Babies deserve the best of everything that can be offered. The first year of life is the most critical for a child, particularly from a nutritional standpoint. Since parents are primarily responsible for their baby's health, it is extremely important for them to understand the unique nutritional requirements of infants.

GROWTH AND DEVELOPMENT

Throughout the first year of a baby's life, amazing changes take place. During this period an infant experiences the most rapid growth and development period in its lifetime. Nutrition is critical at this time, as the baby's diet must support this rapid growth rate. Consider the following examples, which illustrate just how fast this growth rate is:

An infant's weight at birth usually

• doubles by about four or five months of age, and
• triples by about the first birthday

In terms of length, babies generally

• grow 10 to 11 inches between birth and the first birthday, and
• grow an additional 2 to 3 inches by 18 months of age.

Aside from these obvious external physical changes, important growth also takes place in an infant's vital organs. In fact, the brain, heart and kidneys double in size by a baby's first birthday. By 18 months of age, most of the brain cells have been formed. Therefore, appropriate amounts of essential nutrients such as protein, carbohydrate, fat, vitamins, and minerals are necessary to ensure and sustain this rapid yet normal rate of growth and development.

Proper nutrition during the early months of life cannot be overemphasized as it also influences the structure and function of vital organs. Obviously, it is of utmost importance that the infant's nutritional needs are met through a diet adequate to support proper growth and development.

NUTRITIONAL REQUIREMENTS

Because a baby typically receives all nutrients from a single food source or a limited number of sources, it is imperative that the right kinds of nutrients at the right levels be present in that source or sources. A proper balance of protein, fat, carbohydrate, vitamins, and minerals is essential. Too much or too little of any one nutrient in a baby's diet should be avoided.

Remember an infant's nutritional needs are unique. They are, indeed, quite different from an adult's and even from those of older children. Protein consumption is one example when balance in the infant's diet is essential. Although some parents think that a baby cannot be fed too much protein, this is not the case; too much protein can unduly stress an infant's developing kidneys.

Too little of any nutrient may cause problems, as well. Iron deficiency is the most common nutritional problem, affecting infants in all socioeconomic groups. A healthy baby born after a normal, full-term pregnancy generally has enough iron stored in the body to meet iron requirements for the first 4 to 6 months of life. Before this iron is depleted, iron should be supplied in the diet as research suggests iron deficiency in early childhood may lead to long–term changes in behavior that may not be reversed even with iron supplementation sufficient to correct the anemia. Possible sources of iron in an infant's diet include breast milk, iron–fortified infant formula, iron–fortified infant cereals and iron supplements. Iron is important because of its role in the formation of hemoglobin, which carries oxygen through the blood to the rapidly growing cells and tissues. Iron deficiency may result in irritability, listlessness and anemia. Research also has shown iron to be essential for proper mental development.

During the initial and most crucial months of growth and development in a baby's life, nutrition and diet should be a major concern to parents.

What an infant consumes must:

• supply the right type and amount of protein, fat, carbohydrate, vitamins and minerals in order to maintain the rapid, yet normal, rate of growth expected during this time, and yet
• not stress the baby's developing digestive system and kidneys

FEEDING CHOICES

Choosing a method for feeding an infant is ultimately the parent's decision. However, in making this decision, parents should rely on the advice of health professionals. Physicians, nutritionists and other health professionals are extensively trained in this area and can provide sound counsel regarding each infant's unique physiologic and metabolic demands.

Parents should be aware of certain important facts when deciding whether to breastfeed or formula feed their infant. Breastfeeding is the preferred and recommended method of feeding. However, if the decision is made not to breastfeed, breastfeeding is not possible, if a breastfeeding supplement is needed, or if breastfeeding is stopped before the baby is one year of age, a commercially prepared iron-fortified infant formula is the best alternative to human milk.

The American Academy of Pediatrics recommends,

Parents should work with the health professionals caring for their baby to help assure that their baby's nutritional needs are met.

BREASTFEEDING

Breastfeeding is the preferred mode of infant feeding for a variety of reasons:

• Breast milk supplies the nutrients required for an infant's growth and development.
• Breast milk supplies the proper balance of nutrients, minimizing the likelihood of excesses or deficiencies.
• Breast milk does not stress a baby's developing digestive system and kidneys.
• Breast milk is bacteriologically safe and provides immunological protections. By breastfeeding her newly born infant, a mother will pass on some of her own immunities to infections the baby may be exposed to during the first weeks of life, before the baby's own immune system is fully developed.
• Breast milk is convenient and economical for the mother. There is no need to "prepare" a feeding. Mother's milk is ready whenever and wherever she is.
• Breastfeeding involves physical contact between a mother and child. Emotional growth, just as important as physical growth and development, is promoted by this close, enjoyable mother-child interaction.

A mother who plans to breastfeed should be healthy and should eat an adequate and nutritious diet to ensure the quality and quantity of her milk supply. A breastfeeding mother needs an increased caloric intake, additional vitamins, minerals and protein, and an adequate fluid intake. The diet of a breastfeeding mother affects not only her own health and well-being, but that of her child, as well. Some physicians recommend that the diet of the breastfed infant be supplemented with vitamin D, iron, and fluoride beginning early in the infant's life. In fact, the American Academy of Pediatrics “recommend[s] a supplement of 200 IU per day [of vitamin D] for…[a]ll breastfed infants unless they are weaned to at least 500 mL per day of vitamin fortified formula or milk.”

FORMULA FEEDING

The best alternative feeding or supplement to breastfeeding is commercially prepared, iron-fortified infant formula. Historical accounts show that use of replacements for breast milk began centuries ago.

It was not until the later 19th century, though, that scientists and physicians began scientific investigations of breast milk substitutes. Certain discoveries regarding infectious diseases were made, benefits of pasteurization became apparent, and the first studies on infant metabolism began.

The "modern" era of infant formulas of known composition, as a complete food, began in 1915. Processed milk was developed with a fat content adapted to simulate human milk. Soon after, modified evaporated milk formulas came into general use and became widely accepted for a number of decades.

Today's infant formulas are much different than the early formulas, and are modeled on breast milk and the breast-fed infant. Years of development, careful clinical and other research, and continuing refinement have resulted in commercially prepared infant formulas that provide the needed protein, fat, carbohydrate, vitamins and minerals.

Like breast milk, formula also

• provides the proper nutrients at appropriate levels necessary for a baby to sustain a rapid rate of growth and development, and
• will not stress the infant's delicate and developing organ systems.

Because of the special nutritional needs throughout the first year, the baby should be breastfed or receive an iron-fortified formula until at least one year of age, even after the infant is eating solid foods.

The infant formula industry, recognizing the importance of human milk and breastfeeding and fully acknowledging breastfeeding as the preferred feeding practice for babies, is committed to providing the highest quality alternatives possible. Formulas on the market today are produced to meet the nutritional recommendations of the Committee on Nutrition of the American Academy of Pediatrics. In keeping with this commitment, the International Formula Council (an association representing manufacturers of infant formula in the United States) endorsed the Infant Formula Act of 1980 and the subsequent amendments to this Act, which incorporate into law the Committee on Nutrition's recommendations and further assure the safety and appropriate nutrient composition of infant formulas.

COW'S MILK

The American Academy of Pediatrics emphatically states that ordinary cow's milk is not suitable for infants under one year of age. Although nutritious for older children and adults, cow's milk is not appropriate for infants because

• Cow's milk is a poor source of iron. As stated earlier, iron deficiency is the most common nutritional deficiency in infants.
• Cow's milk that has not been specially heat processed (such as the heat processing used in infant formula) can cause intestinal blood loss in some babies.
• Cow's milk contains only small amounts of vitamin C, vitamin E, and copper.
• Cow's milk contains an excessively high level of protein -- approximately two to three times higher than either breast milk or infant formula.
• The fat in cow's milk, different from that present in breast milk and infant formula, is difficult for young babies to digest and absorb.
• The amount of sodium in cow's milk is greater than the amount an infant should receive.

SOY-BASED AND SPECIAL FORMULAS

For infants allergic to cow’s milk, milk from goats and other animals or formulas containing large amounts of intact animal protein are inappropriate substitutes for breast milk or cow’s milk-based formulas. If a baby has a family history of allergy or exhibits symptoms of milk (formula) intolerance, the physician may recommend a soy-based formula to help avoid possible allergic reactions. The Academy of Pediatrics states: “In term infants whose nutritional needs are not being met from maternal breast milk or cow-milk based formulas, isolated soy protein-based formulas are safe and effective alternatives to provide appropriate nutrition for normal growth and development.”

A baby with confirmed allergies will often be given an extensively hydrolysed formula, one in which the protein has been predigested so it will decrease the likelihood of an allergic reaction, or if allergic symptoms persist, a free amino acid-based formula. Both soy, extensively hydrolysed and amino acid-based formulas are nutritionally complete and do not contain whole cow's milk protein.

Other special formulas are available for infants with special needs. Premature infants, infants unable to digest and absorb nutrients adequately, and infants born with genetic disorders of metabolism (i.e., rare disorders in which the body cannot turn food into energy normally) often require special formulas. Such formulas meet unique nutrient requirements and should only be used under the direction of a physician.

SOLID FOODS

Most experts agree that the introduction of solid foods is not necessary before 4 to 6 months of age. Breastmilk or iron-fortified infant formula can provide all of a baby's nutrient needs in the first few months of life. Introducing solid foods too early can contribute to overfeeding in some infants. Some solid foods (notably those made by pureeing adult table foods) may supply too much sodium and too many calories for the young infant.

An informed decision regarding an infant's diet should be based on health professional advice as well as the parents' lifestyles and preferences. The final decision to breastfeed, formula feed or use a combination of both rests with the parents. Breastfeeding is the preferred method of infant feeding. However, if breastfeeding is not adopted, is supplemented or is discontinued before 12 months of age, iron-fortified infant formula is the best alternative.