lifecycle

Adolescent Nutrition

Photo credit: A L L E F . V I N I C I U S Δ

Photo credit: A L L E F . V I N I C I U S Δ

Adolescence is the period of life from 11 to 21 years of age. There is profound biological, emotional, social and cognitive development as a child grows into adulthood. During this important stage of development physical, emotional and cognitive maturity is reached, and there is development of personal identity and a value system that is unique and separate from parents and other family members.

 

This can be a challenging time for an adolescent as she struggles for personal independence, yet recognizes the need for economic and emotional family support. Adolescents are also adjusting to their new bodies that have changed in shape, size, and function.(1) Keep these challenges in mind when viewing the adolescent as being difficult or irrational. Your adolescent is dealing with a lot!

 

Because of the dramatic physical growth and development during this stage, there is an increased need for energy (calories from food), protein, vitamins and minerals.(1) Unfortunately at this stage the struggle for independence often leads to health compromising eating behaviors like excessive dieting/caloric restriction and following fad diets, skipping meals, and using unconventional dietary supplements that may cause more harm than good.(2) With guidance, your adolescent can channel their struggle for independence into healthy behaviors like eating a healthy diet, participating in physical activities, and living a healthy lifestyle overall.(1)

 

During early adolescence, puberty occurs. Sexual maturation, increased height and weight, accumulation of skeletal mass and changes in body composition are observed. The age of onset, duration and tempo of these events varies greatly within and between individuals. Because of these differences, nutritional intake and needs should be based on biological growth and development rather than on chronological age. “Tanner Stages” (sexual maturation rating or SMR) is used by health professionals to assess pubertal maturation, regardless of chronological age.(1,3) SMR is based on the development of breasts and pubic hair in females, and on testicular, penile and pubic hair development in males.(1,3) Table 1 demonstrates the Tanner Stages of development in females and males.(4)

 

In females, the first signs of puberty include the development of breast buds and sparse, fine pubic hair around age 8 to 13 years. Menarche occurs 2 to 4 years after the first signs of puberty, and is typically around SMR stage 4.  The average age of menarche is about 12.4 years, but it can occur as early as 9 to 10 years of age, or as late as 17 years of age. Girls that are highly competitive athletes (female athlete triad)5, and those who severely restrict caloric intake to limit body fat may detrimentally delay menarche. In girls, 15 to 25% of final adult height will be gained during puberty, and linear growth spurts cease on average by age 16 years in most females. Some females will have small increases in height until about 19 years of age. Caloric restriction can slow or delay linear growth.(1,6)

 

The first signs of puberty in boys are enlargement of the testes and change in coloring of the scrotum. This occurs typically between the ages of 10.5 to 14.5 years (11.6 years of age is the average). Development of pubic hair is common during SMR stage 2. The average age of spermarche is about 14 years of age in males. Linear growth peaks in velocity in males during SMR stage 4, either coinciding with or following testicular development and the appearance of faint facial hair. On average, peak velocity of linear growth occurs at 14.4 years of age. Linear growth continues throughout adolescence and ceases at about age 21 years in males.(1,6)

 

Up to 50% of ideal adult body weight is gained during adolescence in both females and males. Body composition changes dramatically in females during puberty.  Lean body mass percent decreases, and body fat percent increases. During puberty females can experience a 120% increase in body fat.(7) In order for menarche to occur, 17% body fat is necessary, and then body fat must be at 25% for the development and maintenance of a regular ovulatory cycle.(8) While this gain in body fat in females is normal and required for normal physiologic function, it is often viewed as negative, leading to compromising health behaviors (excessive dieting, restriction, and exercise, and use of diet aids and laxatives for example) that can lead to serious disordered eating and eating disorders.(1)

 

Peak weight in males coincides with the timing of peak linear growth and peak muscle mass development. Adolescent males may gain an average of 20 lbs per year during peak weight gain.(1) Body fat decreases, and by the end of puberty, males on average have about 12% body fat.(1)

 

By age 18, more than 90% of adult skeletal mass has been formed.(1) Adequate nutrition during childhood and adolescence is therefore critical to support optimum bone growth and development, where a variety of dietary nutrients are necessary for building bone tissue.(1)

 

Eating patterns and behaviors of adolescents can be influenced by a variety of factors including peer influence, parental modeling, food preferences, availability, cost, convenience, personal and cultural beliefs, media and body image.(1,9,10,11)

 

During adolescence, there are dramatic biological changes related to puberty that occur.The development of body image and an increased awareness of sexuality become predominant themes. The dramatic changes that take place can lead to the development of poor body image and unfavorable health behaviors, factors that must be addressed by family members and health practitioners when identified.(1)

 

Peer influence is strong during adolescence. The need for adolescents to fit in can affect nutritional intake, either adversely or beneficially.(1,11) Males that are late bloomers may be more prone to use anabolic steroids and other supplements to fit in with their peers that have matured faster, and females that are early bloomers may resort to disordered eating and present with poor body image.(1) Female early bloomers also may be more likely to take part in adult-like behaviors, such as smoking, drinking alcohol, and engaging in sexual intercourse.(1)

 

Talking to your child about the variations in tempo and timing of growth and development, modeling healthful behaviors, and educating them about making healthy nutritional choices can help them navigate this tumultuous time, and develop healthy body image and health related behaviors to last their lifetime.(1)

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Need assistance or have questions? Contact me today!

 

References:

  1. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  2. Eating disorders in adolescents: Principles of diagnosis and treatment. Paediatrics & Child Health. 1998;3(3):189-192.

  3. Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision. Geneva: World Health Organization; 2010. ANNEX H, SEXUAL MATURITY RATING (TANNER STAGING) IN ADOLESCENTS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK138588/.

  4. Tanner, JM. Growth at adolescence 2nd Edition. Oxford, England: Blackwell Scientific Publications; 1962.

  5. Raj MA, Rogol AD. Female Athlete Triad. [Updated 2017 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2017 Jun-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430787/.

  6. National Research Council (US) and Institute of Medicine (US) Forum on Adolescence; Kipke MD, editor. Adolescent Development and the Biology of Puberty: Summary of a Workshop on New Research. Washington (DC): National Academies Press (US); 1999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK224695/doi: 10.17226/9634

  7. Frisch R.E. Fatness, Puberty, and Fertility The Effects of Nutrition and Physical Training on Menarche and Ovulation. In: Brooks-Gunn J., Petersen A.C. (eds) Girls at Puberty. Springer, Boston, MA; 1983.

  8. Frisch RE, McArthur JW. Menstrual cycles: fatness as a determinant of minimum weight for height necessary for their maintenance or onset. Science. 1974;185(4155):949-51.

  9. Videon TM, Manning CK. Influences on adolescent eating patterns: the importance of family meals. Journal of Adolescent Health. 2003;32(5):365-373.

  10. Wade TD, Lowes J. Variables associated with disturbed eating habits and overvalued ideas about the personal implications of body shape and weight in a female adolescent population. Int. J. Eat. Disord., 2002;32:39–45. doi:10.1002/eat.10054.

  11. Story M, Neumark-Sztainer D, French S. Individual and Environmental Influences on Adolescent Eating Behaviors. Journal of the American Dietetic Association. 2002;102(3):S40-S51. doi.org/10.1016/S0002-8223(02)90421-9.

Toddler Nutrition

Photo credit: Jelleke Vanooteghem

Photo credit: Jelleke Vanooteghem

Children between the ages of 1-3 years are considered toddlers. During this stage of development there is a quick increase in gross and fine motor skills, along with an increased desire for independence, exploration of the environment, and development of language skills.(1)

 

For toddlers to reach their full growth and developmental potential, adequate intake of energy (calories from food) and nutrients is important. Nutritional deficiency, or under-nutrition, during this time can hinder cognitive development. Providing adequate nutrition in a supportive environment can prevent long-term effects of under-nutrition, like failure to thrive and cognitive impairment.(1,2)

 

Toddlers have an increased need to express their own will and this expression may come in the form of negativism and temper tantrums.(1,3) This is where the term “terrible twos” comes from. With increased motor development and an increased desire for independence, toddlers may try to do more than they are able, and this can lead to frustration for them, therefore some of the ‘difficult’ behaviors parents identify at this age.(1,3)

 

Weaning from breast or bottle-feedings typically occurs around 9-10 months of age, and the intake of solid foods increases. Drinking from a cup also tends to begin at this time. It is important for parents to pay attention to cues of readiness for weaning. For example, there may be a lack of interest in breast or bottle feedings. Weaning is a sign that the toddler is becoming more independent and is typically complete by age 12-14 months. Depending on the toddler this age can vary.(1)

 

Toddlers are able to chew different textured foods, and to feed themselves. By 12-18 months of age, they gain more tongue mobility and therefore can eat a wider variety of chopped or soft table foods. By 12 months of age they can pick up small objects and put them in their mouths, like cooked peas and carrots. They may also begin using a spoon. Between 18-24 months they should be able to handle meats, raw fruit and vegetables, and foods of a variety of textures.(1)

 

Due to the strong need for independence with self feeding, toddlers may start to use the phrases like “I do it!” and “no!”. This type of response is normal as they reduce their dependency on parents and caretakers.(3) Self-feeding can be messy as fine motor skills continue to develop. Parents should let children practice self-feeding, while minimizing environmental distractions during mealtime, like television. Adult supervision is important because there is a high risk for choking on foods. The toddler should eat seated with the family, and not be allowed to eat on the run, as we tend to do as busy adults.(1)

 

Toddlers have a need for rituals, and they may develop food jags (strong food preferences and dislikes).(4)  They may go through periods of refusing foods they previously liked. To mitigate this, serve new foods along with familiar ones. New foods are better accepted if they are introduced when the child is hungry and if she sees other family members eating the same foods. Toddlers are curious and they are great imitators, including imitating eating behaviors of others.(1)

 

Mealtime is not the time for battling over food and forced feedings. This is a time for toddlers to practice language and social skills and to develop a positive self-image. Eating breakfast is an important habit to establish for your toddler, and is a healthy eating behavior to continue throughout life. Also, mealtime with the family is important for modeling healthy eating behaviors for children.(1)

 

Toddlers naturally have a decreased interest in food because there is a slowed rate of growth at this age, along with which comes a decreased appetite. With their newfound gross and fine motor skills, they have interests in their environments beyond food and eating, and this is normal.(1)


Portion size for toddlers follows the rule of thumb. One rule of thumb for serving size is 1 tablespoon of food per year of age. That means that a serving for a 2 year old would be about 2 tablespoons. It is preferred to give toddlers smaller portions and have them ask for more rather than to serve larger portions. Overestimating and over serving children can lead to the child being labeled as a picky eater because toddlers can’t eat large amounts of food at one time.(3) Snacks therefore are important, however allowing your child to graze on unhealthy snacks like chips, cookies and sweetened beverages should be avoided because they can blunt the toddler’s appetite for healthy foods at mealtime. Toddlers can control the amount of food they eat by hunger, so allow your child to ‘voice’ their hunger and satiety cues without pressuring them to eat more, otherwise over or underfeeding can occur.(1,5)

PRACTICAL APPLICATIONS OF CHILD FEEDING RESEARCH FOR TODDLERS AND PRESCHOOLERS(1)

 

  • Respond appropriately to the child’s hunger and satiety cues

  • Focus on long-term goals of developing healthy self-controls of eating

  • Look beyond concerns regarding the composition and quantity of foods consumed or fears that your child may eat too much and become overweight

  • Trying to control food intake by attaching punishment or reward to eating is not recommended

  • Severely restrict treats is not recommended because this may make such foods even more desirable

  • Model positive eating behaviors, like eating a variety of fruits and vegetables, and help your child develop preferences for a wide variety of foods consistent with a healthy diet and lifestyle

  • It may take repeated exposure to a new food before your child takes to it, this is normal, be patient and persistent

  • Serving appropriate portion sizes is important, and it’s better to keep them smaller and have your child ask for more if she wants it

  • Mealtimes should take place in a positive, secure and happy environment with the family, and with adult supervision

  • Children should not be forced to eat

  • If your child has low interest in eating, long mealtimes (more than 30 minutes), prefers liquids over solids, refuses foods, or needs to be offered foods as if she is younger than her chronological age, feeding problems may be indicated and further evaluation can be helpful

 

Need assistance or have questions? Contact me today!

 

References:

  1. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  2. Goh LH, How CH, Ng KH. Failure to thrive in babies and toddlers. Singapore Medical Journal. 2016;57(6):287-291. doi:10.11622/smedj.2016102.

  3. Hoecker JL. Mayo Clinic. Infant and toddler health. April 21, 2016. Available from: https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/terrible-twos/faq-20058314. Accessed January 2, 2018.

  4. Pitman T. What to do when your picky eater goes on a food jag. Today’s Parent. September 29, 2015. Available from: https://www.todaysparent.com/toddler/what-to-do-when-your-picky-eater-goes-on-a-food-jag/. Accessed January 2, 2018.

  5. Fox MK, Devaney B, Reidy K, Razafindrakoto C, Ziegler P. Relationship between portion size and energy intake among infants and toddlers: evidence of self-regulation. J Am Diet Assoc. 2006;106(1 Suppl 1):S77-83. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16376632.

Infant Nutrition

Photo credit: Sadık Kuzu

Photo credit: Sadık Kuzu

Full-term infants (39 to 40 weeks gestation1) can do a lot! They can hear, and move in response to familiar sounds like their mother’s voice. They have four states of arousal ranging from sleep to fully alert. Recognizing your infant’s state of arousal is important for being able to nurse successfully. Within hours after birth, newborns have reflexes allowing them to root, suckle and coordinate swallowing and breathing.(2)

 

The mouth of a healthy newborn provides a source of pleasure and exploring, and represents a form of early learning. Anything that interferes with the mouth at this stage, such as an extended period of respiratory support, may lead to your infant associating her mouth with discomfort and this may lead to feeding problems. From a sensorimotor perspective, the stage when infants are sensitive to food textures is also when they begin showing their speech skills.(2)

 

The development of the digestive system in infants can be confusing. An infant with soft, loose stools for example may be thought to have diarrhea. This however is typical for breastfed infants. Another source of confusion is that stomach discomfort may interfere with weight gain. It can take 6 months for the gastrointestinal tract of an infant to mature, and this time can vary depending on the infant.(2,3)

 

During the third trimester of pregnancy, the fetus swallows amniotic fluid. This stimulates the lining of the intestines to grow and mature. At birth, the digestive system of an infant is mature enough to digest fats, protein, and simple sugars. It can also absorb fats and amino acids.(2,3) Infants often have conditions that reflect how immature the gut is. These conditions may include colic, GERD (reflux), unexplained diarrhea, and constipation. Generally, these conditions do not interfere with the absorption of nutrients, and they do not interfere with your infant’s growth.(2,4)

 

Colic should be addressed by rocking, swaddling, or bathing your infant, or by other ways of calming her, by positioning the baby well for eating, or burping her to relieve gas. Colic may be caused by the mother’s diet while breastfeeding and foods that commonly cause this problem include milk, and onions, so changes in the maternal diet can be helpful. Probiotics may be helpful.(2,4,5,6)

 

Using acid blocking medications to manage digestive symptoms such as colic or reflux can lead to problems with the digestion and absorption of nutrients, an increased risk for pneumonia, infections of the gastrointestinal tract, and over time can adversely affect your infant’s growth and development, as well as her overall health and wellbeing.(2,7)

 

Diarrhea can be caused by viral and bacterial infections, food intolerances, or changes in fluid intake. Young infants have more stools each day than older infants, and have them soon after feeding. Breastfed infants tend to have soft stools, and infants fed soy formula experience more constipationTo avoid constipation ensure adequate fluid intake, and avoid medications unless they are prescribed. Using prune or other juices for their laxative effects may result in fluid imbalance and diarrhea. High fiber foods present a choking risk, so they are not recommended for constipated infants.(2) When an infant presents with diarrhea, it is recommended to feed as usual during the bout. Breast milk does not cause diarrhea (it may help prevent it), and during a bout, continuing adequate intake of breast milk or infant formula is usually sufficient for preventing dehydration.(2,8)

 

Temperament refers to your infant’s emotional reactions to new situations, activity level, and sociability. Learning your infant’s temperament may take some time, and understanding it is important for you to appropriately respond to her cues of hunger and fullness. For example, she may feed better when there is not a lot of loud noise, or when you are feeling calm as opposed to being under stress.(2)

 

Most breastfed infants, or those who get the recommended amounts of formula, meet protein requirements without the need to add foods to the diet. There are no recommendations for fat intake, however restricting dietary fat is not recommendedCholesterol intake also should not be limited in infants because it is important for testes, ovary, and brain development. Fat is also needed to provide energy to the liver, brain, and muscles, including the heart. Full-term breastfed babies do not need to supplement fat or essential fatty acids (DHA and EPA). Essential fatty acids are required to make hormones, and for normal growth and development. Carbohydrates are also important because without enough of them, your infant’s body will use protein for energy by pulling it from her muscles, and this can interfere with proper growth and development.(2,9)

 

Infants ideally should be breastfed exclusively during the first 6 months of life, and then for an additional 6 months. For infants less than 6 months of age, no other liquids or foods are recommended in addition to breast milk (or formula). The volume taken in is not the best indicator of nutritional adequacy. Rather, focus on the growth rate and health of your infant.(2)

 

Using cow’s milk (whole, skim, reduced fat, etc.) is not recommended during infancy.(2,9) Iron deficiency anemia can be linked to early introduction of cow’s milk in infants, where calcium interferes with iron absorption in the body.(2,10)

 

Soy based formulas are not recommended because they contain hormone like substances that may adversely impact development, and have long-term reproductive risks.(2,11)Lactose-free and hydrolyzed formulas may be alternatives to soy for infants that are not breastfed and cannot be fed cow’s milk.(2,9)

 

Infants are born with the innate ability to regulate their energy (food) intake.(2) Learning their hunger and fullness cues can prevent under and overfeeding.(2)

 

By age 6 months, infants may be ready to eat from a spoon. If your infant is able to move her tongue from side to side without moving her head, and she can keep her head upright and sit with little support, it is time to try spoon-feeding. Other cues she may give when it comes to feeding, hunger and fullness include:(2)

 

  1. Excitedly watching the food being opened in anticipation of eating it

  2. Tight fists or reaching for the spoon to demonstrate hunger

  3. Showing agitation if the pace of feeding is too slow or if the person feeding her stops

  4. Playing with her food or spoon as she starts to get full

  5. Slowing the pace of eating or turning away from food when she is feeling full

  6. Stopping eating or spitting out food when she has had enough to eat

 

The introduction of solid food can be a challenging time for your infant, and for you. Begin offering food on a spoon in small quantities the size of 1-2 tablespoons for a meal, with one or two meals each day. The goal of offering food on a spoon to infants at 6 months of age is to help stimulate the development of mouth muscles, rather than to provide nutrition, which ideally is being done via breastfeeding.  Spoon feeding involves two new experiences for your infant in that a spoon has a different mouth feel than a breast, and the food does not feel the same as breast milk does on the tongue.(2) For tips on introducing solid foods, see “Getting Toddlers to Eat Solids and Ideas for Picky Eaters”.

 

The position of your infant during feeding is important to avoid choking, discomfort while eating, and ear infections. For the first few months, semi-upright, as your infant would be seated in a car seat or infant carrier, is recommended. Propping a bottle or placing your infant on a pillow can increase the risk for choking, and result in overfeeding. For spoon-feeding, your infant can have better control of her mouth and head if seated with good back and foot support. Sit directly in front of her when offering the spoon, and make eye contact without making her have to turn her head. Using a high chair is appropriate when your infant can sit on her own without assistance. Her hips and legs should be at about 90 degrees, and this position is important for digestion. More spitting up is likely if she is sliding down and out from under the tray of her high chair.(2)

 

Some infants may be resistant to learning new feeding skills or react to food introductions unusually. Problems like this may indicate general health or developmental difficulties. They may also indicate your child is a picky eater. For tips on navigating picky eaters, see “Getting Toddlers to Eat Solids and Ideas for Picky Eaters”, and talk to a qualified health care provider if you are concerned there are deeper issues at play.(2)

 

Weaning from your breast is recommended when your infant is 12 to 24 months of age.(2,12)If your infant is breastfed for the first year of life (as is recommended), introducing a cup for water and other fluids after 6 months of age is recommended. This is around the same time it is recommended to begin attempting spoon-feeding. Developmental readiness for a cup begins around 6 to 8 months of age. The typical portion size of fluid from a cup is about 1 to 2 ounces. Moving from a bottle to a sippy cup developmentally is not the same as moving to a regular cup. Keep in mind the same mouth skills that help your infant control liquids help encourage speech development. We want to foster this development by introducing a cup. Weaning from the breast or bottle too soon may result in a plateau in weight if your infant is not taking in enough energy (calories), and may cause constipation if she is not receiving enough fluids.(2)

 

At 6 months of age, infants go from swallowing only fluids to being able to handle pureed and soupy foods. An infant’s mouth is extremely sensitive to texture and if food with soft lumps is presented too soon, she may choke. Offering lumpy yet soft foods around 6 to 8 months of age helps to stimulate jaw movements that simulate chewing. At 8 to 10 months of age infants can chew and swallow soft, mashed foods. Mature chewing skills are not mastered until toddler age, so offering foods that require little chewing is important.(2)

 

Baby cereal is generally the first food recommended for infants at 6 months of age. Rice cereal is commonly recommended because it is easy to digest and hypoallergenic.(2,12) Note that adding baby food is not recommended to help improve your infant’s sleep as is commonly believed.(2)

 

Fruits and vegetables are also first foods for infants. It is recommended for 6 month olds, that parents introduce only one new food at a time, and to offer it over 2 to 3 days, and the purpose of this is to identify any possible negative reactions to new foods. This timing and spacing of food introductions is important, especially in families with histories of food allergies and intolerances.(2)

 

Commercial baby foods are not necessary for infants.(2) As a parent, you can prepare baby foods at home in your blender or food processor, or by mashing it with a fork. Adding salt and sugar to baby foods prepared at home decreases their nutritional quality. Preparing baby foods at home can save money, provide a wider range of foods for your infant to try, and can be more nutritious (if you do not add salt and sugar to the foods for example). Commercial baby food on the other hand is convenient.(2)

 

Portion sizes for infants should be based on their appetite, keeping in mind their innate ability to control how much food they eat based on their cues of hunger and fullness.(2) Also keep in mind that commercially prepared products such as fruits with added tapioca or baby food desserts and snack foods are not recommended for most infants. Many new parents inadvertently select foods such as these for their infants based on their own likes and dislikes, rather than on the needs of the infant. Regular applesauce, yogurt, soft cooked green beans and mashed potatoes, are examples of foods that can be eaten by infants, as well as other family members once the infant reaches 9 to 12 months of age, making food preparation for your family easier and more streamlined.(2)

 

Examples of foods that present a choking risk include hot dog pieces, hard candy, jelly beans, peanuts and other nuts, chunks of nut butters, whole grapes, uncut stringy meat, sausage, sticky foods (marshmallows, gum, gummy candies), hard fruits or vegetables like raw apples and raw green beans.(2)

 

For the first 6 months, breast milk or formula provides enough water for your infant. All forms of fluid contribute to meeting the water needs of your infant. Replacing infant formula or breast milk with juice, sports drinks, soda or tea contributes to lower quality dietary intake and is not recommended.(2,12)

 

Infants have a limited ability to signal thirst, especially when they are sick. Vomiting and diarrhea can lead to dehydration quickly. Over the counter remedies (like Pedialyte and Gatorade) can easily become overused. Juices are not needed to meet fluid needs. Juice and other sugar containing beverages are not recommended for use before 6 months of age. They increase the risk for overweight and obesity later in life, and they should never be used at bedtime in a bottle because sugar in the mouth can easily lead to the formation of cavities.(2,13,14) Juices can be used after one year of age, and are not recommended for use prior to this time. Juice should be offered in a cup (if it is offered) and never in a bottle. Limiting juice at this stage is important so that it does not become a habit later in life. It is an unnecessary source of added dietary sugar. Excessive use of a baby bottle at bedtime can lead to cavities and ear infections so limit use of bottles as part of your bedtime routine.(2,14,15)Again, offer juice in a cup and not in a bottle, and if offering a bottle for sleep, only fill it with water. Make sure to clean baby teeth to prevent the formation of cavities.(2)

 

During your infant’s first few months of life, the oral need to suck can be easily confused with hunger. Also, not all signs of infant discomfort are related to hunger. A crying baby does not always want or need food. Infants may want to be held, changed, or calmed by movement or touch. Overfeeding is often the result as parents try to comfort their infant, and overfeeding is less likely to occur with breastfeeding compared to formula feeding.(2)

 

Infants typically move their tongue forward and backward. During their first attempts at spoon-feeding this may appear as if your infant is rejecting the food. It may look like your infant is spitting out her food but rather she is learning to swallow. If choking occurs, it may be due to the position of the spoon on the tongue, and not due to dislike of the food being offered. The mouth is very sensitive, particularly toward the back, and if the spoon is placed there, it can cause a gagging reaction, which has nothing to do with the taste of the food.(2)

 

Infants learn food preferences based on their food experiences.(2,16) Breastfed infants can be exposed to a wider variety of tastes within breast milk compared to infants who are formula fed. What the mother eats flavors her breast milk. Breastfed babies may have a quicker acceptance of new foods after the first year of life because of this. There is a genetic predisposition toward sweet tastes(17) and against bitter foods, which can affect food preferences. Lifelong habits are born out of food preferences developed in infancy, so it is important to incorporate a variety of flavors into your infant’s nutritional regimen.(2)

 

The immune system of infants develops over the first few years of life.(18) While breastfeeding, the mother’s immune system may pass some immunity to the infant.(19) Adverse reactions to foods are more common in infants than in children. The most common allergic reactions are respiratory and skin problems (wheezing and skin rashes).(2) You can lower your infant’s risk for food allergy or intolerance by breastfeeding. In families with known food allergies and intolerances, you can lower your infant’s risk by postponing the introduction of foods that are commonly known as allergens, such as peanuts, wheat, eggs, milk, nuts, sesame, fish, and various fruits and vegetables.(2,20) Otherwise, restriction of foods is not recommended because doing so can increase the risk for nutritional inadequacy and reinforce behaviors like rejection of foods, and limiting variety. Breast milk is recommended for infants that are at risk for allergies, soy is not recommended. Also consider the role of environmental allergens in your infant’s symptoms. Often dust and grasses are to blame rather than foods.(2)

 

Recognizing an infant’s needs and responding to them appropriately is important. Infants that are offered only a limited variety of foods without much interaction during mealtime may refuse to eat as a way to get attention, and infants who learn to manipulate the behavior of adults will become even more successful at this when they become toddlers.(2)

 

Need assistance or have questions? Contact me today!

 

References:

  1. The American College of Obstetricians and Gynecologists. ACOG. OB-Gyns Redefine Meaning of “Term Pregnancy.” Published October 22, 2013. Available from: https://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Ob-Gyns-Redefine-Meaning-of-Term-Pregnancy. Accessed January 2, 2018.

  2. Brown J. Nutrition through the Life cycle 4th ed. Belmont, CA: Wadsworth; 2011.

  3. Abrahamse E, Minekus M, van Aken GA, et al. Development of the Digestive System—Experimental Challenges and Approaches of Infant Lipid Digestion. Food Digestion. 2012;3(1-3):63-77. doi:10.1007/s13228-012-0025-x.

  4. Gelfand AA. Infant Colic. Seminars in pediatric neurology. 2016;23(1):79-82. doi:10.1016/j.spen.2015.08.003.

  5. Anabrees J, Indrio F, Paes B, AlFaleh K. Probiotics for infantile colic: a systematic review. BMC Pediatrics. 2013;13:186. doi:10.1186/1471-2431-13-186.

  6. De Weerth C, Fuentes S, de Vos WM. Crying in infants: On the possible role of intestinal microbiota in the development of colic. Gut Microbes. 2013;4(5):416-421. doi:10.4161/gmic.26041.

  7. Slaughter JL, Stenger MR, Reagan PB, Jadcherla SR. Neonatal H2-Receptor Antagonist and Proton Pump Inhibitor Treatment at US Children’s Hospitals. The Journal of pediatrics. 2016;174:63-70.e3. doi:10.1016/j.jpeds.2016.03.059.

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