(See also Nutrition in Infants.)
Breast milk is the nutrition of choice. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for a minimum of 6 months and introduction of appropriate solid food from 6 months to 1 year. Beyond 1 year, breastfeeding continues for as long as both infant and mother desire, although after 1 year, breastfeeding should complement a full diet of solid foods and fluids. To encourage breastfeeding, practitioners should begin discussions prenatally, mentioning the multiple advantages:
For the child: Nutritional and cognitive advantages and protection against infection, allergies, obesity, Crohn disease, and diabetes
For the mother: Reduced fertility during lactation, more rapid return to normal prepartum condition (eg, uterine involution, weight loss), and protection against osteoporosis, obesity, and ovarian and premenopausal breast cancers
Milk production is fully established in primiparas by 72 to 96 hours and in less time in multiparas. The first milk produced is colostrum, a high-calorie, high-protein, thin yellow fluid that is immunoprotective because it is rich in antibodies, lymphocytes, and macrophages; colostrum also stimulates passage of meconium. Subsequent breast milk has the following characteristics:
Has a high lactose content, providing a readily available energy source compatible with neonatal enzymes
Contains large amounts of vitamin E, an important antioxidant that may help prevent anemia by increasing erythrocyte life span
Has a calcium:phosphorus ratio of 2:1, which prevents calcium-deficiency tetany
Favorably changes the pH of stools and the intestinal flora, thus protecting against bacterial diarrhea
Transfers protective antibodies from mother to infant
Contains cholesterol and taurine, which are important to brain growth, regardless of the mother’s diet
Is a natural source of omega-3 and omega-6 fatty acids
These fatty acids and their very long-chain polyunsaturated derivatives (LC-PUFAS), arachidonic acid (ARA) and docosahexaenoic acid (DHA), are believed to contribute to the enhanced visual and cognitive outcomes of breastfed compared with formula-fed infants. Most commercial formulas are now supplemented with ARA and DHA to more closely resemble breast milk and to reduce these potential developmental differences.
If the mother’s diet is sufficiently diverse, no dietary or vitamin supplementation is needed for the mother or her term breastfed infant. However, to prevent vitamin D deficiency rickets, vitamin D 400 units once/day beginning in the first 2 months is given to all infants who are exclusively breastfed. Premature and dark-skinned infants and infants with limited sunlight exposure (residence in northern climates) are especially at risk of vitamin D deficiency. After 6 months, breastfed infants in homes where the water does not have adequate fluoride (supplemental or natural) should be given fluoride drops. Clinicians can obtain information about fluoride content from a local dentist or health department.
Infants lt; 6 months should not be given additional water because hyponatremia is a risk.