Lifespan Nutrition: Infancy ad Toddlerhood

Lecture 6: 6/29/2026

Critical Time for Growth

Highest growth rates:

• Soon after birth: 10%-12% body weight is lost

• 2 weeks: Weight gain starts

• 4-6 months: Birth weight doubles

• 1 year: Birth weight triples, grows ~10 inches

• 2 years: ~half adult height

Highest energy (caloric) requirement based on weight than any other stage of life

Calories Needs

• 0-2 months 100-110 kcal/kg/

• 3-5 month 85-95 kcal/kg/

• 6-8 months 80-85 kcal/kg/

• 9-11 months 80 kcal/kg/d

• 12-24 month 80-83 kcal/kg/d

Critical Time for Brain Development

The first 1,000 days

Birth to 6 months

• Breastmilk preferred sole source

• Infant formula used as an alternative or supplement if necessary

6 months to 12 months

• Introduction of complimentary foods

• Breastmilk or formula remains a primary source

12 to 23 months

• Include wide variety of foods

• Avoid of added sugar and sodium

• Breastmilk still encouraged if available

  • Transition from formula to cow’s milk

Vitamin K

0.5 to 1.0 mg IM Vitamin K (phytonadione) routinely administered to all infants on the first day of life to reduce the risk of Vitamin K deficiency bleeding

Vitamin D

400 IU/day should be given to all exclusively and partially breastfed infants consuming less than 28oz of formula per day

Breastmilk

“Exclusive breastfeeding recommended for first six months of life, followed by continued breastfeeding with introduction to appropriate complementary solids for at least the first year of life and beyond”

Benefits of Breastfeeding for the Infant

• Natural and easily digested

• Contains:

  • Antimicrobial agents

    • anti-inflammatory agent

    • immunoregulatory agents

    • living leukocytes

• Appropriate composition of fat, carbohydrate, protein, water, and vitamins

  • Composition changes dramatically over time to match nutritional needs as the infant grows

• Research shows an association of 6 months of exclusive breastfeeding with decreased rates of:

  • Respiratory tract infection

  • Severe Diarrhea

  • Otitis media

  • Obesity (during childhood)

  • Eczema (atopic dermatitis)

  • Sudden infant death syndrome (SIDS)

  • Asthma

  • Leukemia (during childhood)

  • Type 2 diabetes

  • Necrotizing enterocolitis in premature infants

Timeline of Breastmilk Composition

1. Colostrum (birth to ~3-5 days)

   1. Thick, yellow “first milk”

   2. High in antibodies and immune factors

   3. High in protein, low in fat and lactose

   4. Supports gut development and immunity

2. Transitional Milk (Days 5 to 14)

   1. Milk volume rapidly increases

   2. Pro ↓, Fat ↑, Lactose↑, calories ↑

   3. Supports rapid growth & increased energy needs

3. Mature Milk (2wks to 12mo +)

   1. 87% water

   2. Provides carbs, fats, protein, vitamins, and minerals

   3. Continues to provide antibodies and immune protection

   4. Composition adapts to infant needs

Absolute Contraindications to Breastfeeding

• Classic galactosemia

• Maternal HIV infection

• Maternal Human T-cell lymphotropic virus type I and II infections

• Certain Maternal Medications

• Antineoplastic/Cytotoxic agents (chemotherapy)

• Radioactive isotopes (e.g., iodine-131)

• Some immunosuppressive medication (e.g., MTX)

• Maternal Illicit Drug Use (cocaine and phencyclidine)

Conditions that are NOT usually Contraindications to breastfeeding

• Most maternal common infections or fever

• Mastitis

• Maternal Hepatitis B (if infant receives appropriate prophylaxis)

• Maternal Hepatitis C

• Breast implants

• Influenza vaccine

• Most prescription medications

Breastfeeding Considerations

• Active herpetic lesions on the breast: breastfeeding is discouraged from that breast until healed

• Tobacco use: strongly discouraged

  • Nicotine: ↓milk production and shorter lactation

  • Secondhand smoke: ↑ risk of SIDS, asthma, and other respiratory illnesses

• Alcohol use: only in moderation

  • Breast milk alcohol concentrations closely parallel blood alcohol concentrations (highest levels occurring 30-60min after consumption)

  • Moderate alcohol intake (1 drink) is not known to cause harm

  • Consuming more than 2 standard alcoholic drinks or intoxication during breastfeeding is strongly discouraged

• Marijuana use: effects unknown, thus discouraged

Common Reasons for Discontinuation of Breastfeeding

• Inconvenience or fatigue with breastfeeding

• Concern about milk supply

• Problems with breastfeeding

  • sore nipples, breast pain, engorged breasts, mastitis, leaking milk, poor infant latch

• Mother/infant separation

  • Return to work

• Maternal medical conditions

• Baby center factors and medical conditions

Infant Formulas

• Commercial formulas are FDA-regulated

  • Ensures it is meeting minimum nutritional and safety requirements

  • FDA and AAP warn against homemade infant formulas and illegally imported formulas

• Iron-fortified infant formulas are recommended

• Liquid or powdered forms

• Use until age 12 months, then can transition to cow’s milk (preferably whole milk with Vit D)

Similac Advance

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Similac Alimentum

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Similac Sensitive

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Similac PM 60/40

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Feeding schedule recommendations: 1st days of life

• Feeding every 1-2 hours

• 1-2 oz/feeding

Feeding schedule recommendations: First several weeks of life

• Feeding at least every 2-3 hours

• 2-6oz/feeding

• 16-28oz/day

Feeding schedule recommendations: 4-6 months

• Feeding will be every 3-4 hours

• 4-6oz/feeding

• 22-28oz/day

Feeding schedule recommendations: 6-12 months

• Feeding every 3-4 hours

• 7-8 oz/feeding

• 28-34 oz/day

• introduction of solid foods in between feedings

Self-Regulation & Responsive Feeding

• Key Concept

  • Infants and toddlers are born with the ability to regulate their food intake through internal hunger and fullness cues

• Responsive Feeding Principles

  • Recognize and respond to hunger cues

  • Offer food when a child is hungry

  • Stop feeding when a child shows signs of fullness

  • Avoid pressuring, bribing, or forcing a child to eat

• Why it Matters

  • Promotes healthy eating behaviors

  • Supports appetite and self-regulation

  • May reduce the risk of overeating later in life

Signs a Child is Hungry or Full: Birth Through Age 5 Months

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Signs a Child is Hungry or Full: Age 6 Through 23 Months

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Complementary Feeding

• Should begin between the ages of 4-6 months

• Signs that an infant is ready:

  • Able to control head and neck

  • Sitting up alone or with support

  • Brings objects to the mouth

  • Grasps small objects, such as toys or food

  • Swallowing food rather than pushing it back out onto the chin

• Steps to decrease choking risk:

  • Offer foods in appropriate size, consistency, and shape

  • Make sure the infant is sitting up in a high chair or other safe, supervised place

  • Ensure an adult is supervising feeding during mealtimes

  • Avoid putting infant cereal or other solid foods in an infant bottle

• Introduce foods from all 5 food groups

  • Fruits, vegetables, grains, protein foods, dairy

• New foods may require 8-10 exposures before acceptance

• Prioritize iron- and zinc-rich foods

  • Supports growth, brain development, and immunity

  • Sources: meats, seafood, eggs, dairy products, and legumes

• Introduce common allergens early

  • Early introduction may reduce food allergy risk

  • Common Allergens: Peanut, egg, fish, soy

    • Infants at high risk of peanut allergy (severe eczema and/or egg allergy) should consider introducing peanut-containing products as early as 4-6 months

Foods to Avoid/Limit During Complementary Feeding

• Honey and unpasteurized foods before 12 months

  • Risk of infant botulism

• Cow’s milk before 12 months

  • High protein content can harm immature kidneys and irritate the gastric lining

  • Not a good source of iron or vitamin C

  • Dairy products okay

• Added Sugar

• Limit Sodium