Issues Related to Nutrition

Good nutrition is important during infancy because of rapid growth. Human milk or commercial infant formulas form the basis for the early nutritional needs of the newborn and young infant. The American Academy of Pediatrics recommends breast­feeding for the first 12 months of life. Human milk from a well-nourished mother is easily digested, provides suf­ficient nutrients and calories for normal growth and de­velopment, and has the added benefit of offering some immune protection. Fluoride is recommended for breast­fed infants and those receiving formula made with water containing less than 0.3 ppm of fluoride. Dietary or sup­plemental iron is added at approximately 6 months of age, when the fetal iron stores are depleted.

Mothers who do not choose to breast-feed their child or who are unable to breast-feed may choose from a vari­ety of commercial formulas designed to closely match the nutrition of human milk. Several companies produce in­fant formulas that contain the essential nutrients for in­fants. Although there are some minor differences, most infant formulas are similar, regardless of which company produces the formula.

Some infants may experience difficulties in consum­ing mother's milk or infant formulas that are based on cow's milk because of lactase deficiency. Lactase is an en­zyme that breaks down lactose, the carbohydrate found in human milk and cow's milk. Some infant formulas con-

tain carbohydrates other than lactose. These formulas are made from soybeans. Other feeding intolerances also may occur. Treatment of any milk or formula intolerance de­pends on identification of the specific offender and elimi­nation of it from the diet. Newborns and infants frequently exhibit "spitting up" or regurgitation of formula, despite the absence of a formula intolerance. In general, cow's milk-based formulas are preferable to soy-based formulas, and changing to a soy-based formula should be under­taken only when there is a proven case of intolerance. It is important that all claims of formula intolerance be thoroughly investigated before an infant is changed to a soy-based formula. Education of the parents about the signs and symptoms of intolerance and reassurance that spitting up formula is normal may be all that is required. An infant that is gaining weight, appears alert and well nourished, has adequate stools, and demonstrates normal hunger is unlikely to have a formula intolerance.

One area of infant nutrition that is still the subject of much controversy is the introduction of solid foods. There is great variation in advice regarding when to start solid foods and what solid foods to introduce. In general, human milk or iron-fortified infant formulas should supply most infant nutrition during the first year of life. However, solid foods usually are introduced beginning at 6 months. When solid foods are being introduced, they should be consid­ered as supplemental to the total nutrition and not as the main component of nutrition. Solid foods should be in­troduced only by spoon-feeding. The addition of cereal to formula in a bottle or in "infant feeders" is not recom­mended. It has never been shown that early introduction of solid foods causes the infant to sleep longer at night.

Bland infant cereals, such as rice cereal, usually are introduced first. Slow progression to the addition of in­dividual vegetables, fruits, and, finally, meats occurs as the infant learns to chew and swallow food. Infants also become able to drink from a cup rather than a bottle during this time. The addition of desserts is not recom­mended because these add calories without adding sub­stantial nutrition.

Sometime between 9 and 12 months, the infant's in­take of solid foods and formula increases, and the infant can be weaned from the breast or bottle. Much anxiety can accompany weaning, so it should be done gradually. Mothers may need reassurance that their infant is pro­gressing normally at that time.