Infant Nutrition Presentation

A few questions before we start

1. What should a baby less than 6 months old eat?A. Water, juice, milk, breastmilk and

formulaB. Breast milk or formulaC. Strained or pureed foods, breast

milk, and infant formulaD. Table foods that the rest of the

family eats

Questions Continued…

2. Which of these foods is safe for a baby over 6 months to eat?A. Popcorn

B. Grapes cut into four pieces C. Raisins D. Honey E. Peanuts

Questions Continued…

3. When should a baby start to eat solid foods? A. From 4 to 6 months B. 6 months C. 9 months D. 12 months

Questions Continued…

4. I would feel comfortable teaching others in my community about infant nutrition.

Disagree 1 2 3 4 5 Agree

After this session, you should be able to:

• Explain the importance of breast feeding• Explain the risks of infant formula• Explain when a baby should start eating solids• Explain what foods are good for baby• Explain how much and how often baby should eat• Explain how to tell if baby is getting enough to eat• Teach others about infant nutrition

A Story

Nicole is 19 years old and expecting her first baby in a couple of months. She is trying to decide whether to breast feed or not. She has heard that it is the best way to feed her baby, but isn’t sure if she can do it or that she wants to. She came to the health centre for some help deciding what to do.

Feeding Your Baby From 0 to 6 Months Old

Breastmilk provides food, protection and emotional nurturing for your baby.

Breastmilk ensures normal growth and development of your baby.

Health Canada recommends that babies receive only breastmilk till 6 months with continued breastfeeding for 2 years and beyond.

Breastfeeding is the natural way of feeding your baby• Made to meet baby’s needs• Traditional way to feed baby• Bonding between mom and baby• Inexpensive and convenient• Natural child spacing (not birth control)• Weight loss

Importance of Breast Feeding

But…breastfeeding can be hard

Preparing for a good startFeed baby on cue• Most babies feed 8-12 times per day• For the first few days, mom produces only colostrum • Milk takes between 2-4 days to come in

Baby is hungry if he:• Is making sucking motions with the mouth• Is looking around with an open mouth• Puts fingers in the mouth, cries

You can tell baby is full when he:• Let’s go of breast• Sucks slower, stops sucking • Is happy, relaxed or sleeps

• Most women, if they are only breastfeeding, will be able to produce enough milk for their baby, even for twins

• Some women may need extra help and support • Breast reduction surgery• Low thyroid, polycystic ovarian syndrome, Reynolds’s disease• C-section, epidural or traumic birth experience• Diabetes• Teenager• Smoke• Overweight

Who is likely to need extra help

Is There Ever a Time When Mom Shouldn’t Breastfeed?

There are a few situations when a mom should not breastfeed her baby:

• Mom is HIV positive, baby is HIV negative• Mom has active tuberculosis (TB)

• Once she has been treated for TB and she is no longer at risk for passing it on to baby, she can breastfeed again

In these cases, it is best to use an iron fortified infant formula

What if mom drinks?

Heavy and long-term drinking while breastfeeding may:• Change baby’s nursing and sleeping patterns• Affect mom’s ability to care for baby• Cause behaviour and growth problems in baby

• Occasional light or moderate drinking is okay while breastfeeding• Wait 1-2 hours after drinking before breastfeeding if possible• It is still best to continue breastfeeding even if mom drinks

moderately• Ref: Nutrition for Healthy Term Infants, draft.

Drugs and Herbal Remedies

Drugs:• Most prescription or over-the-counter drugs are safe

during breastfeeding• Some illegal drugs may harm baby • Check with a pharmacist, doctor or www.motherisk.org

to be sure.Herbal remedies:• Some ingredients in herbal remedies may harm baby

• For advice on herbal supplements, call the Medication and Herbal Advice Line (1-888-944-1012)

• I can’t make enough milk for my baby?• This is often cited as the #1 reason why women stop

breastfeeding• If mom is exclusively breastfeeding (hasn’t introduced

even 1 bottle) and is feeding on cue, it is uncommon that she can’t produce enough milk

• However, there are situations where mom doesn’t produce enough milk

• If you are concerned that the baby is not gaining weight, contact a nurse, lactation consultant or doctor

But What If….

• My breast milk doesn’t provide enough nutrition for my baby?• Breast milk is made for baby and fully meets baby’s needs• It is best to eat a healthy diet while breastfeeding, but even if

mom doesn’t, breastfeeding is still better than formula • The Canadian Pediatric Society recommends that babies in

Canada receive 400 IU vitamin D every day to ensure they are getting enough

But What If….

But What If….

• I get sick and can’t breast feed my baby?• Most moms are able to breastfeed when they are sick

• It hurts to breastfeed my baby?• It may pull a bit when first starting to breastfeed but

breastfeeding should not hurt.• If it does hurt, mom should continue to breastfeed and seek

help from Nurse or Lactation Consultant immediately

• I smoke and am not ready to quit?• It is best not to smoke while breastfeeding, but even if mom

does smoke, breastfeeding is still the best choice for baby

Is Baby Getting Enough?

The best way to know if baby is getting enough is if he is growing well

• Be sure to have baby’s nurse follow his weight regularly

What About Formula?• Iron fortified infant formula is the only adequate alternative to breastmilk• It is important to know that there are health risks for baby associated with formula:

• Evaporated cows milk formula, cows milk, soy milk, coffee whitener are not nutritionally complete and are harmful to babies• Low in iron• Cause intestinal bleeding• Iron deficiency anemia • Hard on the kidneys• Lacks essential fats

Other milks

Not breastfeeding can increases mom’s risk of:• Breast cancer• Ovarian cancer• Post-partum depression• Endometrial cancer• Osteoporosis

There are risks to mom as well

Breastfeeding is particularly important for babies at risk of diabetes• Formula increases baby’s risk of developing type 1 and type

2 diabetes and becoming obese

Breastfeeding is particularly important for women with gestational diabetes or pre-existing diabetes• Prevent or delay the onset of type 2 diabetes• Lower insulin requirement• Better blood sugar control

Breastfeeding and diabetes

• Mention breastfeeding at every prenatal class• Show a video in the Health Centre reception area• Show a video at prenatal classes for moms and dads• Invite Elders to prenatal classes to talk breastfeeding• Invite breastfeeding mothers to prenatal classes• Buddy new moms up with other experienced moms • Talk to moms about the risks of infant formula• Run a postnatal group• Talk to moms about what to expect at the hospital• Do numerous and regular post-natal visits

How you can support breastfeeding

WHO/UNICEF’s Baby Friendly Initiative

The baby friendly initiative was established in 1991 to promote, protect, and support the starting and continuation of breastfeeding1. Have a written breastfeeding policy2. Train all health care providers3. Inform pregnant moms about the benefits & management4. Support mothers to establish and maintain BF for 6 months5. Encourage BF beyond 6 months6. Provide a welcome atmosphere for BF families7. Promote collaboration between health care providers and

breastfeeding support groups

Where Can Moms go for Help?Here are some helpful resources you can direct mom to

if she needs help or support:• Local Canadian Prenatal Nutrition Program (CPNP)• LaLeche League Canada

• Visit: http://www.lllc.ca/ • Or call:

• Edmonton: 780-478-0507• Calgary: 403-242-0277• Red Deer: 403-348-1829• Lethbridge: 403-331-1003

• LaLeche League International• http://www.llli.org/

Where Can Moms go for Help?

Alberta Health Link • Edmonton: 780-403-LINK (5465)• Calgary: 403-943-LINK (5465)• Toll-Free: 1-866-408-LINK (5465)

Non-Insured Health Benefits covers the cost of seeing a lactation consultant or attending a breastfeeding clinic

What Should Mom Eat When Breastfeeding?

Mom’s should eat a healthy, balanced diet based on Eating Well with Canada’s Food Guide First Nations, Inuit and Métis version

Breastfeeding increases a woman’s nutrition needs

•Breastfeeding mom’s should eat an extra 1-2 Food Guide servings every day to meet these needs•For example: one cup (250 ml) milk and ½ cup mixed berries

What About Prenatal Vitamins When Breastfeeding?

Breastfeeding moms should also keep taking prenatal multi-vitamins to make sure they are getting enough nutrition

Getting Dad InvolvedEven though only mom can breastfeed baby, dad can play

a very important role in feeding baby. Dad can:• Attend birthing, breastfeeding, and parenting classes • Help with household chores• Bring baby to mom for feeding• Bring mom snacks and water while breastfeeding• Bond with baby by bathing, changing diapers, and playing with him• Skin-to-skin contact• Bottle feed baby mom’s breast milk while mom is away

One of the most important things dad can do is simply support and encourage mom in her choice to breastfeed!

Our Story ContinuedWhen Nicole comes to the health centre for your advice

because she isn’t sure if she wants to breastfeed or not, what do you do to encourage her to breast feed?

A. Tell her that breastfeeding is the best way, and you’re not sure why she is even thinking about using a formula.

ORB. Explain to her why breastfeeding is the best way to feed

her baby, and talk to her about why she wants to use a formula instead.

What Would You Do?

If you said:A. Nicole feels like you aren’t listening to her concerns,

and feels like she is being judged for not wanting to breastfeed her baby. After this appointment she never comes back to the clinic.

What Would You Do?

If you said:A. Nicole feels like you aren’t listening to her concerns,

and feels like she is being judged for not wanting to breastfeed her baby. After this appointment she never comes back to the clinic.

What Would You Do?I you said:B. Nicole explains that she has heard some moms can’t

make enough milk for their babies, and Nicole worries this will happen to her too. She also worries that breastfeeding will be painful and uncomfortable. You explain to her all of the benefits of breastfeeding and you clear up some common false ideas about breastfeeding. Nicole decides that she will give breast feeding a try!

What Would You Do?I you said:B. Nicole explains that she has heard some moms can’t

make enough milk for their babies, and Nicole worries this will happen to her too. She also worries that breastfeeding will be painful and uncomfortable. You explain to her all of the benefits of breastfeeding and you clear up some common false ideas about breastfeeding. Nicole decides that she will give breast feeding a try!

Remember… It is always mom’s (and dad’s) choice to breastfeed or not. It is your job to teach her about the different ways to feed her baby so that she can make an informed decision.

Whatever she decides, she should not be judged, and should be supported in her decision!

Our Story 6 Months Later

Nicole gave birth to a healthy baby boy and named him Jason. With your help and the support of her family and community, she breastfed Jason with no problems. Jason is about to turn 6 months old, and Nicole knows it is almost time to start feeding him solid foods, but doesn’t know how to tell if he is ready and worries about what foods to give him.

Feeding Your Baby from 6 Months and UpAt 6 months, baby is ready to learn to eat solid foodsAt this age:

• Baby is hungrier• Baby’s body is ready for solid foods

Why Wait Until 6 Months?Before he is 6 months, baby is not ready for solid foods

because:• His tummy isn’t ready to handle solid foods• He may be at greater risk for allergies if he eats solid foods

Baby is ready for solid foods if he:• Is watching what others are eating• Is reaching for food• Can sit up on his own• Can hold his head up without help and turn it side to side• Seems hungry or is not as full after breastfeeding• No longer pushes his tongue out of mouth over and over when

foods other than liquids are given

Just because baby doesn’t have teeth doesn’t mean he isn’t ready for foods!

Introducing Solid Foods

The first food baby should eat is an iron-rich food:• Red meats (beef, elk, moose, venison, buffalo, etc)• Chicken, turkey, and fish with no bones• Iron-fortified infant cereals (rice cereal, oat cereal, wheat

cereal)• Beans (kidney beans, lima beans, lentils, etc.)• Egg yolk

Introducing Textures

Different textures are safe for baby at different ages.From about 6-7 months, foods should be:• Smooth• Strained

From about 8-9 months, foods should be:• Lumpy• Grated

From about 9-12 months, foods should be:• Soft• Finely chopped• Finger foods

• Pureed• Mashed

• Minced• Diced

• Dissolve or soften easily in baby’s mouth

Introducing New FoodsIntroduce one new food at a time, waiting 2-3 days before

introducing another new food• This makes it easier to notice if baby shows any signs or symptoms of

food allergies

Go slowly when introducing new foods:• You may have to offer some foods to baby many times before he tries

them• It is important to be patient• If baby does not want to try a food at first, try offering it again a

few days later• Never force baby to eat

Healthy Food Choices for Baby

Once baby is eating a variety of foods every day, try to include 3 to 4 food groups at each meal

Source: Feeding Baby Solid Foods From 6 to 12 Months of Age, Alberta Health and Wellness

Choose Foods from all Four Food Groups for BabyVegetables and Fruits:

• Examples: carrots, squash, yams, sweet potatoes, peas, bananas, peaches, applesauce, canned vegetables and fruits labelled “unsalted” and packed in water

• Start with pureed vegetables and fruits, moving to mashed, then soft cooked vegetable pieces and soft cut up fruit.

Soft Cooked Vegetables

Grain Products:• Start with an iron-fortified cereal (like rice, barley, oats,

wheat)• Always feed baby cereal with a spoon, not in a bottle• Start with a single grain cereal before feeding baby a

mixed grain cereal• Progress to other grain products that are soft like cut-up

pasta, rice, couscous, unsweetened breakfast cereals, toast, plain, unsalted crackers)

Cooked Whole Grain Macaroni

Noodles

Milk and Alternatives:• Breast milk is still the main food in the first year• After baby has been introduced to a variety of iron-rich

foods, cereals, and vegetables and fruits, he can have plain yogurt and cheese cut into small cubes or grated.

• Whole (homogenized, 3.25% milk fat) milk can be started between 9 to 12 months old

Plain, 2.5% Milk Fat Yogurt

Breast Milk

Homogenized Milk

Meats and Alternatives:• Meat: chicken, wild meat, turkey, beef, lamb, pork, fish• Beans: kidney beans, chick peas, lentils• Egg yogs• Tofu• Nut butters: almond butter, sunflower seed butter, peanuts• Start with smooth, pureed meats, moving to minced and soft

meats, and then meats cut into small pieces.

Pureed Chicken Minced Chicken Chicken Cut Into Small Pieces

Some foods are less healthy choices for baby:

Baby does not need sugar, salt, or added fats

These foods are not healthy choices for baby:

• Sweet desserts, jell-o• Cookies• Processed meats• Hot dogs• Sugary cereals• Gravy, butter, margarine, salad dressings• Coffee, tea

• Fried foods• Pickles, olives• Pop, sugary drinks• Canned soups • Candy • Chocolate • Ice cream

Some foods are choking hazards for baby:• Baby should not have these foods

• Hard candies• Popcorn• Nuts and seeds• Raisins• Fish with bones• Chewing gum• Snacks made with skewers

• Some foods are choking hazards, but can be made safe for baby to eat:• Stringy or chewy foods (meat, long pasta, cheese toppings)

• Cut into small pieces for baby• Smooth or rounds foods like grapes or cherries

• Cut into quarters and remove pits• Hard foods like raw vegetables or fruit

• Cook to soften or grate into tiny pieces• Long foods like wieners and hot dogs

• Cut into bite-sized pieces

Some foods can make baby sick:• Baby shouldn’t eat honey until he is at least one year old

• This is because of the risk of botulism (a type of food borne illness)

• To reduce the risk of allergies, baby shouldn’t eat egg white until he is at least one year old• Egg yolks are a good choice for baby to eat

Some foods can make it hard for baby to get enough good nutrition:• Baby shouldn’t have any milk other than breast milk or formula

until he is at least 9 months old• After this, baby should have whole milk• Skim, 1%, and 2% milk don’t have enough fat to meet baby’s

energy needs• Baby doesn’t need water until he is at least 6 months old

If baby has these before he is ready, it can decrease the amount of breast milk he drinks

JuiceBaby does not need juice

• Give baby whole vegetables and fruits instead of juice• Water is best for baby after 6 months• Juices have a lot of sugar and can cause cavities or baby bottle

syndrome • Drinking juice means baby may be too full at meal times to eat

healthy foods• If you do decide to give baby juice:

• Give unsweetened juice, dilute to ½ juice - ½ water• Give less than ½ cup (125 ml) of juice a day• Give baby juice in a cup, not in a bottle or sippy cup

How Much Should Baby Eat?Things to remember:

• Breast milk is still baby’s main food throughout the first year• Breast feed baby before feeding him solid foods• Never force a baby to eat• Every baby is different!

• Some babies will be more interested in food than others, and every baby will eat different amounts of food, and their hunger can vary from day-to-day

How Much Should Baby Eat?Offer small amounts of food to start with:

• Try 1 teaspoon (5 ml) of iron rich food once a day• Slowly add more food as baby’s hunger increases• Once baby is eating a variety of foods, he may eat from 1 to 5

tablespoons (15-75 ml) of each choice offered at a meal

As baby gets older, the number of meals he eats will increase:• At 6 to 8 months: offer 1 to 3 meals per day• At 9 to 11 months: offer 2 to 3 meals per day and snacks

between meals• At 12 months: offer 3 meals per day and snacks between meals.

Source: Feeding Baby Solid Foods From 6 to 12 Months of Age, Alberta Health and Wellness

Is Baby Getting Enough?

The best way to tell if baby is getting enough after he starts solid foods is still if he is growing well• Baby’s weight should still be followed by a nurse

Is Baby Getting Enough?

Signs baby is hungry:• Excited when put in high chair• Sucks or smacks lips• Opens mouth at sight of food• Puts hands/fist in mouth• Leans forward, reaches for food• Cries

Is Baby Getting Enough?

Signs baby is full:• Turns head away from spoon• Closes mouth at sight of spoon• Covers mouth with hands• Fusses, cries• Falls asleep

It is important to remember that baby knows how much to eat• If baby is telling you he’s full, never force him to eat

Happy Mealtimes for a Happy Baby!Here are some tips for successful mealtimes:

• Baby should enjoy meals at the same time as the rest of the family • Sharing family mealtimes with baby helps him learn that mealtimes are a

time for families to come together and share• Sit face-to-face with baby and keep eye contact while you feed him• Let baby eat as quickly or slowly as he wants• Let baby take the lead role when eating

• Wait for his mouth to open when you offer food• Never force baby to eat

• Let baby make a mess as he explores new foods and learns to feed himself

Be a Healthy Role Model!

Baby is just learning how and what to eat, and he is learning from watching you!• Baby wants to be just like you, so be positive about food and

make healthy food choices, and he will grow up to have a healthy relationship with food

Food Safety Tips• Wash your hands with warm, soapy water before

preparing baby’s food• Clean all counters, tables, and cooking and storage

tools in your kitchen with hot water, soap, and a clean cloth before and after preparing baby’s food

• Keep raw meat, fish, poultry, and eggs away from other foods. Don’t use the same cutting board, knife, dishes, or other tools for both raw foods and cooked foods

• Make sure to cook food until it is very hot. Use a food thermometer to be sure

Food Safety Tips

• Store foods in the refrigerator for 1 to 2 days• Never leave food out of the fridge for more than an hour• Never feed baby directly out of the storage container, put a

small amount of food in a bowl to feed baby

• Thaw foods in the fridge, microwave or in a sealed container under cold water• Do not leave foods on the counter to thaw

• Reheat food in the microwave or in a pot on the stove• Always check the temperature of the food before feeding• Microwave food using a glass plate or bowl rather than plastic

What if Nicole came to you?

• Explain why breast feeding is important, and why it’s the best way to feed baby

• Encourage her to breastfeed by talking some of the common myths about breastfeeding

• Explain to her why it is important to avoid smoking, alcohol, and illegal drugs while breastfeeding

• Explain how she can tell if baby Jason is getting enough, whether he is breast feeding or eating solid foods

• Listen to her and support her in her decisions

What if Nicole came to you?• Explain when and why baby should start eating solid

foods, and what foods to introduce first• Explain what foods are and are not good choices for

baby• Giver her some tips on how to create happy meal

times and foster Jason’s healthy relationship with foods, and encourage her to be a healthy role model

• Provide her with information on food safety

Questions and Discussion

Back to our questions from earlier…

1. What should a baby less than 6 months old eat?A. Water, juice, milk, breast milk and

formula.B. Breast milk or formulaC. Strained or pureed foods, breast

milk, and infant formula.D. Table foods that the rest of the

family eats.

Questions Continued…

2. Which of these foods is safe for a baby to eat?A. Popcorn

B. Grapes cut into four pieces C. Raisins D. Honey E. Peanuts

Questions Continued…

3. When should a baby start to eat solid foods? A. 4 months B. 6 months C. 9 months D. 12 months

Questions Continued…

4. I would feel comfortable teaching others in my community about infant nutrition.

Disagree 1 2 3 4 5 Agree

Fax us your evaluation!!!!

780-495-7338