Feeding Guidelines

Nutrition for Children

When it comes to nutrition, the choices that you make as parents can have a huge impact on the quality of your child’s life. Nutrition directly affects physical growth, mental development, and overall health. Encouraging good eating habits early on helps your child make healthier decisions later in life, which decreases the risk of weight-related diseases or nutrition deficiencies. Malnutrition, on the other hand, can lead to illnesses, stunted growth, impaired intellectual development, or even death in extreme cases.

The nutrients that children require include the following:

  1. Carbohydrates (simple, complex, and fiber), which provide energy and aid indigestion. Sources: fruits, vegetables, beans, nuts, seeds.
  2. Healthy (unsaturated) fats to provide energy, maintain nerve health, and produce hormones. Sources: health oils such as olive and canola, avocados, nuts, fatty fish.
  3. Proteins for energy, the building and repairing cells, etc. Sources: dairy foods, leans meats, nuts, legumes, beans, fish, lentils.
  4. Vitamins (A, B, C, D, E, K) for vision, skin, hair, and the nervous system.Sources: fruits, vegetables, dairy, whole grains.
  5. Minerals to maintain the health of various body parts and functions (calcium, iodine, iron, zinc, potassium, magnesium, and more. Sources: fish, meats, dairy foods, leafy green vegetables.
  6. Water, which helps with digestion, blood circulation, the elimination of waste products, maintaining an ideal body temperature, and much more.
  7. The following should be limited as much as possible: saturated fats, trans fats, and cholesterol. Sources: animal products, coconut oil, fast foods.

The following is a general overview of nutritional requirements at the infant, toddler, and preschooler stages of life. Note that the recommended calories, intake, and feedings serve as a guide only; when making decisions about meals, parents should consider body weight and also rely on signs of hunger, satiety, and responsive feeding.

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0–12 months

feeding-rice-cerealAt this initial stage of life, the correct intake of nutrition is essential due to the rapid growth of the infant’s brain.

Human milk is a unique substance that perfectly caters to an infant’s nutritional needs. Breastmilk contains essential nutrients such as calcium, iron, magnesium, zinc, thiamine, riboflavin, vitamins, and more. In additional, the solute load in such milk is lower, and it contains more unsaturated fatty acids. The proteins and fat from breastmilk are more easily digested, while the amount of carbohydrate is suited to the child’s growth rate.

For the first four to six months of life, the infant’s consumption of foods and liquids consists of only breastmilk. Breastfeeding should continue for up to two years; beyond that depends on the mother’s and child’s preference.

In addition to breastmilk, babies should be given a daily vitamin D supplement of 400 IU. The intake of this supplement should continue until your child is two years old or until a point where they are eating various foods and drinking homogenized milk. Depending on the circumstances, a daily fluoride supplement of 0.25 mg might also be needed. Sometimes, supplementary feedings of water, glucose water, diluted formula, or full-strength formula are given.

If the parents have made the decision to give formula instead of breastfeeding, it is important to choose one that is as similar as possible to human milk. Some infants are sensitive to cow’s milk, an allergy that presents as eczema, vomiting, diarrhea, and upper respiratory tract infections. Children raised on a vegetarian diet will have soy formulas.

Babies should be fed on demand, which, initially, is usually every two to three hours. (Newborns are fed eight to 10 times a day). At zero to two weeks, the number of daily feedings should be around six to eight; at two weeks to two months, five to six feedings; and at three months, four to five feedings.

The intake amount depends on the child’s voiding and stooling pattern, and length of feeding depends on the child’s satisfaction. Generally, the latter can range from five to 30 minutes per breast. If giving formula, the daily servings are as follows:

  1. Zero to three months: 18–32 oz
  2. Four to six months: 28–40 oz
  3. Seven to nine months: 24–36 oz
  4. 10 to 12 months: 18–30 ounces

For the first three months of life, the daily energy requirement for a healthy infant is 115–130 kcal per kg of body weight. Premature babies will need slightly higher amounts. From three to six months, this requirements will reduce to 100–110 kcal/kg/ day. The infant should gain about 30 grams per day.

The amount of fluids that an infant should consume varies according to the infant’s age, ranging from 80 to 200 ml/kg per day during the first six months. Protein requirements are high and range from two to three and a half grams per kg of body weight (per day).

From four to six months and onwards, solid foods need to be introduced because breastmilk/formula no longer fulfills the requirements of an infant’s need for energy and nutrients. (It provides about half or a bit more of a child/s energy needs.) Water should also be given. In addition to breastmilk, infants need:

  1. 200 kcal per day at six to eight/nine months – two to three small meals a day, with one to two snacks
  2. 300 kcal/day at nine to 11 months – three to four meals per day, with one to snacks (optional)

One of the goals of adding solids to the diet is so that the child can experiment with different textures and flavors. Start by introducing new foods one by one, which will also help to easily identify allergy sources. The solids that you can give include rice, cereal, barley, oatmeal, fruits, vegetables, and meats. Keep in mind that these should be very soft (ideally mashed, ground, shredded, pureed, etc.) and unseasoned. Do not give sweets/desserts at this point.

When introduced to solids, the infant might seem to spit the food out (thrust out the food with their tongue). This is known as the extrusion reflex. Sometimes you’ll have to offer a certain food several times before it is accepted.

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0-12 Months Growth Chart (boy)

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 girl-weight-birth-to-36-months-page-001

0-12 Months Growth Chart (girl)

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1–3 years

pediatric-nutritionFrom one to two years, breast milk provides about a third of a child’s energy needs, as well as nutrients. At 12 to 23 months, infants needs an additional 550 k cal per day, occurring in three to four meals per day as well as one to two snacks (depending on the child’s preference).

As months go by, the breast milk intake decreases while the intake of calories from food increases.

At one to two years, complementary foods need to be especially rich in protein, energy, and micro nutrients such as iron, calcium, Vitamin A, and Vitamin C. Fortified foods and/or vitamin-mineral supplements may be needed. Fats should not provide the majority of energy, and sugar should be avoided.

During the toddler years, the amount of calories required generally depend on age, growth, and activity level; however, the standard is 1,000–1,400 calories per day. These should come from grains, vegetables, fruits, milk, meats/poultry, and beans; and should include the following nutrients: protein, fats, water, calcium, vitamins, potassium, chloride, niacin, ascorbic acid, etc. Their fluid requirements is 125 ml/kg (2 ounces/lb).

From 12 to 18 months, their growth rate slows but activity increases. Be prepared that toddlers may refuse meals, accept only certain foods, and have sporadic appetites.

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1–3 Years Old Growth Chart (boy)

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1–3 Years Old Growth Chart (girl)

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3–5 years

feeding-guidelinesAt the preschooler age, begin a regular schedule of three main meals and two to three snacks per day. Children in this age group can usually eat what the rest of the family eats, but still need smaller portions.

Preschoolers require about 100/kcal/kg/day. They need to fulfill a daily calcium requirement of 800mg, which is essential for health bones and teeth. This can be obtained by drinking milk and consuming yogurt, cheese, and ice cream (the latter should of course be limited). Children also need a daily dose of 1.5–1.8 grams of protein (per kg of body weight), which can be obtained through lean meats, fish, eggs, nuts, and legumes. Lastly, kids under 5 years of age should be given a daily supplement of vitamins A, C, and D.

Here are some general tips that apply to any child consuming solids:

  1. Limit refined grains and go for whole-grain foods such as brown bread, oats, and whole-wheat pasta.
  2. When considering protein sources for your kids, opt for nuts (keeping in mind allergies), free-range eggs, and lean meats.
  3. Avoid giving your child fried meals as much as possible. Select foods that have been grilled, steamed, or roasted.
  4. Instead of sodas, energy drinks and so forth, encourage the consumption of healthy liquids: water, herbal teas, freshly squeezed juices, milk, etc.

References