Topic 2 Nutritional needs and dietary guidelines in infancy
AGE GROUP: 0-2 YEARS OLD
- What, when and how children are fed, particularly in the first two years of life, is critical to health, development and survival.
- The early initiation of breastfeeding – putting newborns to the breast within the first hour of life – is critical to newborn survival and to establishing breastfeeding over the long term.
- Feeding infants nothing but breastmilk for the first six months of life is the safest and healthiest option for children everywhere and has great potential to save lives.
- Very few children benefit from recommended breastfeeding practices.
- Starting at 6 months of age, children’s nutrient needs are greater than what breastmilk alone can provide.
- Nutritional needs for growth and development in children 6–23 months of age are greater per kilogram of body weight than at any other time in life.
- Feeding children solid, semi-solid or soft foods from 6 months of age is key to prevent deficiencies that could result in undernutrition.
- Diets that meet at least minimum frequency and diversity standards are essential to preventing micronutrient deficiencies, stunting and wasting.
- Data show that worldwide, most children aged 6–23 months were not fed according to global recommendations.
The World Health Organisation (WHO) and UNICEF recommend:
- Initiation of breastfeeding within 1 hour of birth
- Exclusive breastfeeding for the first 6 months of life (complete avoidance of other foods and liquids, including water)
- Complementary breastfeeding for up to 2 years and beyond. In the meantime, children should initiate eating safe and adequate complementary foods.
- Infants should be breastfed on demand! (Day or Night). Bottles, teats, pacifiers should be avoided.
Exclusive breastfeeding for 6 months has various benefits for both the baby and the mother.
Breastfeeding is an important energy and nutrient source. It can meet:
- all the energy needs of a child aged 0-6 months
- 1/2 or more of the energy needs of a child aged 6-12 months
- 1/3 of the energy of a child aged 12-24 months
At 6 months of age, the infant’s energy and nutritional needs begin to exceed the amount provided by breast milk. Therefore complementary foods are required to meet these needs.
The principles of proper complementary feeding are:
- Breastfeeding should be contacted on a regular basis and always on demand up to 2 years of age
- Young children should be fed slowly and patiently. Encourage should be prioritized over forcing to eat food
- The carer should maintain eye contact and interact with the child through the feeding process
- The food portion is small at first, but gradually increases in size, as the child grows
- Food consistency and variety should be a priority and gradually increase
In the following table, the neurological development of infants and young children and implications for types of foods that can be consumed at different ages are summarized:
There is no evidence on the ideal order in which the food groups should be introduced to an infant which starts the consumption of solid foods. By the time of 7 to 8 months can eat a variety of foods from different food groups. The following table presents some indicative recommendations on how the solid foods should be introduced to an infant.
AGE GROUP: 2-3 YEARS OLD
Daily energy intake should be:
- Boys ≈1129 kcal/day (82.4 kcal/kg/day)
- Girls ≈ 1047 kcal/day (80.6 kcal/kg/day)
Macronutrients:
- 45-60% carbohydrates (with at least 10 g fibers)
- 35-40% fat (limit saturated fat)
- Protein: ≈ 0.97-0.90 g/ kg/ day
- 450 mg of calcium
- 7 mg of iron
- 140 μg DFE of folate
- 15 μg of Vitamin D
- <2 grams of added salt (1 teaspoon ≈ 5 grams)
Food consumption frequency
- 1 serving of fruits
- 1 serving of vegetables
- 2 servings of dairy
- 3 servings of grains (ideally whole grains)
- 1-2 servings of fat
- 5 glasses of liquids (tea, milk, soups, beverages), of which 3-4 glasses are water
- Up to 3 servings of legumes (each serving is about 60 grams of cooked legumes)
- 2-3 servings of white and red meat (each serving is about 60 grams)
- 4-7 eggs
- 2 servings of fish or seafood (each serving is about 60-90 grams)
To avoid chocking hazards:
- Cook or boil vegetables enough, so that they every part is soft
- Raw vegetables and fruits should be cut in small pieces
- Remove the bones in fish and meat meticulously!
Divide the 1 recommended serving of fruit to 2 halves though the day.
Ensure that the freshly squeezed juice is consumed in a limited timeframe, either wise the vitamin content may abate.