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Bright Futures: Nutrition Supervision

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Bright Futures: Nutrition Supervision BRIGHT FUTURES: NUTRITION Nutrition Supervision 17 FUTURES Bright BRIGHT FUTURES: NUTRITION Infancy Infancy 19 FUTURES Bright BRIGHT FUTURES: NUTRITION Infancy Infancy CONTEXT Infancy is a period marked by the most rapid growth and physical development experi- enced throughout life. Infancy is divided into several stages, each of which is unique in terms of growth, developmental achievements, nutrition needs, and feeding patterns. The most rapid changes occur in early infancy, between birth and age 6 months. In middle infancy, from ages 6 to 9 months, and in late infancy, from ages 9 to 12 months, growth slows but still remains rapid. During the first year of life, good nutrition is key to infants’ vitality and healthy develop- ment. But feeding infants is more than simply offering food when they are hungry, and it serves purposes beyond supporting their growth. Feeding also provides opportunities for emotional bonding between parents and infants. Feeding practices serve as the foundation for many aspects of family development (ie, all members of the family—parents, grandparents, siblings, and the infant—develop skills in responding appropriately to one another’s cues). These skills include identifying, assessing, and responding to infant cues; promoting reciprocity (infant’s responses to parents, grand- parents, and siblings and parents’, grandparents’, and siblings’ responses to the infant); and building the infant’s feeding and pre-speech skills. When feeding their infant, parents gain a sense of responsibility, experience frustration when they cannot interpret the infant’s cues, and develop the ability to negotiate and solve problems through their interactions with the infant. They also expand their abilities to meet their infant’s needs. GROWTH.AND.PHYSICAL.DEVELOPMENT For infants to grow at appropriate rates, they need adequate calories and essential nutri- ents. Conversely, poor growth is an important indicator of nutritional inadequacy. Immediately after birth, infants lose approximately 10% of their body weight because of fluid loss and some breakdown of tissue. They usually regain their birth weight within 7 days. Typically, infants double their birth weight by age 4 to 6 months and triple it by age 1. On average, infants gain 4 to 7 oz per week in the first 4 to 6 months and 3 to 5 oz per week from ages 6 to 18 months. Infants usually increase their length by 50% in the first year of life, but the rate of increase slows during the second half of the year. From birth to age 6 months, infants gain approximately 1 inch a month, and from ages 6 to 12 months, they gain about a half inch a month. Growth rates of exclusively breastfed and formula-fed infants differ. Breastfed infants grow more rapidly during the first 6 months of life but less rapidly during the remainder of the first year.1–3 Infants’ growth depends on nutrition, perinatal history, genetic factors (eg, 21 parental height, genetic syndromes, disorders), and other physical factors. To meet growth demands, infants require a high intake of calories and adequate intakes FUTURES of fat, protein, vitamins, and minerals. During the first year of life, breast milk, infant formula, or a combination of both provide 40% to 50% of calories from fat and are thus Bright BRIGHT FUTURES: NUTRITION important sources of calories, essential fatty formula. By age 3 months, an infant’s digestive acids, and fat-soluble vitamins. Fats should not system has matured enough to allow the absorp- be restricted during the first year of life.4 For full- tion of more complex foods. term infants, breast milk from a well- nourished For most infants, the first primary tooth appears mother offers enough vitamins and minerals, at around age 6 months. Teeth erupt every few with the exception of vitamin D, during the first months, usually in right and left pairs alternat- 6 months. Infants who are born at term usually Infancy ing between the upper and lower jaws, and pro- have sufficient iron stores for 4 to 6 months. ceeding from the front of the mouth to the back. However, since breast milk contains very little These first teeth, however, do not change how iron, breastfed infants are at risk of iron defi- infants process food, because infants usually gum ciency by age 6 months and should receive an their food even if they have front teeth. iron supplement beginning at age 4 months.5 During infancy, the amount and type of physical Ideally, mothers should exclusively breastfeed activity that an infant engages in changes dramat- for a minimum of 4 months, but preferably for ically. At first, infants spend most of their time 6 months.6 Formula, when correctly prepared sleeping and eating. Activity begins with reflexes and given in adequate volume, provides sufficient that promote the infant’s survival. For example, amounts of all nutrients, including vitamins and the rooting reflex causes the infant to turn his minerals. Complementary (solid) foods can be mouth toward the breast or bottle and suckle. introduced between ages 4 and 6 months when Over the next few months, these reflexes disap- the infant is developmentally ready. After age pear, and infants slowly gain control over their 6 months, solid foods aid in the development movements. With increasing control comes more of appropriate feeding and eating skills for all physical activity, including sitting up, rolling over, infants and provide additional nutrients to meet crawling, standing, and eventually walking. the Dietary Reference Intakes for breastfed infants. Development is an individual process. Some Significant developmental changes that occur in infants sit earlier than others. Some walk as the first year of life have a profound effect on the early as age 9 months, and others walk months way infants feed. Newborns are able to locate the after their first birthday. Although the order in mother’s breast, latch onto the nipple, and suck which infants acquire motor skills is typically to receive colostrum and then milk. At about age the same, the speed with which they acquire 4 to 6 months, infants are developmentally ready them is different. The ways infants are held and (ie, when the tongue thrust reflex [pushing food handled, the toys they play with, and their envi- out of the mouth] is fading, their sucking reflex ronments all influence their physical activ- has changed to allow more coordinated swal- ity and motor skills development. Families lowing, they can sit with support, and they have that play with their infants, encouraging roll- good head and neck control) to eat complemen- ing, crawling, and then walking, are nurturing tary foods. Over the next few months, they learn age-appropriate development. to chew and swallow, manipulate finger foods, drink from a cup, and ultimately feed themselves. In late infancy, infants’ physical maturation, DEVELOPMENTAL.ISSUES mastery of purposeful activity, and loss of new- Infants need a nurturing environment and posi- born reflexes allow them to eat a wider variety tive feeding patterns to promote healthy eat- foods, including foods with different textures, ing habits, learn to eat a balanced diet of varied than they were able to consume during early foods, and learn to eat in moderation. and middle infancy.7 During the first year of life, feeding the hungry As infants grow, their ability to consume a greater infant helps him learn to trust that his needs will volume and variety of food increases. Thus new- be met. For optimal development, newborns borns need small, frequent feedings, whereas 22 should be fed as soon as possible when they older infants are able to consume more vol- express hunger. Parents must be careful observers ume at one time and require fewer feedings. of the infant’s behavior, so that they can respond. FUTURES Newborns’ digestive systems can effectively The suck-and-pause sequence in breastfeeding digest breast milk or specifically designed infant or infant-formula feeding and behaviors such Bright BRIGHT FUTURES: NUTRITION as making eye contact, opening the mouth, and Health professionals are uniquely positioned turning to the parent are an infant’s first com- to influence women in their decisions about munication with her parents. As infants become whether to breastfeed. Health professionals more secure in their trust, they can wait longer should emphasize that breast milk is the ideal for feeding. Infants should develop feeding skills food for infants and should encourage breast- Infancy at their own rate. feeding whenever possible.6 Breastfeeding pro- Difficulties in early feeding evoke strong emo- vides infants with significant protection against a tions in parents and can undermine parenting variety of infectious diseases, particularly in areas confidence and parents’ sense of competency. with poor sanitation and contaminated water Thus feeding difficulties must be addressed in a and food supplies. Compared with formula-fed timely manner. Over time, parents become more infants, breastfed infants have fewer and less- skilled at interpreting their infant’s cues and severe bacterial and viral diseases, including increase their repertoire of successful responses meningitis, gastroenteritis, otitis media, pneu- to those cues. As they feed their infant, parents monia, botulism, urinary tract infections, and 6 learn how their actions comfort and satisfy. necrotizing enterocolitis. Even if the infant is breastfed for only a few weeks or months, the Close physical contact between the infant and a benefits are significant. Discussing the benefits of parent during feeding facilitates healthy social breastfeeding during prenatal care enables par- and emotional development. A sense of caring ents to make informed choices about whether and trust evolves, which lays the groundwork and for how long to breastfeed their infant. for communication patterns throughout life. Breastfeeding success is in large part dependent A healthy feeding relationship involves a divi- on health professionals’ supportive attitudes, a sion of responsibility between the parent and the hospital climate that is conducive to the initiation infant.
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