Harvey's Garden

Infant nutrition and breastfeeding

3 min read

Tip

Exclusively or partially breastfed infants require vitamin D and iron supplementation until they can meet their daily requirements through their diet.

Breastfeeding

  • Recommendation: Exclusive breastfeeding for the first ~6 months of life. Continue for ≥1 year as complementary foods are introduced.
  • Benefits for Infant:
    • GI: Decreased risk of necrotizing enterocolitis (NEC), gastroenteritis.
    • Immune: ↓ risk of otitis media, respiratory infections (e.g., RSV), UTIs. Maternal IgA passed to infant provides passive immunity.
    • Other: ↓ risk of SIDS, T1DM, obesity, and certain childhood cancers.
  • Benefits for Mother: ↓ risk of breast/ovarian cancer, T2DM, postpartum depression. Promotes uterine involution (via oxytocin).
  • Contraindications (in US):
    • Maternal: Active untreated TB, HIV infection (in developed countries), active herpetic breast lesions, illicit drug use, specific medications (e.g., chemotherapy), galactosemia in infant.
  • Composition of Breast Milk:
    • Colostrum: “Liquid gold” - first few days postpartum. High in protein, immunoglobulins (IgA), minerals, and vitamins.
    • Mature Milk: Lower in protein but higher in fat and lactose than colostrum.
      • Protein: Primarily whey (more easily digested) and casein.
      • Fat: Main source of calories. Contains essential fatty acids (DHA, ARA).
      • Carbohydrates: Lactose is the primary carb.

Formula Feeding

  • Standard Formula: Cow’s milk-based, iron-fortified. Modified to resemble human milk (e.g., ↑ whey:casein ratio). Should be used for all non-breastfed infants until age 1.
  • Specialized Formulas:
    • Soy-based: For galactosemia or hereditary lactase deficiency.
    • Hydrolyzed (predigested): For infants with cow’s milk protein allergy or malabsorption.

Micronutrient Supplementation

  • Vitamin D:
    • All infants (breastfed & formula-fed): Start 400 IU/day of vitamin D shortly after birth.
    • Rationale: Prevents rickets. Breast milk is low in Vit D. Formula-fed infants who drink <1 L/day may not get enough.
  • Iron:
    • Breastfed infants: Start iron supplementation (1 mg/kg/day) at age 4 months until iron-containing solid foods are introduced.
    • Preterm infants: Require higher iron supplementation (2-4 mg/kg/day) starting by 1 month of age.
    • Formula-fed infants: Receive adequate iron from iron-fortified formula.
  • Vitamin K: All newborns receive an IM injection of Vitamin K at birth to prevent hemorrhagic disease of the newborn.
  • Fluoride: Not recommended before 6 months of age. After 6 months, may be needed if local water supply is deficient.

Introduction of Complementary Foods (“Solids”)

  • When: Around 6 months of age. Signs of readiness include good head control, sitting up with support, and loss of the tongue-thrust reflex.
  • What:
    • Start with iron-fortified infant cereal (rice, oatmeal).
    • Introduce single-ingredient pureed foods one at a time (every 3-5 days) to monitor for allergies.
    • Highly allergenic foods (e.g., peanuts, eggs) can be introduced around 6 months. Early introduction may ↓ allergy risk.
  • Foods to Avoid in the First Year:
    • Cow’s milk: Until age 1 year (can cause iron-deficiency anemia from GI bleeding).
    • Honey: Until age 1 year (risk of infant botulism).
    • Choking hazards: Hot dogs, whole grapes, nuts, hard candy, popcorn.
    • Excess juice or sugary drinks.

Mnemonic

支离破碎（汁泥末碎） 汁2-3、泥4-6、末7-9、碎10-12

  • 出生后1-3个月开始添加新鲜果汁，鱼肝油——增强补充维生素D。
  • 出生后4-6个月开始添加泥状食物，如米粉、蛋黄。
  • 出生后7-9个月开始添加末状食物，如肉末、肝泥，
  • 出生后10-12个月开始添加碎状食物，如碎菜、碎肉。

Key Growth & Intake Facts

  • Weight:
    • Initial loss of 5-10% of birth weight is normal; regained by 10-14 days.
    • Weight doubles by ~4-6 months.
    • Weight triples by 1 year.
  • Caloric Needs: Approx. 100-110 kcal/kg/day for the first few months.

Graph View

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