{"id":331,"date":"2019-06-25T16:02:34","date_gmt":"2019-06-25T20:02:34","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/nutr1100\/chapter\/infancy\/"},"modified":"2019-07-23T20:28:49","modified_gmt":"2019-07-24T00:28:49","slug":"infancy","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/nutr1100\/chapter\/infancy\/","title":{"raw":"Infancy","rendered":"Infancy"},"content":{"raw":"Diet and nutrition have a major impact on a child\u2019s development from infancy into the adolescent years. A healthy diet not only affects growth, but also immunity, intellectual capabilities, and emotional well-being. One of the most important jobs of parenting is making sure that children receive an adequate amount of needed nutrients to provide a strong foundation for the rest of their lives.\r\n\r\nThe choice to breastfeed is one that all new mothers face. Support from family members, friends, employers, and others can greatly help with both the decision-making process during pregnancy and the practice of breastfeeding after the baby\u2019s birth. In the United States, about 75 percent of babies start out being breastfed. Yet by the age of six months, when solid foods should begin to be introduced into a child\u2019s diet along with breast milk, only 15 percent of infants in the United States were still breastfed exclusively, according to the Centers for Disease Control and Prevention (CDC).[footnote]Breastfeeding: Promotion and Support. Centers for Disease Control and Prevention. http:\/\/www.cdc.gov\/breastfeeding\/promotion\/index.htm. Updated August 4, 2017. Accessed November 29, 2017.[\/footnote]\r\n\r\nHowever, the approval and assistance of family members, friends, employers, health-care providers, and policymakers can make an enormous difference and provide the needed promotion and support for mothers who wish to breastfeed their children. Education about breastfeeding typically begins with health-care providers. During prenatal care and often soon after a woman has given birth, doctors, nurses, and other clinicians can explain the benefits of breastfeeding and describe the proper technique. Nearly all births in the United States and Canada occur in hospital settings, and hospital practices in labor, delivery, postpartum care, and discharge planning can inform and support women who want to breastfeed. Once a new mother has left the hospital for home, she needs access to a trained individual who can provide consistent information. International Board Certified Lactation Consultants (IBCLCs) are health-care professionals (often a registered nurse or registered dietitian) certified in breastfeeding management that work with new mothers to solve problems and educate families about the benefits of this practice. Research shows that breastfeeding rates are higher among women who had infants in hospitals that make IBCLCs available to new mothers, rather than those who gave birth in institutions without these professionals on staff.[footnote]Executive Summary: The Surgeon General\u2019s Call to Action to Support Breastfeeding. US Department of Health and Human Services, Office of the Surgeon General. http:\/\/www.surgeongeneral.gov\/topics\/breastfeeding\/executivesummary.pdf. Updated August 12, 2014. Accessed December 2, 2017.[\/footnote]\r\n\r\nIn addition, spouses, partners, and other family members can play critical roles in helping a pregnant woman make the decision to breastfeed and assisting with feeding after the baby is born. Employment can also factor into a woman\u2019s decision to breastfeed or her ability to maintain the practice. Employed mothers have been less likely to initiate breastfeeding and tend to breastfeed for a shorter period of time than new mothers who are not employed or who have lengthy maternity leaves. In 2010 in the United States, the passage of the Affordable Care Act (ACA) called for employers to provide accommodations within the workplace for new mothers to pump breast milk. This law requires a private and clean space within the workplace, other than a restroom, along with adequate break time for a woman to express milk.[footnote]Executive Summary: The Surgeon General\u2019s Call to Action to Support Breastfeeding. US Department of Health and Human Services, Office of the Surgeon General. http:\/\/www.surgeongeneral.gov\/topics\/breastfeeding\/executivesummary.pdf. Updated August 12, 2014. Accessed DEcember 8, 2017.[\/footnote]\r\n
\r\n

Everyday Connection<\/h3>\r\nA women's right to breastfeed anywhere and at any time is protected in Canada by the Canadian Charter or Rights and Freedoms. Some provinces, such as Ontario and BC, also have specified rights for breastfeeding in the workplace and public.\r\n\r\nhttp:\/\/www.infactcanada.ca\/breastfeeding_rights.htm<\/a>\r\n

\"\u201cFor children breastfeeding provides the highest attainable standard of health; a basic human right. For women, the right to breastfeed in public and the right to be accommodated by the employer or educational institution to continue to breastfeed on returning to work or school is a human right.<\/em>\u201d[footnote]Breastfeeding Committee for Canada. Breastfeeding statement of the Breastfeeding Committee for Canada [Internet]. Ottawa (ON): BCC; 2002 Available from: http:\/\/www.breastfeedingcanada.ca\/documents\/webdoc5.pdf Accessed\u00a0May 31, 2018.[\/footnote]<\/p>\r\n\r\n<\/div>\r\nMembers of a community can also promote and support breastfeeding. New mothers can join peer counseling groups or turn to other women within their community who have previous experience with breastfeeding. In addition, community-based programs can provide education and support. La Leche League is an international program that provides mother-to-mother support, encouragement, and education about breastfeeding for women around the world. For more information on La Leche League, visit http:\/\/www.llli.org<\/a>.\r\n\r\nAlthough breastfeeding should be recommended and encouraged for almost all new mothers, it is important to remember that the decision to breastfeed is a personal choice and women should not be made to feel guilty if they cannot, or choose not, to breastfeed their infants. In some rare cases, a woman is unable to breastfeed or it is not in the baby\u2019s best interest.\r\n\r\nNutritional choices that parents make, such as the decision to breastfeed or bottle-feed, not only affect early childhood development, but also a child\u2019s health and wellness later in life. Therefore, it is imperative to promote and support the best practices for the well-being of infants and mothers alike.\r\n

Infancy (Birth to Age One)<\/h1>\r\n[caption id=\"attachment_327\" align=\"alignnone\" width=\"342\"]\"\" Image by Marie Kainoa Fialkowski Revilla \/ CC BY 4.0<\/a>[\/caption]\r\n\r\nA number of major physiological changes occur during infancy. The trunk of the body grows faster than the arms and legs, while the head becomes less prominent in comparison to the limbs. Organs and organ systems grow at a rapid rate. Also during this period, countless new synapses form to link brain neurons. Two soft spots on the baby\u2019s skull, known as fontanels, allow the skull to accommodate rapid brain growth. The posterior fontanel closes first, by the age of eight weeks. The anterior fontanel closes about a year later, at eighteen months on average. Developmental milestones include sitting up without support, learning to walk, teething, and vocalizing among many, many others. All of these changes require adequate nutrition to ensure development at the appropriate rate.[footnote] McMillan B. Illustrated Atlas of the Human Body. Sydney, Australia: Weldon Owen. 2008, 248.[\/footnote]\r\n\r\nHealthy infants grow steadily, but not always at an even pace. For example, during the first year of life, height increases by 50 percent, while weight triples. Physicians and other health professionals can use growth charts to track a baby\u2019s development process. Because infants cannot stand, length is used instead of height to determine the rate of a child\u2019s growth. Other important developmental measurements include head circumference and weight. All of these must be tracked and compared against standard measurements for an infant\u2019s age.\r\n\r\nFor infants and toddlers from birth to 24 months of age, the WHO growth charts are used to monitor growth. These standards represent optimal growth for children at this age and allow for tracking growth trends over time through percentile rankings. Growth charts may provide warnings that a child has a medical problem or is malnourished. Insufficient weight or height gain during infancy may indicate a condition known as failure-to-thrive (FTT), which is characterized by poor growth. FTT can happen at any age, but in infancy, it typically occurs after six months. Some causes include poverty, lack of enough food, feeding inappropriate foods, and excessive intake of fruit juice.\r\n\r\nFigure 12.4 WHO Growth Chart For Boys From Birth To 24 Months\r\n\r\n[caption id=\"attachment_326\" align=\"alignnone\" width=\"541\"]\"\" Image by Centers for Disease Control and Prevention<\/a> \/ Public Domain[\/caption]\r\n

Nutritional Requirements<\/h1>\r\nRequirements for macronutrients and micronutrients on a per-kilogram basis are higher during infancy than at any other stage in the human life cycle. These needs are affected by the rapid cell division that occurs during growth, which requires energy and protein, along with the nutrients that are involved in DNA synthesis. During this period, children are entirely dependent on their parents or other caregivers to meet these needs. For almost all infants six months or younger, breast milk is the best source to fulfill nutritional requirements. An infant may require feedings eight to twelve times a day or more in the beginning. After six months, infants can gradually begin to consume solid foods to help meet nutrient needs.\r\n

Energy and Macronutrients<\/h2>\r\nEnergy needs relative to size are much greater in an infant than an adult. A baby\u2019s resting metabolic rate is two times that of an adult. The RDA to meet energy needs changes as an infant matures and puts on more weight. The IOM uses a set of equations to calculate the total energy expenditure and resulting energy needs. For example, the equation for the first three months of life is (89 x weight [kg] \u2212100) + 175 kcal.\r\n\r\nBased on these equations, the estimated energy requirement for infants from zero to six months of age is 472 to 645 kilocalories per day for boys and 438 to 593 kilocalories per day for girls. For infants ages six to twelve months, the estimated requirement is 645 to 844 kilocalories per day for boys and 593 to 768 kilocalories per day for girls. From the age one to age two, the estimated requirement rises to 844\u20131,050 kilocalories per day for boys and 768\u2013997 kilocalories per day for girls.[footnote]Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids.Food and Nutrition Board, Institute of Medicine. Washington, D.C.: The National Academies Press. 2005, 169\u201370.[\/footnote] How often an infant wants to eat will also change over time due to growth spurts, which typically occur at about two weeks and six weeks of age, and again at about three months and six months of age.\r\n\r\nThe dietary recommendations for infants are based on the nutritional content of human breast milk. Carbohydrates make up about 45 to 65 percent of the caloric content in breast milk, which amounts to a RDA of about 130 grams. Almost all of the carbohydrate in human milk is lactose, which infants digest and tolerate well. In fact, lactose intolerance is practically nonexistent in infants. Protein makes up about 5 to 20 percent of the caloric content of breast milk, which amounts to 13 grams per day. Infants have a high need for protein to support growth and development, though excess protein (which is only a concern with bottle-feeding) can cause dehydration, diarrhea, fever, and acidosis in premature infants. About 30 to 40 percent of the caloric content in breast milk is made up of fat. A high-fat diet is necessary to encourage the development of neural pathways in the brain and other parts of the body. However, saturated fats and trans fatty acids inhibit this growth. Infants who are over the age of six months, which means they are no longer exclusively breastfed, should not consume foods that are high in these types of fats.\r\n

Micronutrients<\/h2>\r\nAlmost all of the nutrients that infants require can be met if they consume an adequate amount of breast milk. There are a few exceptions, though. Human milk is low in vitamin D, which is needed for calcium absorption and building bone, among other things. Therefore, breastfed children often need to take a vitamin D supplement in the form of drops. Health Canada recommends providing vitamin D for exclusively breastfed infants\u00a0at 10 \u00b5g\/day (400 IU\/day).\u00a0Infants at the highest risk for vitamin D deficiency are those with darker skin and no exposure to sunlight. Breast milk is also low in vitamin K, which is required for blood clotting, and deficits could lead to bleeding or hemorrhagic disease. Babies are born with limited vitamin K, so supplementation may be needed initially and some states require a vitamin K injection after birth. Also, breast milk is not high in iron, but the iron in breast milk is well absorbed by infants. After four to six months, however, an infant needs an additional source of iron other than breast milk.\r\n

Fluids<\/h2>\r\nInfants have a high need for fluids, 1.5 milliliters per kilocalorie consumed compared to 1.0 milliliters per kilocalorie consumed for adults. This is because children have larger body surface area per unit of body weight and a reduced capacity for perspiration. Therefore, they are at greater risk of dehydration. However, parents or other caregivers can meet an infant\u2019s fluid needs with breast milk or formula. As solids are introduced, parents must make sure that young children continue to drink fluids throughout the day.\r\n

Breastfeeding<\/h1>\r\nThe alveoli cells produce milk. To secrete it, they contract and push milk into the ductules and the milk sinus, which collects the milk. When a nursing infant\u2019s gums press on the areola and nipple, the sinuses squeeze the milk into the baby\u2019s mouth. The nipple tissue becomes firmer with stimulation, which makes it more flexible and easier for the baby to grasp in the mouth. After the birth of the baby, nutritional needs must be met to ensure that an infant not only survives, but thrives from infancy into childhood. Breastfeeding provides the fuel a newborn needs for rapid growth and development. As a result, the WHO recommends that breastfeeding be done exclusively for the first six months of an infant\u2019s life. Exclusive breastfeeding is one of the best ways a mother can support the growth and protect the health of her infant child. Breast milk contains all of the nutrients that a newborn requires and gives a child the best start to a healthy life. Many women want to breastfeed their babies. Unfortunately, a mother\u2019s intention alone may not be enough to make this practice possible. Around the world, less than 40 percent of infants under the age of six months are breastfed exclusively.[footnote]10 Facts on Breastfeeding. World Health Organization. http:\/\/www.who.int\/features\/factfiles\/breastfeeding\/en\/. Updated August 2017. Accessed December 2, 2017. \u00a0[\/footnote]\r\n\r\nFigure 12.5 Structure of the Lactating Breast\r\n\r\n\"\"\r\n\r\nNew mothers must also pay careful consideration to their own nutritional requirements to help their bodies recover in the wake of the pregnancy. This is particularly true for women who breastfeed their babies, which calls for an increased need in certain nutrients.\r\n

Lactation<\/h2>\r\nLactation is the process that makes breastfeeding possible, and is the synthesis and secretion of breast milk. Early in a woman\u2019s pregnancy, her mammary glands begin to prepare for milk production. Hormones play a major role in this, particularly during the second and third trimesters. At that point, levels of the hormone prolactin increase to stimulate the growth of the milk duct system, which initiates and maintains milk production. Levels of the hormone oxytocin also rise to promote the release of breast milk when the infant suckles, which is known as the milk ejection reflex. However, levels of the hormone progesterone need to decrease for successful milk production, because progesterone inhibits milk secretion. Shortly after birth, the expulsion of the placenta triggers progesterone levels to fall, which activates lactation.[footnote]King J. Contraception and Lactation: Physiology of Lactation. Journal of Midwifery and Women\u2019s Health. 2007; 52(6), 614\u201320.[\/footnote]\r\n\r\nNew mothers need to adjust their caloric and fluid intake to make breastfeeding possible. The RDA is 330 additional calories during the first six months of lactation and 400 additional calories during the second six months of lactation. The energy needed to support breastfeeding comes from both increased intake and from stored fat. For example, during the first six months after her baby is born, the daily caloric cost for a lactating mother is 500 calories, with 330 calories derived from increased intake and 170 calories derived from maternal fat stores. This helps explain why breastfeeding may promote weight loss in new mothers. Lactating women should also drink 3.1 liters of liquids per day (about 13 cups) to maintain milk production, according to the IOM. As is the case during pregnancy, the RDA of nearly all vitamins and minerals increases for women who are breastfeeding their babies. The following table compares the recommended vitamins and minerals for lactating women to the levels for non-pregnant and pregnant women from Table 12.3 \"Recommended Nutrient Intakes during Pregnancy\"<\/a>.\r\n\r\nTable 12.3 Recommended Nutrient Intakes during Lactation\r\n
\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Nutrient<\/td>\r\nNon-pregnant Women<\/td>\r\nPregnant Women<\/td>\r\nLactating Women<\/td>\r\n<\/tr>\r\n
Vitamin A (mcg)<\/td>\r\n700.0<\/td>\r\n770.0<\/td>\r\n1,300.0<\/td>\r\n<\/tr>\r\n
Vitamin B6 (mg)<\/td>\r\n1.5<\/td>\r\n1.9<\/td>\r\n2.0<\/td>\r\n<\/tr>\r\n
Vitamin B12 (mcg)<\/td>\r\n2.4<\/td>\r\n2.6<\/td>\r\n2.8<\/td>\r\n<\/tr>\r\n
Vitamin C (mg)<\/td>\r\n75.0<\/td>\r\n85.0<\/td>\r\n120.0<\/td>\r\n<\/tr>\r\n
Vitamin D (mcg)<\/td>\r\n5.0<\/td>\r\n5.0<\/td>\r\n5.0<\/td>\r\n<\/tr>\r\n
Vitamin E (mg)<\/td>\r\n15.0<\/td>\r\n15.0<\/td>\r\n19.0<\/td>\r\n<\/tr>\r\n
Calcium (mg)<\/td>\r\n1,000.0<\/td>\r\n1,000.0<\/td>\r\n1,000.0<\/td>\r\n<\/tr>\r\n
Folate (mcg)<\/td>\r\n400.0<\/td>\r\n600.0<\/td>\r\n500.0<\/td>\r\n<\/tr>\r\n
Iron (mg)<\/td>\r\n18.0<\/td>\r\n27.0<\/td>\r\n9.0<\/td>\r\n<\/tr>\r\n
Magnesium (mg)<\/td>\r\n320.0<\/td>\r\n360.0<\/td>\r\n310.0<\/td>\r\n<\/tr>\r\n
Niacin (B3) (mg)<\/td>\r\n14.0<\/td>\r\n18.0<\/td>\r\n17.0<\/td>\r\n<\/tr>\r\n
Phosphorus<\/td>\r\n700.0<\/td>\r\n700.0<\/td>\r\n700.0<\/td>\r\n<\/tr>\r\n
Riboflavin (B2) (mg)<\/td>\r\n1.1<\/td>\r\n1.4<\/td>\r\n1.6<\/td>\r\n<\/tr>\r\n
Thiamine (B1) (mg)<\/td>\r\n1.1<\/td>\r\n1.4<\/td>\r\n1.4<\/td>\r\n<\/tr>\r\n
Zinc (mg)<\/td>\r\n8.0<\/td>\r\n11.0<\/td>\r\n12.0<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nSource: Institute of Medicine. 2006. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: The National Academies Press. https:\/\/doi.org\/10.17226\/11537<\/a>. Accessed December 10, 2017.\r\n\r\n<\/div>\r\nCalcium requirements do not change during breastfeeding because of more efficient absorption, which is the case during pregnancy, too. However, the reasons for this differ. During pregnancy, there is enhanced absorption within the gastrointestinal tract. During lactation, there is enhanced retention by the kidneys. The RDA for phosphorus, fluoride, and molybdenum also remains the same.\r\n

Components of Breastmilk<\/h2>\r\nHuman breast milk not only provides adequate nutrition for infants, it also helps to protect newborns from disease. In addition, breast milk is rich in cholesterol, which is needed for brain development. It is helpful to know the different types and components of breastmilk, along with the nutrients they provide to enable an infant survive and thrive. Colostrum is produced immediately after birth, prior to the start of milk production, and lasts for several days after the arrival of the baby. Colostrum is thicker than breast milk, and is yellowish or creamy in color. This protein-rich liquid fulfills an infant\u2019s nutrient needs during those early days. Although low in volume, colostrum is packed with concentrated nutrition for newborns. This special milk is high in fat-soluble vitamins, minerals, and immunoglobulins (antibodies) that pass from the mother to the baby. Immunoglobulins provide passive immunity for the newborn and protect the baby from bacterial and viral diseases.[footnote]Breastfeeding: Overview. \u00a0American Pregnancy Association. http:\/\/www.americanpregnancy.org\/firstyearoflife\/breastfeedingoverview.htm.Updated May 16, 2017. Accessed November 29, 2017.[\/footnote]\r\n\r\nTwo to four days after birth, colostrum is replaced by transitional milk. Transitional milk is a creamy liquid that lasts for approximately two weeks and includes high levels of fat, lactose, and water-soluble vitamins. It also contains more calories than colostrum. After a new mother begins to produce transitional milk, she typically notices a change in the volume and type of liquid secreted and an increase in the weight and size of her breasts.[footnote]Breastfeeding: Overview. American Pregnancy Association. http:\/\/www.americanpregnancy.org\/firstyearoflife\/breastfeedingoverview.htm. Updated May 16, 2017. Accessed November 29, 2017.[\/footnote]\r\n\r\nMature milk is the final fluid that a new mother produces. In most women, it begins to secrete at the end of the second week postpartum. There are two types of mature milk that appear during a feeding. Foremilk occurs at the beginning and includes water, vitamins, and protein. Hind-milk occurs after the initial release of milk and contains higher levels of fat, which is necessary for weight gain. Combined, these two types of milk ensure that a baby receives adequate nutrients to grow and develop properly.[footnote]Breastfeeding: Overview. American Pregnancy Association. http:\/\/www.americanpregnancy.org\/firstyearoflife\/breastfeedingoverview.htm. Updated May 16, 2017. Accessed November 29, 2017.[\/footnote]\r\n\r\nAbout 90 percent of mature milk is water, which helps an infant remain hydrated. The other 10 percent contains carbohydrates, proteins, and fats, which support energy and growth. Similar to cow\u2019s milk, the main carbohydrate of mature breast milk is lactose. Breast milk contains vital fatty acids, such as docosahexaenoic acid (DHA) and arachidonic acid (ARA). In terms of protein, breast milk contains more whey than casein (which is the reverse of cow\u2019s milk). Whey is much easier for infants to digest than casein. Complete protein, which means all of the essential amino acids, is also present in breast milk. Complete protein includes lactoferrin, an iron-gathering compound that helps to absorb iron into an infant\u2019s bloodstream.\r\n\r\nIn addition, breast milk provides adequate vitamins and minerals. Although absolute amounts of some micronutrients are low, they are more efficiently absorbed by infants. Other essential components include digestive enzymes that help a baby digest the breast milk. Human milk also provides the hormones and growth factors that help a newborn to develop.\r\n

Diet and Milk Quality<\/h3>\r\nA mother\u2019s diet can have a major impact on milk production and quality. As during pregnancy, lactating mothers should avoid illegal substances and cigarettes. Some legal drugs and herbal products can be harmful as well, so it is helpful to discuss them with a health-care provider. Some mothers may need to avoid certain things, such as spicy foods, that can produce gas in sensitive infants. Lactating women can drink alcohol, though they must avoid breastfeeding until the alcohol has completely cleared from their milk. Typically, this takes two to three hours for 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor, depending on a woman\u2019s body weight.[footnote]Harms R. Breast-Feeding and Alcohol: Is It Okay to Drink?. Mayo Foundation for Medical Education and Research. Accessed February 21, 2012. http:\/\/www.mayoclinic.com\/health\/breast-feeding-and-alcohol\/AN02131. Updated March 11, 2016. Accessed November 28, 2017. [\/footnote] Precautions are necessary because exposure to alcohol can disrupt an infant\u2019s sleep schedule.\r\n

Benefits of Breastfeeding<\/h2>\r\nBreastfeeding has a number of benefits, both for the mother and for the child. Breast milk contains immunoglobulins, enzymes, immune factors, and white blood cells. As a result, breastfeeding boosts the baby\u2019s immune system and lowers the incidence of diarrhea, along with respiratory diseases, gastrointestinal problems, and ear infections. Breastfed babies also are less likely to develop asthma and allergies, and breastfeeding lowers the risk of sudden infant death syndrome. In addition, human milk encourages the growth of healthy bacteria in an infant\u2019s intestinal tract. All of these benefits remain in place after an infant has been weaned from breast milk. Some studies suggest other possible long-term effects. For example, breast milk may improve an infant\u2019s intelligence and protect against Type 1 diabetes and obesity, although research is ongoing in these areas.[footnote]Breastfeeding Benefits Your Baby\u2019s Immune System. Healthy Children.org. American Academy of Pediatrics. http:\/\/www.healthychildren.org\/English\/ages-stages\/baby\/breastfeeding\/pages\/Breastfeeding-Benefits-Your-Baby%27s-Immune-System.aspx. Updated January 1, 2006. Accessed November 28, 2017.[\/footnote]\r\n\r\nBreastfeeding has a number of other important benefits. It is easier for babies to digest breast milk than bottle formula, which contains proteins made from cow\u2019s milk that require an adjustment period for infant digestive systems. Breastfed infants are sick less often than bottle-fed infants. Breastfeeding is more sustainable and results in less plastic waste and other trash. Breastfeeding can also save families money because it does not incur the same cost as purchasing formula. Other benefits include that breast milk is always ready. It does not have to be mixed, heated, or prepared. Also, breast milk is sterile and is always at the right temperature.\r\n\r\nIn addition, the skin-to-skin contact of breastfeeding promotes a close bond between mother and baby, which is an important emotional and psychological benefit. The practice also provides health benefits for the mother. Breastfeeding helps a woman\u2019s bones stay strong, which protects against fractures later in life. Studies have also shown that breastfeeding reduces the risk of breast and ovarian cancers.[footnote]Reproductive History and Breast Cancer Risk. National Cancer Institute. http:\/\/www.cancer.gov\/cancertopics\/factsheet\/Risk\/reproductive-history. Updated November 9, 2016. Accessed November 28, 2017.[\/footnote]\r\n
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The Baby-Friendly Hospital Initiative<\/h3>\r\nIn 1991, the WHO and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI), which works to ensure that all maternities, including hospitals and free-standing facilities, become centers of breastfeeding support. A maternity can be denoted as \u201cbaby-friendly\u201d when it does not accept substitutes to human breast milk and has implemented ten steps to support breastfeeding. These steps include having a written policy on breastfeeding communicated to health-care staff on a routine basis, informing all new mothers about the benefits and management of breastfeeding, showing new mothers how to breastfeed their infants, and how to maintain lactation, and giving newborns no food or drink other than breast milk, unless medically indicated. Since the BFHI began, more than fifteen thousand facilities in 134 countries, from Benin to Bangladesh, have been deemed \u201cbaby friendly.\u201d As a result, more mothers are breastfeeding their newborns and infant health has improved, in both the developed world and in developing nations.[footnote]The Baby-Friendly Hospital Initiative. United Nations Children\u2019s Fund. http:\/\/www.unicef.org\/programme\/breastfeeding\/baby.htm. Updated December 18, 2017. Accessed December 18, 2017.[\/footnote]\r\n\r\n<\/div>\r\n

Barriers to Breastfeeding<\/h2>\r\nAlthough breast milk is ideal for almost all infants, there are some challenges that nursing mothers may face when starting and continuing to breastfeed their infants. These obstacles include painful engorgement or fullness in the breasts, sore and tender nipples, lack of comfort or confidence in public, and lack of accommodation to breastfeed or express milk in the workplace.\r\n\r\nOne of the first challenges nursing mothers face is learning the correct technique. It may take a little time for a new mother to help her baby properly latch on to her nipples. Improper latching can result in inadequate intake, which could slow growth and development. However, International Board Certified Lactation Consultants (IBCLCs), OB nurses, and registered dietitians are all trained to help new mothers learn the proper technique. Education, the length of maternity leave, and laws to protect public breastfeeding, among other measures, can all help to facilitate breastfeeding for many lactating women and their newborns.\r\n

Contraindications to Breastfeeding<\/h2>\r\nAlthough there are numerous benefits to breastfeeding, in some cases there are also risks that must be considered. In the developed world, a new mother with HIV should not breastfeed, because the infection can be transmitted through breast milk. These women typically have access to bottle formula that is safe, and can be used as a replacement for breast milk. However, in developing nations where HIV infection rates are high and acceptable infant formula can be difficult to come by, many newborns would be deprived of the nutrients they need to develop and grow. Also, inappropriate or contaminated bottle formulas cause 1.5 million infant deaths each year. As a result, the WHO recommends that women infected with HIV in the developing world should nurse their infants while taking antiretroviral medications to lower the risk of transmission.[footnote]Infant and Young Child Feeding. World Health Organization. http:\/\/www.who.int\/mediacentre\/factsheets\/fs342\/en\/index.html. Updated July 2017. Accessed December 5, 2017.[\/footnote]\r\n\r\nBreastfeeding also is not recommended for women undergoing radiation or chemotherapy treatment for cancer. Additionally, if an infant is diagnosed with galactosemia, meaning an inability to process the simple sugar galactose, the child must be on a galactose-free diet, which excludes breast milk. This genetic disorder is a very rare condition, however, and only affects 1 in thirty- to sixty thousand newborns.[footnote]Galactosemia. Genetics Home Reference, a service of the US National Library of Medicine. http:\/\/ghr.nlm.nih.gov\/condition\/galactosemia. Published December 12, 2017. Accessed December 14, 2017.[\/footnote] When breastfeeding is contraindicated for any reason, feeding a baby formula enables parents and caregivers to meet their newborn\u2019s nutritional needs.\r\n

Bottle-Feeding<\/h2>\r\nMost women can and should breastfeed when given sufficient education and support. However, as discussed, a small percentage of women are unable to breastfeed their infants, while others choose not to. For parents who choose to bottle-feed, infant formula provides a balance of nutrients. However, not all formulas are the same and there are important considerations that parents and caregivers must weigh. Standard formulas use cow\u2019s milk as a base. They have 20 calories per fluid ounce, similar to breast milk, with vitamins and minerals added. Soy-based formulas are usually given to infants who develop diarrhea, constipation, vomiting, colic, or abdominal pain, or to infants with a cow\u2019s milk protein allergy. Hypoallergenic protein hydrolysate formulas are usually given to infants who are allergic to cow\u2019s milk and soy protein. This type of formula uses hydrolyzed protein, meaning that the protein is broken down into amino acids and small peptides, which makes it easier to digest. Preterm infant formulas are given to low birth weight infants, if breast milk is unavailable. Preterm infant formulas have 24 calories per fluid ounce and are given until the infant reaches a desired weight.\r\n\r\nInfant formula comes in three basic types:\r\n
    \r\n \t
  1. Powder that requires mixing with water. This is the least expensive type of formula.<\/li>\r\n \t
  2. Concentrates, which are liquids that must be diluted with water. This type is slightly more expensive.<\/li>\r\n \t
  3. Ready-to-use liquids that can be poured directly into bottles. This is the most expensive type of formula. However, it requires the least amount of preparation. Ready-to-use formulas are also convenient for traveling.<\/li>\r\n<\/ol>\r\nMost babies need about 2.5 ounces of formula per pound of body weight each day. Therefore, the average infant should consume about 24 fluid ounces of breastmilk or formula per day. When preparing formula, parents and caregivers should carefully follow the safety guidelines, since an infant has an immature immune system. All equipment used in formula preparation should be sterilized. Prepared, unused formula should be refrigerated to prevent bacterial growth. Parents should make sure not to use contaminated water to mix formula in order to prevent foodborne illnesses. Follow the instructions for powdered and concentrated formula carefully\u2014formula that is overly diluted would not provide adequate calories and protein, while overly concentrated formula provides too much protein and too little water which can impair kidney function.\r\n\r\nIt is important to note again that both the Health Canada, the Canadian Paediatric Society, Dietitians of Canada and the WHO state that breast milk is far superior to infant formula. This table compares the advantages of giving a child breast milk to the disadvantages of using bottle formula.\r\n\r\nTable 12.4 Breast Milk versus Bottle Formula\r\n
    \r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
    Breast Milk<\/td>\r\nBottle Formula<\/td>\r\n<\/tr>\r\n
    Antibodies and lactoferrin in breast milk protect infants.<\/td>\r\nFormula does not contain immunoprotective factors.<\/td>\r\n<\/tr>\r\n
    The iron in breast milk is absorbed more easily.<\/td>\r\nFormula contains more iron than breast milk, but it is not absorbed as easily.<\/td>\r\n<\/tr>\r\n
    The feces that babies produce do not smell because breastfed infants have different bacteria in the gut.<\/td>\r\nThe feces that bottle-fed infants produce tends to have a foul-smelling odor.<\/td>\r\n<\/tr>\r\n
    Breast milk is always available and is always at the correct temperature.<\/td>\r\nFormula must be prepared, refrigerated for storage, and warmed before it is given to an infant.<\/td>\r\n<\/tr>\r\n
    Breastfed infants are less likely to have constipation.<\/td>\r\nBottle-fed infants are more likely to have constipation.<\/td>\r\n<\/tr>\r\n
    Breastfeeding ostensibly is free, though purchasing a pump and bottles to express milk does require some expense.<\/td>\r\nFormula must be purchased and is expensive.<\/td>\r\n<\/tr>\r\n
    Breast milk contains the fatty acids DHA and ARA, which are vital for brain and vision development.<\/td>\r\nSome formulas contain DHA and ALA.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\nSource: Breastfeeding versus Bottle Feeding. American Pregnancy Association. http:\/\/www.americanpregnancy.org\/firstyearoflife\/breastfeedingandbottle.html<\/a>. Updated May 16, 2017. Accessed December 5, 2017.\r\n

    Introducing Solid Foods<\/h1>\r\nInfants should be breastfed or bottle-fed exclusively for the first six months of life according to the WHO. (The American Academy of Pediatrics recommends breast milk or bottle formula exclusively for at least the first four months, but ideally for six months.) Infants should not consume solid foods prior to six months because solids do not contain the right nutrient mix that infants need. Also, eating solids may mean drinking less breast milk or bottle formula. If that occurs, an infant may not consume the right quantities of various nutrients. If parents try to feed an infant who is too young or is not ready, their tongue will push the food out, which is called an extrusion reflex. After six months, the suck-swallow reflexes are not as strong, and infants can hold up their heads and move them around, both of which make eating solid foods more feasible.\r\n\r\nSolid baby foods can be bought commercially or prepared from regular food using a food processor, blender, food mill, or grinder at home. By nine months to a year, infants are able to chew soft foods and can eat solids that are well chopped or mashed. Infants who are fed solid foods too soon are susceptible to developing food allergies. Therefore, as parents and caregivers introduce solids, they should feed their child only one new food at a time, to help identify allergic responses or food intolerances. An iron supplement is also recommended at this time.\r\n\r\nTable 12.5 Appropriate Foods for Complementary Feeding\r\n
    \r\n\r\n\r\n\r\n\r\n\r\n
    WHAT FOODS TO GIVE AND WHY<\/td>\r\nHOW TO GIVE THE FOODS<\/td>\r\n<\/tr>\r\n
    BREAST MILK: continues to provide energy and high quality nutrients up to 23 monthsSTAPLE FOODS: provide energy, some protein (cereals only) and vitamins\r\n
      \r\n \t
    • Examples: cereals (rice, wheat, maize, millet, quinoa), roots (cassava, yam and potatoes) and starchy fruits (plantain and breadfruit)<\/li>\r\n<\/ul>\r\nANIMAL-SOURCE FOODS: provide high quality protein, haem iron, zinc and vitamins\r\n
        \r\n \t
      • Examples: liver, red meat, chicken, fish, eggs (not good source of iron)<\/li>\r\n<\/ul>\r\nMILK PRODUCTS: provide protein, energy, most vitamins (especially vitamin A and folate), calcium\r\n
          \r\n \t
        • Examples: milk, cheese, yogurt and curds<\/li>\r\n<\/ul>\r\nGREEN LEAFY AND ORANGE-COLOURED VEGETABLES: provide vitamins A, C, folate\r\n
            \r\n \t
          • Examples: spinach, broccoli, chard, carrots, pumpkins, sweet potatoes<\/li>\r\n<\/ul>\r\nPULSES: provide protein (of medium quality), energy, iron (not well absorbed)\r\n
              \r\n \t
            • Examples: chickpeas, lentils, cowpeas, black-eyed peas, kidney beans, lima beans<\/li>\r\n<\/ul>\r\nOILS AND FATS: provide energy and essential fatty acids\r\n
                \r\n \t
              • Examples: oils (preferably soy or rapeseed oil), margarine, butter or lard<\/li>\r\n<\/ul>\r\nSEEDS: provide energy\r\n
                  \r\n \t
                • Examples: groundnut paste or other nut pastes, soaked or germinated seeds such as pumpkin, sunflower, melon, sesame<\/li>\r\n<\/ul>\r\n<\/td>\r\n
    		Infants 6\u201311 months\r\n
      \r\n \t
    • Continue breastfeeding<\/li>\r\n \t
    • Give adequate servings of:<\/li>\r\n \t
    • \u2014<\/li>\r\n \t
    • Thick porridge made out of maize, cassava, millet; add milk, soy, ground nuts or sugar<\/li>\r\n \t
    • \u2014<\/li>\r\n \t
    • Mixtures of pureed foods made out of matoke, potatoes, cassava, posho (maize or millet) or rice: mix with fish, beans or pounded groundnuts; add green vegetables<\/li>\r\n \t
    • Give nutritious snacks: egg, banana, bread, papaya, avocado, mango, other fruits, yogurt, milk and puddings made with milk, biscuits or crackers, bread or chapati with butter, margarine, groundnut paste or honey, bean cakes, cooked potatoes<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
    Children 12\u201323 months\r\n