Nutrition

Before Your Baby Arrives

You begin making choices about feeding your baby long before your baby is born. Pregnancy provides you with the chance to think about the food you eat, how you will feed your baby and the eating habits you want for your growing family. While pregnant you should follow these guidelines:

• Expect to gain 25-35 pounds.
• Practice good family mealtime habits, such as eating together with the TV off.
• Eat calcium-rich food such as dairy products, calcium-fortified orange juice, broccoli, and leafy green vegetables.
• Eat iron-rich food such as meat, poultry, fish, liver, legumes, soybean products, dried fruits, and iron-fortified cereals.
• Eat food rich in folic acid such as leafy green vegetables, fruits, milk, and folic acid-fortified cereals. Check with your doctor to be sure your folic acid intake is adequate.
• Be faithful in taking the prenatal vitamins and folic acid your doctor recommends.
• Avoid alcohol, caffeine, and tobacco products.

Top Five Reason to Breastfeed

• Human breast milk is the perfect food for human infants and is superior to all commercial formulas.
• Human breast milk composition changes from day to day, from feeding to feeding and from the beginning of the feeding to the end of the feeding. The change in the composition of breast milk makes it possible to meet your baby’s changing nutritional needs.
• Breastfed babies have fewer infectious illnesses and fewer allergic problems in the first year of life.
• Nursing your baby is good for your health, too. Breastfeeding mothers recover more quickly from the pregnancy, have a faster return to pre-pregnancy weight, and have a reduced risk of premenopausal breast cancer and a reduced risk of ovarian cancer.
• Breastfeeding is convenient and saves money. It saves you money since you don’t have to buy expensive infant formulas. It also reduces health care costs in general since breastfed babies are healthier than formula-fed babies.

Doctors advise against breastfeeding if you have a disease that can be passed to your baby through your breast milk. Doctors also advise against breastfeeding if:

• You take certain medications – for example anticancer medications – that pass into breast milk and could harm your baby.
• You have a serious health problem such as kidney failure or heart disease.
• You use drugs such as cocaine, or are a heavy user of alcohol.

Health Alert: No Alcohol, No Tobacco

If you are pregnant or think you could be pregnant, do not drink alcoholic drinks including beer and wine. If you are pregnant or think you could be pregnant and use tobacco products like cigarettes or chewing tobacco, stop! Your doctor can help you find a program to break the habit.

Alcohol use during pregnancy is a common cause of preventable intellectual and neurodevelopmental disabilities in the United States.

Smoking during pregnancy can cause miscarriage, fetal death, premature birth, and low birth weight.

Birth to 6 Months

There are many important aspects of nutrition to consider for your baby. Below are the highlights and frequently asked questions.

Breast milk is the perfect food for your baby, but is it enough?

Signs that your baby is not getting adequate breast milk include:

• Not having 6-8 wet diapers a day
• Failure to nurse 8-12 times a day
• Not seeming content after nursing
• Acting unusually irritable or unusually drowsy
• Weak sucking, gagging frequently, or having difficulty latching on

Call your doctor if your baby is exhibiting any of these signs that they are not receiving adequate breast milk. Your doctor will probably want your baby to be seen right away.

Please remember while breast milk is the best food for baby, supplementing with infant formula is the best alternative option especially in the first few days of life when breast milk is not available yet or if there are other reasons interfering with breastfeeding.

Vitamins and Minerals

Term breastfed babies may need an iron supplement after 4 to 6 months of age if they are not taking appropriate iron-containing complementary foods (including iron-fortified cereals, baby food).

Preterm born babies may require iron supplement much earlier and will be prescribed by your doctor as necessary.

Exclusively breastfed babies require vitamin D supplement in the first 12 months of life.

Formula fed babies do not require supplementary vitamins and minerals because formulas already include them.

Fast Fact: Healthy babies do not require extra water until 4 months of age or as recommended by your doctor. Formula (when properly prepared) and breast milk are adequate to meet your baby’s fluid needs. Juice is not recommended in the first 6 months of life.

Healthy Habits: Safe Food Handling

Do not save the formula (or expressed breast milk) left in the bottle after the baby has finished a feeding. Germs from your baby’s mouth may have contaminated the milk, and refeeding the leftover milk may cause your baby to become ill.

Milestones: Introducing solid foods

Around the age of 4-6 months, you may consider starting solid foods to your baby’s diet after discussing it with your doctor at the 4 month well visit appointment. Infant cereal (examples would be oatmeal, wheat) is the most frequently recommended first solid food. You may start introducing new foods, one new food at a time at a frequency of one new food every 3 days in order to look for possible allergies. Next after cereal would be the introduction of vegetables and lastly the fruits. Make sure to use applesauce consistency for baby food whether bought from the store or home-made.

Health Alert: Babies, Bottles, and Formula

Follow directions exactly when preparing concentrated or powdered formula to ensure that the correct balance of nutrients and water is maintained. Feeding formula that is too weak or too concentrated is dangerous to your baby’s health.

Do not use the microwave to warm your baby’s bottle. Microwaves heat unevenly, creating hot spots that can burn your baby’s mouth. Microwaves may also change the composition of the milk.

Never “prop” your baby’s bottle. Babies should be held while they are feeding. Propping is the practice of giving a baby a bottle by leaning the bottle against a pillow or other support rather than holding the baby and the bottle. Propping puts the baby at risk for choking and robs the baby of the opportunity for warm and loving interaction with the person holding them.

Frequently Asked Questions

Q: Why can’t babies under 1 year of age have honey?

A: Honey may be contaminated with the spores of the germs that cause botulism. Babies with botulism can develop muscle weakness, which sometimes progresses to paralysis and, rarely, even death.

Q: Will adding cereal to my baby’s diet help my baby sleep through the night?

A: No. Hunger is not waking your baby and cereal does not help your baby sleep through the night. Your baby is a light sleeper and once awakened, can’t get back to sleep without help. When your baby develops a mature sleep pattern and learns to self-comfort when awake but not hungry, you’ll get a good night’s sleep.

6 Months to 1 Year

There are many important aspects of nutrition to consider for your child. Below are the highlights, tips and FAQs.

Vitamins and Minerals

Fluoride supplement is usually not needed. If your local water is not adequately fluoridated, you use a reverse osmosis filter for your drinking water, or you give your child only bottled water, your child may require fluoride supplementation in the second year of life. To check the fluoride level in your water, call your local water company. Call your county health department to have your well water tested. When you know the results, ask your child’s physician if your child requires fluoride supplementation.

Older infants who still drink formula and who eat a variety of foods that include good sources of iron and vitamins A and C don’t require supplemental vitamins. However, children with certain chronic health problems or healthy children who are finicky eaters may require vitamin and mineral supplementation.

Your doctor will probably screen your baby for anemia around one year of age and depending on the results, your baby may require iron supplements.

Whole milk should be avoided until 12 months of age have been completed to reduce the risk of iron deficiency.

Health Alert: Food Allergies

If there is a strong history of allergy in your family, consult your physician for specific advice about feeding your infant. There have been recent changes in introducing peanut-products to infants’ diet. Make sure you discuss all of your concerns and questions with your physician before introducing new foods to your baby’s diet.

Health Tip:

• No bottles in bed. Bottles in bed increase the risk of tooth decay and ear infections.
• Start thinking of stopping the use of pacifiers and bottles at one year of age.
• Introduce the use of cups around 6 months of age.

Healthy Habits: Safe Food Handling

Use a clean cloth to wipe tops of baby food jars before opening jar. Do not use food from any jar if the safety button is raised, the lid does not “pop” on turning, or if the “use by” date has passed.

There are many advantages to home-prepared baby foods. They help your baby adjust to the food your family eats and are less expensive. Remember, when preparing baby food at home:

• Do heat, broil, steam or bake foods.
• Do use fresh vegetables so that vitamin A and vitamin C are not lost. Heat vegetables in small amounts of water to preserve nutrients.
• Do cook meat to a temperature of at least 160° F.
• Do use cooked food within two days.
• Don’t add salt, sugar, or spices.
• Avoid using canned food with high levels of salt, sugar, or preservatives.
• Don’t prepare these foods at home: spinach, beets, turnips, or collard greens. These foods may contain high levels of nitrate that can cause a problem with the hemoglobin in your baby’s blood.
• Don’t cook acidic foods such as tomatoes in aluminum. Small amounts of aluminum may dissolve and be absorbed into the food.
• Avoid copper pots for cooking since the copper may destroy the vitamin C.

Toddler: 1-2 Years

There are many important aspects of nutrition to consider for your toddler. Below are the highlights and FAQs.

Vitamins and Minerals

A well-balanced diet is the best source for vitamins and minerals for most toddlers. A healthy toddler whose diet matches the Food Guide Pyramid gets more than adequate amounts of vitamins and minerals. Even small servings of the various food groups are adequate if you pay special attention to offering good sources of iron and vitamins A and C.

Children who are unable to absorb nutrients from the food they eat due to gastrointestinal problems, children with food sensitivity, and children with chronic illnesses may be advised by their physician to take supplementary vitamins and minerals.

Healthy Habits: Healthy Snacks for Older Toddlers

Offer older toddlers two or three snacks a day. Children should sit when eating. Have a supply of healthy snacks available, such as:

• Fresh fruits: diced apples, bananas, peaches
• Vegetables: well-cooked and diced carrots, green beans, potatoes
• Dairy products: sliced or diced cheese, fresh or frozen yogurt, milk
• Breads and cereals: small pieces of pretzels or bagels
• Meats and proteins: smooth peanut butter spread thin on bread, cracker or small strip of apple

Healthy Habits: Fat in Your Toddler's Diet

Dietary fat provides calories for growth and energy for active play. It is also important for healthy skin, shiny hair, absorbing some vitamins, and healing wounds. Fat should supply 30 percent of your toddler’s daily calories.

In the first 2 years of life, children should drink whole milk (after being weaned from breast milk or formula).

After age 2, you should gradually decrease dietary fat. Do simple things like switching from whole milk to reduced-fat milk and decreasing the amount of fat you cook with.

Health Alert: Choking Hazards Food List

The following foods should not be given to toddlers or children younger than age 5 (source: American Academy of Pediatrics, Guide to Your Child’s Nutrition).

• Hard candies, jelly beans, chewing gum
• Popcorn, raisins, marshmallows, seeds and nuts

The following foods may be given to children between the ages of 2 and 5 only if they are cut into small pieces or strips:

• Hot dogs. Slice lengthwise before cutting crosswise to reduce the risk of choking.
• Grapes or cherries. Peeling, removing seeds or pits, and cutting in half reduces choking risk.
• Raw carrots, apples, celery and green beans. Dicing or cutting into small strips reduces choking risk.
• Peanut butter. Be sure to spread thinly.
• Large chunks of any food such as meat, potatoes, or raw vegetables and fruits. Dice or cut into small strips.
• Processed frozen potato products shaped like a hot dog. Mash or cut length-wise to reduce the risk of choking.

Frequently Asked Questions

Q: How much milk should my toddler drink daily?

A: Two to three 6-8 ounce glasses a day is about right. Offer water when your child is thirsty. Don’t overdo milk between meals. Juice should be very limited. Excessive milk intake may lead to constipation. Excessive juice intake may lead to softer, more frequent bowel movements.

Q: How much should my toddler be eating?

A: The best indicator of how well your toddler is eating is his or her growth chart. Make sure you ask your physician at all well visits to show you the growth chart and discuss the percentiles to make sure your child is growing according to his genetic potential in weight, height and head circumference. A toddler requires 3 meals a day and 2 snacks in between.

Some simple rules to follow with a meal include:

• Your child’s fist size represents their portion of rice, cereal, fruits or vegetables.
• Your child’s palm size represents their portion of protein.
• Your child’s top of the thumb represents their portion of salad dressing, butter or mayonnaise that goes with the meal.
• Set a good example for your child, if you don’t ask for seconds, your child won’t either.

Q: My toddler was a great eater but now that he or she turned 2 years old I cannot get him to eat anything healthy? What should I do?

A: Parents, you are not alone. All toddlers will start saying “No” at this stage of their life to anything and everything even if they want it.

• Don’t make mealtime a battle.
• Stand your ground; keep offering a variety of healthy foods and snacks. Don’t be discouraged. All caregivers should be on the same page including loving grandparents or family members who babysit occasionally.
• A good habit for the whole family to follow is to chew and swallow one bite of a new food once a day. It takes many trials of any new food for your toddler to like it.
• Get creative. Allow your toddler to help prepare meals or snacks with you even if it gets messy. Encourage your toddler to self-feed too.
• You can find a sample menu and more tips on healthychildren.org website.

Preschool: 3-5 Years

Children will feel better and behave better when they eat and sleep well. The preschool years are essential years for proper brain development. At this stage, children should be eating the same foods as the rest of the family. These are important aspects of nutrition to consider for your child. Below are the highlights and FAQs.

Healthy Habits: Eating Habits

Don’t allow your child to eat while watching television or playing. If your child eats while “vegging out” in front of the TV or while “surfing the Net,” then eating will become a habit and not a response to hunger. Your child can take on extra calories, which add extra weight and can start a child on the “slippery slope” to obesity.

Milestones: Table Manners

At age 4, your child should be ready to learn table manners. Everyone in the family plays a part in the instruction of mealtime manners.

Do … sit together at the table as often as possible and include your child in the meal preparation. Do use mealtimes to discuss pleasant topics that include your child and let your child select new foods or recipes. Always model good mealtime manners.

Do not … read the paper, allow toys at the table or have the TV on. Do not give your child meal preparation jobs that are too hard or take too long. Don’t argue or use mealtime for lectures or personal criticism. Don’t serve large portions of new foods or expect your child to do as you say and not as you do.

Healthy Habits: Snacking

Use snacks to satisfy hunger, not as treats or rewards. Offer nutritious snacks 1-2 hours before meals. If meals are more than four hours apart, include some protein and fat to satisfy hungry appetites.

Health Alert: Choking Hazards

To reduce the risk of your child choking, post a list for family, friends, and sitters of foods that are choking risks and are not to be given to your child. Insist that your child sits at the table to eat – no eating while running or playing. Don’t allow tickling during mealtimes and teach your child not to talk while eating. Don’t give chewing gum to a child under 6 years of age. Make sure anyone caring for your child knows what to do if your child chokes.

Frequently Asked Questions

Q: How can I get my finicky eater to eat?

A: Try these ideas. Include your child in grocery shopping and food preparation. Be patient with your child and keep mealtimes pleasant. Offer nutritionally acceptable choices and role model good eating behaviors such as drinking milk at meals. Be sure to praise your child for tasting new foods. If your child refuses a new food, offer the food again in a few weeks. (Young children are discovering new foods and flavors. One study showed a new food must be offered an average of 10 times before it is accepted.)

Q: Is my child at the right weight?

A: The preschooler years are the years where early identification of overweight or obese children occurs. Every time you take your child to your doctor’s office for a well visit, your child will have measurements done including weight and height which are used to determine their BMI (body mass index). After the age of 2 years, a BMI greater than 95th percentile for age is a good indicator of a weight problem. Your doctor will be able to assess your child’s risk of obesity and offer specific advice.

Q: I like to drink almond milk at home. Is it ok if I switch my child to almond milk?

A: Milk is more than just a drink. It is a great source of calcium, vitamin D, fat and protein which are important for the growth of children. Below is a chart to guide families on their choice of milk. Whenever possible, physicians recommend cow milk unless the child has certain food allergies or health problems.

School Age: 6-11 Years

Optimal nutrition will help keep your child working at their fullest potential at school. It is important to emphasize the importance of breakfast among other things. Below are many important aspects of nutrition to consider for your child as well as FAQs:

Vitamins & Minerals

Vitamin and mineral supplementation is rarely required in middle childhood. If your child is healthy and eats a reasonably balanced diet, supplementation is unnecessary. Supplementation should be considered if your child has an eating disorder, poor eating habits, or if he or she follows a restrictive or alternative diet such as a fad diet, a vegan diet (excludes all food of animal origin), or a fruitarian diet (only raw and dried fruits, seeds, sprouted seeds and grains, and nuts; no cooked foods, vegetables, or animal products).

Megavitamin therapy (extremely large vitamin doses) is not safe. If you are tempted to try megadose vitamin therapy for your child or for yourself, beware! Vitamins or minerals in very large amounts can lead to serious health problems. Fat soluble vitamins – A, D, E, and K – are stored in the body and, if taken in large doses, can build up to toxic levels causing problems such as deafness, kidney stones, headaches, and blurred vision. When high dose vitamin or mineral supplementation is appropriate, it needs to be prescribed and monitored by a physician.

It is also important to maintain adequate intake of calcium and vitamin D.

Healthy Habits: Breakfast Ideas

Breakfast really matters. Studies show that children who don’t eat breakfast have difficulty concentrating and staying alert at the beginning of the school day. Eating breakfast actually improves school performance.

The following foods are easy to prepare and can be eaten for breakfast:

• Cold cereal with fruit
• Whole wheat toast with peanut butter
• Yogurt with fruit
• Whole grain toaster waffles topped with fresh or canned fruits
• Breakfast bars with milk
• Warmed up leftover pizza

The following foods can be eaten as a breakfast on-the-run:

• Granola bar with milk
• Bagel or toasted English muffin with peanut butter
• Raisin/bran or fruit/oatmeal muffin with juice
• Crackers and cheese with juice

Healthy Habits: Food Handling

If you pack your child’s lunch for school, make sure to purchase an insulated, soft pack and an unbreakable thermos. Follow these additional tips below to make packing healthy school lunches easier.

• Use plastic containers for crushable foods.
• Thoroughly wash and dry all reusable containers.
• Wash hands before preparing food.
• Choose foods that require no refrigeration.
• Wash fruit before packing.
• Peel and wash vegetables before packing.
• Pack portions that match your child’s appetite.

Frequently Asked Questions

Q: What are some good sources of fiber for my child’s school lunch box?

A: Sandwiches made with whole wheat bread provide a good source of fiber. Fresh fruits and vegetables such as apples, celery, and carrots are all high-fiber foods that are safe bets as child pleasers.

Q: How do I help my child make good choices while at school or away from home?

A: Encourage your child to make good food choices by using some of the examples below.

• Leave the potato chips. Choose baked tortilla chips.
• Leave the cheese snacks. Choose pretzels or popcorn.
• Leave the candy bars. Choose granola bars or trail mix.
• Leave the soft drinks. Choose water, low-fat milk or chocolate milk.
• Leave the ice cream. Choose a pure fruit popsicle or frozen yogurt.
• Leave the cookies. Choose graham crackers or fig bars.
• It also helps to go over the choices on the school’s lunch calendar ahead of time.

Adolescents: 12-21 Years

• There are many important aspects of nutrition to consider for your adolescent. A teenager’s nutritional needs are reflected in a pubertal growth spurt that happens at this time of their life.
• Boys require an average of 2,800 calories per day.
• Girls require an average of 2,200 calories per day.

Below are the highlights regarding vitamins and minerals and healthy food habits.

Vitamins and Minerals

Several medications commonly prescribed for teens, like oral contraceptives, certain antibiotics and the acne medicine such as Accutane, change the requirement for specific vitamins or minerals. Ask your child's doctor for specific directions.

Children between the ages of 9 and 18 need 1,300 milligrams of calcium a day. Young adults between the ages of 19 and 24 need 1,000 milligrams of calcium per day. Adequate calcium intake in teen years is essential to build strong bones for life. Calcium can be lost from bone throughout life, but it can only be added during adolescence through the 20's. Inadequate calcium intake during the teen years means an increased risk of osteoporosis and hip fractures later in life.

Some teens may need calcium supplements. Three servings of fat-free or low-fat milk or equivalent milk products should meet daily recommendations. Teens who avoid dairy products need to increase their intake of other foods high in calcium, such as calcium-fortified orange juice. For teens with inadequate dietary calcium intake, many doctors suggest taking a nonprescription, calcium-containing antacid tablet or a soft chewable calcium supplement daily.

Teens require iron—considerably more than during the preteen years. Boys require the extra iron to keep up with the demands of new muscles and more blood for a bigger body. Girls require the extra iron for growth and to replace the iron lost in the menstrual blood. Iron requirements are further increased for males and females who are active in athletics.

Healthy Habits: Food Supplements Are Second Choice

It is better to spend your money on good foods, not on food supplements. The FDA does not regulate supplements as medication, and as a result, different brands vary in their quality and nutrient levels. If you give your children supplements, make sure to tell your physician, since they may interact with medications your children are taking.

Useful Information

Soft drinks, juice and sports drinks have replaced milk as the mealtime drink of teenagers.

When teens drink a 12-ounce can of cola instead of a 12-ounce glass of milk, they lose 450 milligrams of calcium, which is one-third of their daily requirement of calcium.

Less than 10 percent of girls ages 9 to 17 get the recommended daily amount of calcium, which is crucial for building strong bones.

Health Alert

Teens that restrict the number of calories they eat may be stunting their growth. When calories are limited, growth takes a back seat. Calories go first to provide the energy for basic life processes. Next, they provide fuel for physical activity. If there are calories left over, they are used for growth. When there are no extra calories, the teen's growth suffers. Inadequate calorie intake can also affect emotions and the body's ability to fight infection. Consult your physician immediately if you suspect that your teen is deliberately decreasing calorie intake or following a non-prescribed diet.