Weight Gains
Normal healthy children
 0-3 mos: 25-35g/d (regain BW by 10

days)
 3-6 mos: 15-20 g/d (double birth wt)
 6-12 mos: 10-21 g/d (triple birth wt)
 Energy Needs

150 mls/kg
How Much to Feed
 Canadian Feeding Guidelines
Just the Highlights

 Start Lumpy This Photo by Unknown

Author is licensed under
CC BY
 Well cooked minced, mashed or shredded meat or
alternatives and iron-fortified cereals
 Safe finger foods (pieces of soft cooked vegetables and
fruits, soft ripe fruits, grated cheese, bread crusts or
toasts
 No Delay in starting allergenic foods
 Except liquid milk and honey
 Toss the sippy cup
 Open cups support development of mature feeding
skills from the age of 6 months
 FYI - Developmental Findings:
Gross Motor Skill
Age (months) Gross Motor Skill

3 -Raise head and chest from prone position

6-7 -Sitting without support
9-10 -Starts to crawl
9 -Pulls to standing position with support
9-11 -Starts to walk with support
12-15 -Stands independently
15 -Walks independently
 Questions?

This Photo by Unknown Author is licensed under CC BY-SA