11.3: Feeding Infants

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Page ID: 201621

Heather Carter and Amber Tankersley
Pittsburg State University

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Learning Objectives

By the end of this section, you should be able to:

Describe the changes in nutritional needs as children mature (get older).
Advocate for the support of breastfeeding mothers.
Relate bottle-feeding practices.
Discuss the transition to solid foods and self-feeding.

Introduction

To provide all children with appropriate nutrition, it is important to understand how nutritional needs and feeding practices change as children mature. Children with special needs may have different nutritional and feeding needs. Working with families and medical providers, programs can ensure that they meet each and every child’s needs. Early care and education programs can also support and empower families to provide the best nutrition to their children.

Feeding Infants

Infants have different nutritional needs because of the rapid growth rates. During this period, infants are also entirely dependent on their parents and other caregivers to meet these needs. For almost all infants six months or younger, breast milk is the best source to fulfill nutritional requirements. However, advances in infant formula have allowed it to more closely mimic breast milk, and is considered a great alternative for families who are unable or choose not to breastfeed. "Fed is best." An infant may require feedings eight to twelve times a day, or more, in the beginning. Between four and six months, infants can gradually begin to consume solid foods to help meet nutrient needs based on pediatric recommendations.

How often an infant wants to eat will also change over time due to growth spurts, which typically occur at about 2 weeks and 6 weeks, and again at about three months and six months of age.⁶³²

Breastfeeding

The 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. Protein makes up about 5 to 20 percent of the caloric content of breast milk. About 30 to 40 percent of the caloric content in breast milk is made up of fat. A diet in high unsaturated fat is necessary to encourage the development of neural pathways in the brain and other parts of the body.

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Supporting Breastfeeding in Early Care and Education

Early care and education programs play an important role in supporting breastfeeding All staff members—despite their comfort or experience with breastfeeding—play an important role in breastfeeding promotion. They have an opportunity to share the facts about breastfeeding with families, and to help them decide what's best for them and their babies.⁶³⁴

You can support breastfeeding mothers when you:

Talk about why breastfeeding is so good for their infant.
Tell them you want to care for breastfed infants and support breastfeeding mothers.
Share other places in the community they can go to for help with breastfeeding.
Share and discuss resources about breastfeeding.
Try to time feedings to the mother’s schedule (being sure to respond to the infant’s needs and cues).
Offer a place to nurse that is comfortable, quiet, and private.
Communicate about their infant’s day.⁶³⁵

Nellis Child Development Center II — Figure 14.1 – This childcare center provides mothers a space to breastfeed.⁶³⁶

Feeding with Breast Milk in Early Care and Education Programs

Mothers may choose to have their breastfed infants fed in one of several ways when the infant is in child care including:

a mother uses her breaks to come to the childcare site at feeding times to nurse her infant;
child care provider gives the infant the breast milk that the mother has expressed on the previous day.

Follow the feeding method that the mother chooses. Feeding advice such as the use of infant formula should come from the infant's doctor or clinic.

Storing Breast Milk

Ask mothers to bring in enough breast milk to feed the infant each day. Bottles should have just the amount both you and the mother think the infant will take at each feeding. This amount will be about 2 to 4 ounces of breast milk for the younger infant. As the infant gets older, the mother can put more breast milk in each bottle.

Keep breast milk in the refrigerator or freezer until ready to use. Breast milk that is not frozen, should be disposed of if not eaten within 72 hours.

Ideally, parents should label breast milk containers before bringing them into an early childhood program, with their child's name and the date the milk was expressed. The containers should then be stored per the table guidelines below (Council for Professional Recognition, 2023, p. 83; CDC, 2023).

Location	Temperature	Duration	Comments
Countertop, table	Room temperature (up to 77^F or 25^ C)	6-8 hours	Keep containers covered and cool. Covering the container with a cool towel may keep milk cooler.
Insulated cooler bag	5-39^F or -15-4^ C	24 hours	Keep ice packs in contact with milk containers at all times. Limit opening cooler bag.
Refrigerator	39^F or 4^ C	5 days	Store milk in the back of the refrigerator.
Freezer
Freezer compartment of a refrigerator	39^F or -15^ C	2 weeks	Store milk toward the back of the freezer, where the temperature is most constant. Though milk stored for longer durations in the ranges listed is safe, some of the milk lipids will degrade, resulting in lower quality.
Freezer compartment of a refrigerator with separate doors	0^F or -18^ C	3-6 months
Chest or upright deep freezer	-4^F or -20^ C	6-12 months

Although breast milk is ideal for almost all infants, not all mothers will be able to breastfeed and some mothers should not breastfeed (including women with HIV, who are being treated for cancer, or who are taking drugs that are not safe while breastfeeding).

Formula Feeding

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’s 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’s milk protein allergy. Hypoallergenic protein hydrolysate formulas are usually given to infants who are allergic to cow’s 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.

Infant formula comes in three basic types:

Powder that requires mixing with water. This is the least expensive type of formula.
Concentrates, which are liquids that must be diluted with water. This type is slightly more expensive.
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.

Most infants 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 breast milk or formula per day.

Preparing and Storing Formula

Many early care and education programs provide commercially prepared formulas to infants, under the direction of the family. Bottles of formula should come prepared in bottles labeled with the infant’s name and the date. Unused mixed formula should not be stored for more than 24 hours.

Formula may be prepared up to 24 hours in advance, as long as it is stored in the refrigerator to prevent the formation of bacteria. It is recommended to use room temperature water to mix the formula, based on the manufacturer's directions.

Open containers of ready-to-serve formula should be used within or discarded after 48 hours (Nemours Foundation, 2018).

Heating and Using Breast Milk or Formula

When thawing frozen breast milk, the Centers for Disease Control recommends placing the frozen milk container in the fridge or submerging it in warm water. Never use a microwave to heat formula or breast milk, as it heats unevenly, can destroy the milk's nutrients, and may cause the container to explode (CDC, 2023; Council for Professional Recognition, 2023).

Whether an infant drinks breast milk or formula, the remaining milk from a bottle or cup that has been served should never be reused for another feeding. Discard any leftovers immediately after the feeding, if the infant is done, or within one hour after the milk has been heated/offered.

Bottle-Feeding (Both Expressed Breast Milk and Formula)

Always wash your hands before handling bottles or feeding the infant. Use only clean bottles, nipples, and cups. For infants that do not crawl, bottles and nipples should be sterilized. If you need to reuse them, sterilize them by boiling them in water for 5 minutes or by washing them in a dishwasher.

Double-check the labels on bottles before feeding to ensure the infant is getting the correct breast milk or formula. Always hold the infant when bottle feeding. Try different positions for infants who do not want to take their bottles. Some infants are happier if you feed them in the usual cradle position. Others prefer a different position. Do not prop up a bottle to feed an infant or put an infant in a crib with a bottle. Bottle propping could cause the infant to choke, tooth decay, and ear infections.

infant being bottle fed looking up towards adult — Figure 14.2 – Not only is holding an infant during bottle feeding safest, but it is also an important time for caregiver and infant to connect and build their relationship.⁶³⁹

Burp by placing the infant high over your shoulder or over your knee. You can also lean the infant forward in a sitting position supported by your hands. Pat or rub the infant's back. This puts gentle pressure on the abdomen to push extra air from the stomach.⁶⁴⁰

Unused breast milk or formula should be discarded after feeding as bacteria from the infant’s mouth may have made it into the bottle.

When to Feed

In the early months, infants will need to be fed “on demand”—this means that they are able to feed whenever they are hungry or show hunger cues. Hunger cues are unique to each infant. An infant might:

Have a specific hunger cry
Root or look around for food
Suck on their hand or fingers
Become irritable or restless
Repeat a unique behavior to demonstrate hunger

When adults respond to an infant’s hunger cues, the infant can also tell how much food they want and when they are full. This feeding practice supports healthy eating habits, growth, and development later in life.⁶⁴¹

Introducing Solid Foods

Infants should be breastfed or formula-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 before 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.⁶⁴²

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Knowing When an Infant is Ready for Solid Foods

Here are several ways you can tell that an infant is ready to eat solid foods:

The infant’s birth weight has doubled.
The infant can control their head and neck movements.
The infant can sit up with some support.
The infant can show you they are full by turning their head away or by not opening their mouth.
The infant begins showing interest in food when others are eating.

Solid baby foods can be bought commercially or prepared from regular food using a food processor, blender, food mill, or grinder.⁶⁴³ Baby food can be served at room temperature. If it is warmed, it must be stirred to distribute evenly.⁶⁴⁴

Portion a small amount of food you intend to serve the baby on an infant-sized spoon. When beginning solid foods, timing is important. To keep mealtimes positive, choose a time when the infant is happy and when you have the patience and time to focus. Offer 1 to 2 teaspoons after breast milk or formula feeding. This can increase over time to 2 to 3 tablespoons. Any uneaten food will need to be thrown away after a feeding.

It is normal for infants to refuse new foods. Sometimes it can take 10 to 12 times of offering a food before an infant will accept it. An infant knows when they have had enough and may turn their head away. Don’t force them to keep eating.⁶⁴⁵

As families and caregivers introduce solids, they should feed the 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.⁶⁴⁶

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Foods to Avoid for Infants

Never give honey to infants. It may contain bacteria that can cause botulism, a rare, but serious illness.
Do not give infants cow's milk until they are 1 year old. Before age 1, they have a difficult time digesting cow's milk.
Avoid foods with added salt or sugar.
Do not give infants egg white until after they are 1 (egg yolks 3-4 per week are okay)⁶⁴⁷

Learning to Self-Feed

With the introduction of solid foods, young children begin to learn how to handle food and how to feed themselves. At six to seven months, infants can use their whole hand to pick up items (this is known as the palmer grasp). They can lift larger items, but picking up smaller pieces of food is difficult. At eight months, a child might be able to use a pincer grasp, which uses fingers to pick up objects.⁶⁴⁸

Serve food that is soft and mashed. Cut food into small pieces (cubes no larger than 1/4 inch) or thin slices that your baby can easily chew and swallow. Avoid high-risk choking foods such as small, slippery foods; dry foods that are hard to chew or sticky; and tough foods.⁶⁴⁹

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Finger Foods

Here are some good food choices for self-feeding children:

Soft-cooked vegetables
Washed and peeled fruits
Graham crackers
Melba toast
Noodles

Here are foods to avoid as they are a choking hazard:

Apple chunks or slices
Grapes
Berries
Raisins
Dry flake cereals
Hot dogs
Sausages
Peanut butter
Popcorn
Nuts
Seeds
Round candies
Raw vegetables⁶⁵⁰

To minimize choking, ensure that infants are seated while eating. If using a high chair, make sure to use the safety straps.⁶⁵¹

After the age of one, children slowly begin to use utensils to handle their food. Unbreakable dishes and cups are essential, since very young children may play with them or throw them when they become bored with their food.⁶⁵³

toddler holding spoon and reaching for sliced bananas on plate — Figure 14.3 –This older infant has been served food on an unbreakable plate with a small utensil.⁶⁵²

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Engaging Families in Supporting Their Infant’s Nutrition

Here are tips you can share with families

If breastfeeding is harder than you thought it would be you are not alone!
Lots of people say that breastfeeding just comes “naturally” but for many moms, it doesn’t.
Going back to work and wanting to get back into a normal family routine can make it hard to stick with breastfeeding. Using a breast pump can help ensure your baby still gets the best nutrition.
If you need support or help at any time while you are breastfeeding call 1-800-994-9662 (the National Breastfeeding Hotline) for free breastfeeding support.
Don’t use pillows or other objects to hold a bottle for your baby. This makes it hard for her to spit out the bottle when she’s done - it can cause her to keep eating after she’s full.
Make sure you take the bottle away if your baby falls asleep. If you let the baby keep the bottle in her mouth when he’s sleeping, formula can stay in her mouth and can damage his teeth or cause her to choke.
Stick with ONLY breast milk or formula for feeding your baby until she is 6 months old. Unless your doctor tells you something different, adding cereal to a baby’s bottle adds extra calories to her diet that she doesn’t need.⁶⁵⁵
Infants are usually ready to eat solid foods at about 6 months of age.
If you introduce one new food at a time, you will be able to identify any foods that cause allergies in your baby.⁶⁵⁶
Start solid feedings with iron-fortified baby cereal mixed with breast milk or formula. Mix it with enough milk so that the texture is very thin. Start by offering the cereal 2 times a day, in just a few spoonfuls.
You can make the mixture thicker as your baby learns to control it in their mouth.
You can also introduce iron-rich pureed meats, fruits, and vegetables. Try green peas, carrots, sweet potatoes, squash, applesauce, pears, bananas, and peaches.
Some dietitians recommend introducing a few vegetables before fruits. The sweetness of fruit may make some vegetables less appealing.
The amount your child eats will vary between 2 tablespoons (30 grams) and 2 cups (480 grams) of fruits and vegetables per day. How much your child eats depends on their size and how well they eat fruits and vegetables.⁶⁵⁷

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Resources for Further Exploration

References

For references according to subscript, please see pages 308-335 of the original Health, Safety and Nutrition book (Paris, 2021) on Google Drive.

Centers for Disease Control and Prevention (CDC). (2023). Breast milk storage and preparation. Retrieved from : https://www.cdc.gov/breastfeeding/br...reastmilk.html

Council for Professional Recognition. (3rd Ed.). (2023). Essentials for working with young children. Author.

The Nemours Foundation. (2018). Breastfeeding vs. formula feeding?. Retrieved from: https://kidshealth.org/en/parents/br...e-feeding.html

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Supporting Breastfeeding in Early Care and Education

Knowing When an Infant is Ready for Solid Foods

Foods to Avoid for Infants

Finger Foods

Engaging Families in Supporting Their Infant’s Nutrition