Nutrition for healthy term infants, six to 24 months: An overview

Question 1

What are the principles re: nutrition in infants 6-24mo?

Answer 1

1. Breastfeeding is an important source of nutrition for older infants and young children as complementary foods are introduced. Breastfeed exclusively for the first six months, and continued for up to two years or longer is important for nutrition, immunologic protection, growth and development of infants and toddlers.
2. Supplemental vitamin D is recommended for infants and young children who are breastfed or receiving breastmilk.
3. Complementary feeding, along with continued breastfeeding, provides the nutrients and energy to meet the needs of the older infant.
4. Responsive feeding promotes the development of healthy eating skills.
5. Iron-rich complementary foods help to prevent iron deficiency.
6. Foods for older infants and young children must be prepared, served and stored safely.
7. From one year of age, young children begin to have a regular schedule of meals and snacks. Generally follow the advice in Canada’s Food Guide

Question 2

What are the recommendations re: nutrition in infants 6-24mo?

Answer 2

1. Support breastfeeding for up to two years or beyond, as long as mother and child want to continue.
2. Recommend a daily vitamin D supplement of 10 µg (400 IU) for infants and young children who are breastfed or receiving breastmilk.
3. Recommend gradually increasing the number of times a day that complementary foods are offered while continuing to breastfeed.
4. Recommend iron-rich meat, meat alternatives, and iron-fortified cereal as the first complementary foods. Encourage parents and caregivers to progress to introduce a variety of nutritious foods from the family meals.
5. Ensure that lumpy textures are offered no later than nine months. Encourage progress towards a variety of textures, modified from family foods, by one year of age.
6. Encourage responsive feeding based on the child’s hunger and satiety cues.
7. Promote offering finger foods to encourage self-feeding.
8. Encourage use of an open cup, initially with help.
9. Continue to recommend a variety of iron-rich foods. Ensure that foods such as meat and meat alternatives and iron-fortified cereal are offered a few times each day
10. If parents and caregivers are introducing cow milk, advise them to delay until nine to 12 months of age. Recommend limiting cow milk intake to no more than 750 mL per day.
11. Recommend infants and young children always be supervised during feeding.
12. Recommend parents and caregivers avoid offering hard, small and round, or smooth and sticky, solid foods. These may cause aspiration and choking.
13. Promote safe food preparation and storage to prevent foodborne illness. Recommend avoiding products that contain raw or undercooked meat, eggs, poultry or fish; unpasteurized milk or milk products; unpasteurized juice; and cross-contamination between cooked and uncooked foods.
14. Advise parents and caregivers not to give honey to a child under one year of age. This helps to prevent infant botulism.
15. Recommend a regular schedule of meals and snacks, offering a variety of foods from the four food groups.
16. Recommend foods prepared with little or no added salt or sugar.
17. Explain to parents and caregivers that nutritious, higher-fat foods are an important source of energy for young children.
18. Encourage continued breastfeeding, or offering 500 mL per day of homogenized (3.25% M.F.) cow milk.

19 Advise limiting fruit juice and sweetened beverages. Encourage offering water to satisfy thirst.

20. Encourage parents and caregivers to be role models and instil lifelong healthy eating habits.

Question 3

What are the recommendations regarding non-breastfed infants?

Answer 3

1. Recommend commercial infant formula until nine to 12 months of age (cow milk-based is the standard infant formula; there may be indications for soy-based infant formula or formulas for special medical purposes).
2. Advise pasteurized homogenized (3.25% M.F.) cow milk be introduced at nine to 12 months of age. Skim milk is not appropriate in the first two years.
3. Advise that, for most healthy young children, there is no indication for the use of commercial formulas beyond one year of age.
4. Advise that soy, rice, or other plant-based beverages, whether or not they are fortified, are inappropriate alternatives to cow milk in the first two years.
5. Recommend avoiding prolonged bottle feeding and giving bottles at night.