Infant nutrition: The best nutrition from birth to year one. | Precision Nutrition

Infant nutrition:
The best nutrition from birth to year one.

By Ryan Andrews

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New parents are subjected to all kinds of contradictory advice about infant nutrition. But with a few simple guidelines – and some advice from Precision Nutrition parents – you can be sure that you are getting your infant off to the healthiest start.

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In life, as in other things, where you start can determine where you finish.

Infancy — the first year of life — is a prime time for growth and changes throughout the body.

What we eat as infants strongly affects our long-term body weight, health, metabolic programming, immune system, and overall aging.

The first 6 months

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Breast is best for both mom and baby.

Babies can be exclusively breast-fed for their first six months of life.

Breast milk is the optimal nutrient mix for infants. It’s full of good stuff like antibodies, antimicrobial factors, enzymes, and anti-inflammatory factors along with fatty acids (which promote optimal brain development).

Breastfeeding keeps the baby developing and growing properly, helps infants fight off disease (such as gastrointestinal and respiratory infections) both now and in the future, and may even ensure that the baby grows up to prefer healthy food.

Because breastfeeding stimulates the release of beneficial hormones such as oxytocin and prolactin, it can help the mother lose weight and bond with her baby.

Breast milk is delivered in a biodegradable “organic package”, so mom doesn’t need to use as much plastic packaging (since tiny humans easily absorb plastic-contained endocrine disruptors).

Do your best. And get help if you need it.

Not every mother takes to breastfeeding naturally or quickly. If breastfeeding is difficult, PN parents Erin Weiss-Trainor and Krista Schaus suggest you seek support from a doula or a midwife.

In addition, lactation consultants are very helpful. The techniques they teach have helped many women successfully breastfeed, even after a difficult start.

[Erin also recommends the work of Jack Newman and Dr. Sears (The Breastfeeding Book and The Baby Book About Everything).]

And while breastfeeding is best, don’t feel guilty if you can’t breastfeed exclusively. There are many circumstances that might make breastfeeding difficult.

For example, you might not be able to breastfeed if you have a health problem, or are taking particular medications. You are not to blame. Just do your best.

“Don’t feel you’ve failed if you have to resort to some formula, or exclusively use formula,” says PN parent Brian St. Pierre.

In fact, most formula-fed children do just fine. Just be sure to talk to your pediatrician about the best formula option. And avoid soy-based infant formulas.

What mom eats/drinks can pass into breast milk.

What you as a pregnant or nursing mother eat, your baby eats.

Of course, breast milk will be especially healthy if mom eats nutritiously while she’s pregnant and breastfeeding.

For example, PN parent Amanda Graydon had a daily shake with greens+, creatine, glutamine, beta-alanine, and BCAAs.  She also supplemented with carnitine and a few additional nutrients, all of which can be passed along, in small amounts, through breast milk.

But it doesn’t have to be that sophisticated. Just follow simple and fundamental Precision Nutrition habits and take advantage of our quick-prep tips (such as zipping up some fruits and veggies in the blender for easy and nourishing Supershakes).

Supplementation while breastfeeding

Breast milk will provide all of the nutrients the infant needs for the first six months of life. However, some babies may need a bit of supplementation at times.

Vitamin D

Because modern life — especially in northern latitudes — leaves so many of us with low vitamin D levels, many mothers are deficient in vitamin D while pregnant and breastfeeding. Additionally, preemies are often low in vitamin D.

This means that infants may need a vitamin D supplement. The American Academy of Pediatrics (AAP) recommends a daily vitamin D supplement of 400IU for all breast-fed infants, starting immediately after birth.

Note: once formula fed infants are up to about 30 oz of formula per day (which is usually around 2 months), you can discontinue vitamin D supplementation. However, it is recommended that breast fed infants continue vitamin D supplementation for at least one year.

In the end, some babies can get enough vitamin D from breast milk. But the mom needs to have solid vitamin D levels for this to happen, which most don’t.  If you’re pregnant or a new mom, check with your doctor and pharmacist about testing your vitamin D levels, and the best and safest options for your infant.

Vitamin B12

Breastfeeding mothers who eat an exclusively plant-based (vegan) diet should supplement with vitamin B12.

Iron

A fetus will store iron from the mother’s blood while in the womb.  Premature babies need extra iron because they do not build up enough stores.

Breast milk doesn’t have much iron, but it is well absorbed.  Iron stores will last until about six months of age, thus no iron supplement should be required during this time.  Formula-fed infants will likely get enough iron.

Probiotics

Babies are born with a sterile environment inside. As they pass through the birth canal, the mothers’ bacteria colonize infants’ mucous membranes and gastrointestinal tract. This is normal and desirable — just how Nature intended.

However, in an environment of modern cleanliness, or perhaps after a C-section, this bacterial colonization doesn’t happen as easily or well. This can lead to later gastrointestinal, respiratory, and/or ear-nose-throat type infections in babies, as well as a lower immune system.

In this case, parents can supplement with an infant probiotic formulation — talk to your pharmacist to find out what’s best.

For more on beneficial bacteria, see All About Probiotics.

Fluids & hydration

The amount of fluid in breast milk or formula will usually be enough, so normally you shouldn’t need to supplement with water.

However, infants easily and quickly become dehydrated under certain conditions, such as if the infant has a fever or is vomiting a lot; or if  the climate is very hot.

Rehydration is also crucial if infants have diarrhea. (In this case, add a little sugar and salt to the water to make a simple electrolyte solution.)

Use urine colour as a guide: Dark yellow urine will signify dehydration. Clear urine signifies potential over-hydration. You want to see something somewhere in the middle. (Baby will undoubtedly oblige with a urine sample, probably at the most socially inconvenient time.)

Months 6-12

baby-6-12

Introducing solid food

Until about 4-6 months old, infants can’t digest most foods.

Infants are ready for solid foods once they have doubled their birth weight, providing they can hold their heads up, sit in a high chair, open their mouths when food is presented, and swallow. This usually occurs around six months old.

At first, offer solid foods in addition to breast milk, not as a replacement for it. The first “solid” foods should also be liquid-like. (Don’t give your baby beef jerky right off the bat.)

Take your time when introducing new foods.

Don’t rush. Lean Eating Coach, mother, and Registered Nurse Eileen MacRae suggests offering one new food every 3-4 days. This gives you time to see how your baby responds.

Pay attention.

If you notice any type of negative reaction (such as respiratory, skin, or GI issues), wait 1-3 months before trying that food again.

Solid food timeline

Step 1: Rice cereal (maybe)

Rice cereal with breast milk or formula is a common first food.  It’s generally well-tolerated with low potential for allergy.

However, rice cereal is rooted in tradition rather than science. There’s no strong evidence that this is a better option than other single-grain cereals (or grains in general). Try it and see how it goes.

Step 2: Vegetables

Vegetables are full of nutrients and not as sweet as fruits. Puréed vegetables such as sweet potatoes, beets, squashes, or carrots are easy to cook and mash.

Step 3: Fruit

Introduce fruit after vegetables. If fruit is the first food, baby might expect every food to taste sweet; an important factor considering that food tastes formed early in life can persist.

Also, babies don’t yet have the ability to digest fructose effectively. So, unless you want explosive diarrhea, keep fruit intake moderate and avoid high-fiber fruits like prunes for a while.

You can try things like:

  • mashed banana with breast milk
  • cooked and puréed fruit (such as pears, peaches, or apples)

Step 4: Higher-protein foods

This includes well-cooked and mashed beans/lentils/green peas, and finely chopped meats.  You could even add a little undenatured, unflavored whey protein to pureed foods, formula, etc.

It can take a while for the infant’s GI tract to adjust. Some undigested food might be found in the stool; this is okay and all part of the process.

12 months and older

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By around one year old, you can add a pretty good roster of foods, such as:

  • avocado
  • tree nuts
  • string beans
  • asparagus
  • puréed fresh fruit
  • egg yolk (note: iron from egg yolks isn’t well absorbed)
  • mashed lentils/beans (make sure these are adequately cooked)
  • meat, chicken, or mild-tasting fish

Finely chop, mash, and/or purée most of these, especially meat or any little bits that can’t be easily gummed — or that can cause choking.

Introduce with caution

While fish is usually tolerated easily, experts vary on when to introduce shellfish/crustaceans. The general consensus is to wait until the child is a little older. Shellfish is a common childhood allergen, along with:

  • whole eggs/egg white
  • peanuts
  • cow’s milk
  • wheat
  • soy

Also look for any reactions when introducing nightshades — potatoes, tomatoes, and peppers.

If or when you add these to your child’s diet later on, observe carefully and look for any reactions before adding something else. Most kids will do just fine with many of these foods.

What does baby like?

Every mom and dad has a feeding-time horror story of their baby deciding to redecorate the wall, floor, ceiling, or hapless parent’s shirt.

Bbbbbbtttt goes baby. Splat go the mashed peas everywhere. OK, let’s try that one later.

Sometimes it’s hard to know what babies will like from one bite to the next. Be patient and persistent.

Here are some tricks and tips for helping your baby eat a wide variety of foods despite an often-picky infant palate.

Eat a wide variety of foods while pregnant.

What you eat can affect what baby will tolerate and like.

Adoptive mom and PN parent Susan Olding can attest to this: Her daughter, adopted at ten months from China, showed a strong preference for the dominant flavour notes of her native cuisine right from the start, happily gobbling up bitter and cool green veggies like bok choy, gai lan, and watercress.

Use timing to your advantage.

Introduce new foods when babies are hungriest. For Amanda Graydon, that was in the morning. So that’s when she’d try new foods. Smart!

Add a touch of sweetness.

Humans are born with an innate preference for sweetness, which in nature signifies valuable energy-rich foods. Blend up a little bit of sweet potato or fruit into otherwise less-sweet foods (such as more bitter vegetables).

But avoid processed sugar.

Again, remember that what your baby starts with will affect their adult food preferences. So avoid processed sugar — especially hidden in commercial baby foods along with fruit purées and juices — as much as possible.

And avoid honey for the first year or so, as it can contain bacteria that infants can’t yet deal with.

Keep at it.

If your baby refuses to eat a particular food, that’s okay. (This might happen more often with vegetables.)

Leave the food out of the routine for a while and come back to it later. Often babies and children need to try novel foods over and over before they adjust to them. Keep the experience as positive and relaxed as possible, and do your best.

Don’t worry; if baby’s eating various other foods, nutrient intake should be adequate.

“Let baby lead the way when it comes to solid foods,” Erin Weiss-Trainor suggests. 

“With our first, we followed the “books” and started to introduce solids around 4-6 months. We started with cereal-based foods, then fruits and veggies, then meats and dairy. We avoided eggs, honey, and nuts/seeds until older.

“With baby #2 and 3, we let them explore more. Once they showed signs of interest (reaching for food on our plates), I’d share right from our plate – making sure food size and texture was age-appropriate.”

Stick with whole foods.

Infants are intuitive eaters.  They know how much they need.

But there is a catch – the conditions have to be right.  Force-feeding and/or introducing processed foods (such as juice or jam) before whole foods can destroy this delicate self-regulation.

Follow your baby’s hunger levels and food preferences, while seeking to gently expand their repertoire with high-quality, nutrient-rich choices.

amalynn-food
A lunchtime snapshot before Amalynn (2-yr old daughter of JB and Amanda) digs in.

Feeding schedules

Learning hunger cues is important for both parents and babies. (And parents, why not re-learn your own natural hunger cues along with discovering your infant’s?)

Remember that infants will be highly self-regulated. They’ll want to eat when they’re hungry, and stop when they’re full.

I trusted my kids’ hunger

“When they told me they were hungry”, says Erin Weiss-Trainor, “I fed them. And when they weren’t hungry, I stopped.”  It was a natural cycle of supply and demand.

“When the baby needed to eat more, I made more milk. As they ate less, I produced less.  It’s a beautiful thing to experience – baby being so in tune with hunger. And mom and baby being so in tune with each other.”

Try not to pressure your baby into a set schedule in the early days, or wake them to feed during the night.

Relax and see if you can find their rhythms. (Trust us, babies will wake up just fine on their own and let you know when it’s midnight snack time!)

If baby is spitting up a lot or making large watery stools, especially if they’re supplementing with formula, they may be over-feeding. Back off slightly and see if you notice a difference in their hunger signals and bowel habits.

Help your baby communicate

Because language develops relatively late, and both babies and adults get frustrated and cranky when they can’t communicate effectively, Krista Schaus recommends teaching your baby sign language.

When baby can sign for “more”, “hungry”, “full”, “gimme that thing”, and even “diaper change”, life becomes easier.

“My son was signing before six months,” Krista says. “He even made up his own signs by the time he was one year old.”

Weight gain & growth

Each baby is unique. Just like in Scrawny to Brawny, some are fast gainers. Some are slow gainers. Some will gain fast right out of the gate then stabilize, others will lag and then blast off.

As babies slow down their growth, they’ll be less hungry on average (although 60% of their intake is feeding their brains rather than the rest of their developing bodies).

But again, appetite will vary day to day. Some days, babies will be ravenous all-consuming beasts. Other days, there’s not a mashed banana in the world that’ll interest them.

So don’t panic if your baby doesn’t seem to be sticking to a steady weight gain or eating schedule. These are just average guidelines:

  • During the first three months, you can expect your baby to gain around 2 lb/month.
  • 6 months – 1 lb/month
  • 9 months – less than 1 lb/month

Consider the time of day when the infant is weighed (e.g., when they last eliminated and ate).  Babies usually only get weighed when they go to the doctor. This is often enough (and might be often enough for some adults).

Making food at home

It’s easy and cost-effective to make baby food at home. All you need is a food processor or small blender such as a Magic Bullet. (Or a bit of elbow grease and a fork for mashing.)

Early on, your baby’s food choices will be limited, but over time you can mash, chop, and/or purée most of the foods you happen to be eating. Makes food prep simple, and more importantly — you know exactly what your baby’s getting.

Make sure you blend/mash the food well, and avoid any foods that might cause choking.  Chunks/clumps of any food, hot dogs, candy, nuts, grapes, nut butter, and popcorn all tend to cause problems.

Of course, follow the basic rules of food safety. Wash your hands, refrigerate or heat food appropriately, discard uneaten food promptly, etc.

If you use commercial baby food, check the ingredients. Only feed out of the jar if you are going to use the entire jar.

Nutrient requirements

If you’re feeding your older baby a relatively wide range of high-quality, nutrient-dense foods when they’re hungry, that’s probably all you need to worry about. But here are some general guidelines for nutrient intake in older babies and young children (6 months – 2 years).

Fats

Growing babies and children need plenty of fat, particularly saturated, monounsaturated, and omega-3 fats. Look for naturally occurring whole-food fats such as:

  • avocado;
  • coconut;
  • butter and other high-fat dairy;
  • meat;
  • eggs; and
  • fatty fish from healthy animals. (But be aware of heavy metals in fish – See All About Eating Seafood.)

Nuts, seeds, and nut butters (including flax, hemp, and chia seeds) can come later once you’re sure that your child tolerates them and can eat them properly.

Omega-3 fats (DHA/EPA) in particular are critical for overall health; body composition; and eye, brain and nervous system development. Consider an infant-appropriate DHA/EPA supplement.

Iron

Babies need iron for cognitive, neurological, motor, and behavioral development, and they start to require additional dietary iron around 6 months.

Start adding iron-rich foods around this time. This can begin with iron-fortified rice cereal and over time include other iron-rich foods such as:

  • leafy greens
  • orange-fleshed squash
  • figs
  • raisins
  • nuts & seeds
  • lentils
  • artichokes
  • peas & lima beans
  • potatoes
  • chicken or beef liver (try sneaking a little bit in to blended meat)
  • red meat (beef, venison, ostrich, etc.)
  • chicken (dark meat) and duck
  • fish

While some iron is important, don’t go overboard. Check to be sure you aren’t overdoing the iron if you rely on a lot of fortified baby foods. (Here’s a link to some more reading on iron for babies and children.)

Note: Cow’s milk contains very little iron, can cause iron to be lost in the feces, and can damage an infant’s GI tract. Don’t give babies younger than 1 year old soy/almond/hemp/rice/cow’s milk.

Zinc

Cells need zinc.  Infants older than six months of age who eat a 100% plant-based (vegan) diet might need a zinc supplement.

Foods rich in zinc:

  • peas & beans
  • nuts & seeds
  • napa cabbage
  • hearts of palm
  • sun-dried tomatoes
  • cocoa powder
  • meat, poultry (especially darker cuts), fish
  • cheese

Vitamin B12

Infants older than six months of age eating a 100% plant-based (vegan) diet will need a vitamin B12 supplement.

Fluoride

If water isn’t fluoridated, a supplement might be necessary. Too much will also cause problems.

Iodine

Iodine keeps the thyroid healthy.  Infants older than six months of age who eat non-iodized salt and a limited variety of foods might need a supplement.

Foods rich in iodine include:

  • dried prunes
  • strawberries
  • sea vegetables
  • yogurt
  • eggs
  • iodized salt

You can often sneak sea vegetables in particular into baby food to hide the taste — sprinkle a little crumbled dried seaweed into mashed veggies and blend it up.

Hydration

Stick with mostly water or herbal tea. Save vegetable and fruit juices for special occasions, unless you make them yourself from blending up fresh/cooked fruits and vegetables.

The first couple of years of a child’s life can establish life-long taste preferences and their metabolic environment. Sugar now means cavities, body fat, and over-sweet taste preferences later.

Juice is high in sugar and is often the leading source of sugar for infants. And despite package claims, juice is also a poor source of fruit and/or vitamins.

Artificially sweetened beverages can make naturally sweet foods taste less appealing.  Also, artificial sweeteners might have negative health outcomes.

Summary and recommendations

Infants don’t shop and prepare their own food.  That means they depend on parents and caregivers to shop and prepare foods that promote optimal health. And that means you and me.

To give your baby the best start:

  • If you can, breastfeed for at least the first six months of the infant’s life.
  • If required, add a vitamin D and/or B12 supplement after 2-3 months.
  • At around six months of age, start with some basic solid foods.
  • Start with something like rice cereal, then vegetables, then fruits and protein-dense foods. Introduce only one new food at a time, and see how it goes.
  • Choose whole foods. These are nutritious and satiating, and develop appropriate taste preferences.
  • Follow your baby’s hunger signals, and food preferences, while also gently and patiently adding food variety and mealtime structure. Don’t rush new foods, but be persistent and stick with it.
  • Talk with your doctor and pharmacist about supplements (calcium, greens, iron, zinc, iodine, omega-3 fats, probiotics, etc.) if appropriate.
  • Go for organic and/or food items with lower levels of pesticides.  Use the following list if you are unable to buy exclusively organic.
  • Minimize added sugars. This includes fruit juice and other processed foods. Read labels.
  • For the first six months of life breast milk usually provides enough fluid.  After six months of age, water and herbal tea are fine. Avoid cow, soy, and other processed milks for the first year.
  • Do your best. Parenting is hard enough, and each child is unique. Don’t try to get it “perfect”. Use the basic PN habits and quick food prep tips to make things easier.

Resources

Predict your child’s risk of obesity: http://healthland.time.com/2012/11/29/predicting-obesity-at-birth//

Dr Sears’ Website: http://www.askdrsears.com/

Baby Lead Weaning: http://en.wikipedia.org/wiki/Baby-led_weaning

The AAP and WHO: http://www.aap.org/en-us/Pages/Default.aspx ; http://www.who.int/en/

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References

Click here to view the information sources referenced in this article.