General Guidelines for Baby Feeding

Introduction:

Proper growth and development of the baby depend on the nutrition obtained during the first year of life. Practicing good eating habits from this age promotes healthy and nutritious eating patterns in the long run. Feeding depends on the infant’s readiness, developmental age, and feeding skills. Major growth changes occur during the first year after birth. Babies thrive on breastfeeding or formula feed during the first few months.

How to Know if a Baby Is Hungry?

A hungry baby shows the following signs:

• Crying.

• Moving their heads from one side to another.

• Opening their mouths.

• Sticking out the tongue.

• Place their fists or hands into the mouth.

• Move their mouths as if they are sucking.

• Pushing against their mother’s breasts or towards a bottle.

• Drooling and smacking of lips.

• Staring at the person who feeds as they move.

• According to Dunstan baby language, a baby makes the sound ‘neh’ before crying if they are hungry.

• Hunger awakens the baby even from a deep sleep.

How to Know if a Baby Is Ready for Solid Feed?

Solid foods can be commenced between four to six months of age. Breastfeeding is recommended till six months of age. Solid feeds should be alternated with breastfeeding. A baby who is ready to take solid food shows the following signs:

• Baby is able to sit upright or straight with minimal or no support in a high chair. Foldable baby high chairs can help the baby in doing tasks like eating, playing, and relaxing.

• Baby can hold their heads for longer durations.

• Baby is hungry even after eight to ten breastfeeding sessions or 32 ounces in case of formula feeds.

• Baby shows interest in adult foods.

• Reaches for and puts things in the mouth.

• Retains the food in the mouth instead of pushing it onto the chin.

• Able to push the food with the tongue to the back of their mouth.

• Turns their head away if they do not want something.

• Baby willingly opens the mouth to spoon feeding.

A pediatrician’s (child specialist) opinion has to be obtained before feeding solid foods to children who require special needs and babies born prematurely.

What Are the Food Portions and the Amount of Intake in Infants?

Food portions and the amount of intake based on age are as follows:

General Guide to Food Portions and Amount of Intake Based on Age -

• At the age of zero to four months, the type of food given is breast milk and infant formula, which is given in eight to 12 feeds per day and two to four ounces.

• At the age of four to six months, the type of food given is breast milk (four to six feeds per day), infant formula (six to eight ounces per day), and infant cereal (one to two tablespoons).

• At six to eight months, breast milk (three to five feeds), infant formula (six to eight ounces), infant cereal (two to four tablespoons), crackers and bread (two crackers or half bread slice), juice or water (zero to three ounces), fruit or vegetable (two to three spoons) and meat or beans (one to two tablespoons).

• At eight to 12 months, breast milk (three to four feeds), infant formula (six to eight ounces), infant cereal (two to four tablespoons), crackers and bread (two crackers or half bread slice, juice or water (three ounces), fruit or vegetable (three to four tablespoons), meat or beans (three to four tablespoons), and cheese or yogurt (0.5 ounces of cheese or half cup yogurt).

The above is a general guide and can differ with babies.

What Is the Feeding Guide for the First Year in Babies?

Breast milk and infant formula are the two most important sources of nutrition for infants in the first year. Breast milk is rich in antibodies and helps the baby fight infections. A pediatrician can be consulted before starting solid foods. Solid foods should not be given to babies before four months of age because -

• Breast milk and infant formula contain all the needed nutrients.

• The baby is not physically developed to start feeding solid foods from a spoon.

• Starting solid foods too early can lead to poor feeding experiences that can cause weight gain in both infancy and childhood.

• Nothing can replace breast milk, but infant formula contains cow’s milk, vitamins, minerals, and other nutrients. Plain cow’s milk cannot be given directly since certain components in cow’s milk are difficult to digest and lack certain nutrients that infants require.

The American Academy of Pediatrics (AAP) suggests that all infants, children, and adolescents must take sufficient Vitamin D either through cow’s milk, formula, or supplements to prevent Vitamin D deficiency. The American Academy of Pediatrics now recommends a minimum intake of 400 IU of Vitamin D per day for the above groups immediately after birth. A pediatrician can suggest the proper type and dosage of Vitamin D supplements.

What Is the Guide for Breastfeeding?

The following are the general guidelines for breastfeeding infants between zero to 12 months:

• Newborns should be breastfed every two o three hours even at night. The mother should respond to the hunger cues of the baby such as crying, inserting the fists into the mouth, and so on, and feed the baby promptly in a comfortable, quiet, and relaxed environment.

• It is normal for many infants to wake up in the night to feed and this can happen for several months.

• Alternate breasts should be used while feeding and one breast must be emptied before moving to the other. This ensures that the hindmilk which is rich in nutrients is fed to the baby.

• The child’s hunger cues should be followed instead of keeping a schedule. The number of wet diapers and weight gain can be indicators of whether the baby is getting sufficient breast milk or not.

• If the mother is unable to breastfeed, the breastmilk can be pumped to maintain the supply. The pumped breastmilk should be stored in a safe place at an appropriate temperature. Even when feeding breastmilk in bottles, it should not be forced and the baby’s hunger cues must be noticed. Forcing the baby to empty the bottle can lead to overfeeding and weight gain.

• With proper methods and support, a mother can breastfeed infants sufficiently including twins.

What Is the Guide for Formula Feeding?

The following are the general guidelines for formula-feeding infants between zero to 12 months:

• When breastmilk cannot be given to babies for certain reasons, formula feeds can be given. Formula feeds should be selected carefully after consulting a pediatrician.

• Bottle-feeding sessions should be interactive and both the bottle and the baby should be held by the parent or the caregiver. Just giving the bottle to the kid or placing it in their mouth can cause tooth decay and ear infections.

• The child’s hunger cues should be followed instead of keeping a schedule. The number of wet diapers and weight gain can be indicators of whether the baby is getting sufficient formula milk or not.

• The formula feed remains the primary source of calories, proteins, calcium, and Vitamin D during the first year of life in babies. The amount of formula intake will decrease as the baby shifts to solid food.

What Are the General Guidelines for Feeding Beverages to Infants?

Only breast milk or formula feed should be given in bottles till one year of age unless specified by a pediatrician. Breastmilk or formula feed can be introduced in a cup at six months of age. Fruit juice is not advised in babies below one year of age. When juice is given, it must be ensured that it is 100 % pasteurized (heat-treated to kill harmful bacteria) and should be limited to six ounces per day. Juice should not be kept in bottles. Sugar-sweetened beverages should be avoided in infants. Water can be given from six months of age.

What Are the General Guidelines for Feeding Solid Foods in Infants?

Guidelines for feeding solid foods are:

• Solid foods should be offered when the infant is seated in a comfortable position and is upright. The infant should be moderately hungry and should sit with support. The feeding environment needs to be calm.

• Feeding solid foods should begin with small portions and then gradually increase as the child eats more. It is recommended to feed using a spoon and begin with solid foods like finger foods (small pieces of food that can be eaten from the hand).

• The infant should be introduced to a variety of flavors of foods with different textures. The food choices should not be limited to those of the parent or caretaker. Offering a wide range of foods promotes healthy eating habits in the future.

• The parent or the caretaker is responsible for offering a variety of foods with various textures. It is the responsibility of the infant to decide what and how much to eat.

• Salt or sugar should not be used in baby foods to make them attractive as these can result in obesity in adults. Infants need to taste a particular food many times before accepting it. They should be given sufficient time to get into the feeding routine.

• If the infant shows a dislike for food or is tolerant towards a new food it should be discussed with a pediatrician.

• Commercial baby foods should be avoided. Infants notice adults, so by being a role model, the parent or caretaker can encourage them to take healthy foods.

• Any food allergies should be reported to the pediatrician. Honey in any form should strictly not be given to infants below one year of age as it can cause infant botulism (infant botulism occurs when the bacterial spores get into the infant’s intestines and produce toxins).

• Fat and cholesterol need not be restricted unless suggested by a physician. These are essential for the development of the brain and nervous system along with general growth in infants.

• Solid foods like cereals should not be given in bottles as they can cause choking. Bottles should not be heated in microwave ovens as they can burn the baby’s mouth. Instead, it can be heated under warm tap water or in a pan of warm water.

• Infants should be monitored while eating and should be asked to sit down to eat or drink.

• Hard foods that can pose choking hazards like popcorn or nuts, hard fresh fruits like apples, meat that is not well cooked or chopped, cheese cubes, and peanut butter should be avoided. Apples can be cooked to soften and chopped into very small pieces before giving.

When to Wean a Baby?

Most infants are ready to wean from bottle feeding by 12 to 18 months of age however, it is up to the baby and the mother to decide. The baby may be ready to wean from breastfeeding if they are more interested to explore solid foods, eat on a regular schedule, and do not sit when trying to breastfeed. The weaning process is gradual and the first step can be tried by offering water in a cup at six months. Bottle feeding should be stopped by two years of age.

Can an HIV Positive Mother Breastfeed the Baby?

HIV can be transmitted from the mother to her baby during pregnancy, labor, and through breast milk. Studies show that antiretroviral treatment (ART) for HIV mothers can substantially reduce the risk of transmission to babies through breastfeeding. The World Health Organization (WHO) recommends all HIV-infected individuals including pregnant and lactating women to take ART therapy once the infection is detected. Mothers living in malnourished areas and areas where certain diseases and deaths from these diseases are prevalent like diarrhea, pneumonia, and so on should exclusively breastfeed their babies till six months of age. Solid foods can be introduced at an appropriate age and accompanied by breastfeeding till one year of age.

Conclusion:

How, when, and what to feed infants should not be a matter of concern for parents as infants know when they are full or hungry. The parents need to just pay attention to their hungry cues and offer them a wide range of foods to enable them to explore. Any concerns can be discussed with a pediatrician (child specialist).