The Start Healthy Infant and Toddler Feeding Guidelines*

What

Research Question:
a) What are infants' and toddlers' nutrient requirements?

Conclusion:
The Dietary Reference Intakes (RDA and AI) provide recommendations for nutrient intakes for healthy individuals and populations including infants and toddlers. However, these are estimates only. It is important to monitor growth and development.

Research Question:
b) What nutrients are needed from complementary foods?

Conclusion:
After 6 months, most breast fed infants need complementary foods to meet current recommendations (DRI) for energy, manganese, iron, fluoride, vitamin D, vitamin B6, niacin, zinc, vitamin E, magnesium, phosphorus, biotin and thiamin. Amounts of energy and nutrients needed from complementary feeds will vary depending upon the intake of human milk or formula. Although iron-fortified infant formula provides the recommended intakes of energy and nutrients until about one year of age depending on intake, all infants need complementary foods for exposure to flavors and textures as well as to master eating skills.

Research Question:
c)What is the evidence that specific nutrients require special emphasis in the diets of infants and toddlers?

Conclusion:
National nutrition monitoring in the United States of biochemical indicators of nutritional status of infants and toddlers suggests that iron needs special emphasis, the prevalence of deficiency being highest among children less than 2 years of age. Provision of complementary foods such as meats and fortified cereals contribute significant amounts of iron and is helpful in preventing deficiency. Because rickets due to vitamin D deficiency has been observed recently in dark-skinned breast fed infants and other infants without adequate sun exposure, 200 IU vitamin D is recommended as a supplement for breast fed infants and infants receiving less than 500 ml formula per day. Intakes of the essential fatty acids may require emphasis once breast milk or formula is replaced with cows milk.

Research Question:
d) What foods should be avoided to reduce food allergy risk?

Conclusion:
Infants with a strong family history of food allergy (ie those whose parents had or have food allergies and/or those who have a sibling with significant allergy )should be breast fed for as long as possible and should not receive complementary foods until 6 months of age. The introduction of the major food allergens such as eggs, milk, wheat, soy, peanuts, tree nuts, fish and shellfish should be delayed until well after the first year of life. Those foods that are associated with “life-long” sensitization (peanut, tree nuts, and shellfish) should not be introduced until even later years. Consideration of a hypoallergenic formula, duration of formula use, and other dietary restrictions should be decided in consultation with the health care provider.

There is no evidence that restriction or avoidance of any foods is necessary for the infant who is not at risk for allergy. Caregivers, however, are advised to introduce new foods one at a time and to watch for adverse reactions. Studies documenting an optimal time before the introduction of the next new food were not found. Recommendations range from 2 days to a week. One new food every 2 to 4 days (e.g., 2-3 per week) seems reasonable.

Research Question:
e) What is the role of physical activity for infants and toddlers?

Conclusion:
While there is no evidence that physical activity in infants or toddlers is related to activity or health in later years, age-appropriate, daily physical activity in a safe, nurturing environment may help promote physical development and movement skills and teach the healthy habit of activity. Encourage parents and caregivers to promote enjoyment of movement and motor skill confidence at an early age. Motor skills, like cognitive skills, flourish when the infant is exposed to a stimulating environment. Early childhood is a key period for promoting physical activity because during this time, fundamental motor skills (walking, running, jumping, etc.) begin to develop. When activity is encouraged, these skills can further develop into advanced patterns of motor coordination. Television viewing should be discouraged for children under 2 years of age.