Infant Nutrition Presentation

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• Infant Nutrition Presentation

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A few questions before we start

• What should a baby less than 6 months old eat?
• A. Water, juice, milk, breastmilk and formula
• B. Breast milk or formula
• C. Strained or pureed foods, breast milk, and
  infant formula
• D. Table foods that the rest of the family eats

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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

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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

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Questions Continued

• I would feel comfortable teaching others in my
  community about infant nutrition.
• Disagree 1 2 3 4 5 Agree

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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

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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 isnt sure if she can do it or that she wants
  to. She came to the health centre for some help
  deciding what to do.

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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.

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Importance of Breast Feeding

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

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Butbreastfeeding can be hard
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Preparing for a good start

• Feed 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
• Lets go of breast
• Sucks slower, stops sucking
• Is happy, relaxed or sleeps

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Who is likely to need extra help

• 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,
  Reynoldss disease
• C-section, epidural or traumic birth experience
• Diabetes
• Teenager
• Smoke
• Overweight

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Is There Ever a Time When Mom
Shouldnt 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

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What if mom drinks?

• Heavy and long-term drinking while breastfeeding
  may
• Change babys nursing and sleeping patterns
• Affect moms 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.

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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)

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But What If.

• I cant make enough milk for my baby?
• This is often cited as the 1 reason why women
  stop breastfeeding
• If mom is exclusively breastfeeding (hasnt
  introduced even 1 bottle) and is feeding on cue,
  it is uncommon that she cant produce enough milk
  
• However, there are situations where mom doesnt
  produce enough milk
• If you are concerned that the baby is not gaining
  weight, contact a nurse, lactation consultant or
  doctor

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But What If.

• My breast milk doesnt provide enough nutrition
  for my baby?
• Breast milk is made for baby and fully meets
  babys needs
• It is best to eat a healthy diet while
  breastfeeding, but even if mom doesnt,
  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

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But What If.

• I get sick and cant 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

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Is Baby Getting Enough?

• The best way to know if baby is getting
  enough is if he is growing well
• Be sure to have babys nurse follow
  his weight regularly

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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

• Ear infections
• Chest infections
• Diarrhea
• Asthma
• Leukemia
• SIDS
• Allergies
• Celiac disease
• Ulcerative colitis and Chrones
• Lower IQ and cognitive development
• Obesity in childhood and adulthood
• Infection from food born illness (E.Sakazaki)
• Improper preparation

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Other milks

• 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

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There are risks to mom as well

• Not breastfeeding can increases moms risk of
• Breast cancer
• Ovarian cancer
• Post-partum depression
• Endometrial cancer
• Osteoporosis

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Breastfeeding and diabetes

• Breastfeeding is particularly important for
  babies at risk of diabetes
• Formula increases babys 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

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How you can support breastfeeding

• 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

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WHO/UNICEFs Baby Friendly Initiative

• The baby friendly initiative was established in
  1991 to promote, protect, and support the
  starting and continuation of breastfeeding
• Have a written breastfeeding policy
• Train all health care providers
• Inform pregnant moms about the benefits
  management
• Support mothers to establish and maintain BF for
  6 months
• Encourage BF beyond 6 months
• Provide a welcome atmosphere for BF families
• Promote collaboration between health care
  providers and breastfeeding support groups

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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/

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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

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What Should Mom Eat When Breastfeeding?

• Moms should eat a healthy, balanced diet
  based on Eating Well with Canadas Food Guide
  First Nations, Inuit and Métis version
• Breastfeeding increases a womans nutrition needs
• Breastfeeding moms 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

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What About Prenatal Vitamins When Breastfeeding?

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

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Getting Dad Involved

• Even 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 moms 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!

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Our Story Continued

• When Nicole comes to the health centre for your
  advice because she isnt 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 youre not sure why she is even thinking
  about using a formula.
• OR
• B. 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.

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What Would You Do?

• If you said
• A. Nicole feels like you arent 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.

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What Would You Do?

• If you said
• A. Nicole feels like you arent 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.

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What Would You Do?

• I you said
• B. Nicole explains that she has heard some moms
  cant 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!

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What Would You Do?

• I you said
• B. Nicole explains that she has heard some moms
  cant 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!

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• Remember It is always moms (and dads) 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!

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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 doesnt know how to
  tell if he is ready and worries about what foods
  to give him.

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Feeding Your Baby from 6 Months and Up

• At 6 months, baby is ready to learn to eat solid
  foods
• At this age
• Baby is hungrier
• Babys body is ready for solid foods

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Why Wait Until 6 Months?

• Before he is 6 months, baby is not ready for
  solid foods because
• His tummy isnt 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

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• Just because baby doesnt have teeth doesnt mean
  he isnt ready for foods!

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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

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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 babys mouth

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Introducing New Foods

• Introduce 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

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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
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Choose Foods from all Four Food Groups for Baby

• Vegetables 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.

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• 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)

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• 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

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• 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.

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• 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

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• 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

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• 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

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• Some foods can make baby sick
• Baby shouldnt 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 shouldnt
  eat egg white until he is at least one year old
• Egg yolks are a good choice for baby to eat

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• Some foods can make it hard for baby to get
  enough good nutrition
• Baby shouldnt 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 dont have enough fat to
  meet babys energy needs
• Baby doesnt 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

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Juice

• Baby 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

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How Much Should Baby Eat?

• Things to remember
• Breast milk is still babys 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

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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 babys 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.

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Source Feeding Baby Solid Foods From 6 to 12
Months of Age, Alberta Health and Wellness
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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
• Babys weight should still be followed by a nurse

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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

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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 hes full, never force him
  to eat

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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

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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

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Food Safety Tips

• Wash your hands with warm, soapy water before
  preparing babys 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 babys food
• Keep raw meat, fish, poultry, and eggs away from
  other foods. Dont 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

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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

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What if Nicole came to you?

• Explain why breast feeding is important, and why
  its 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

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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 Jasons healthy relationship
  with foods, and encourage her to be a healthy
  role model
• Provide her with information on food safety

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Questions and Discussion
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Back to our questions from earlier

• What should a baby less than 6 months old eat?
• A. Water, juice, milk, breast milk and formula.
• B. Breast milk or formula
• C. Strained or pureed foods, breast milk, and
  infant formula.
• D. Table foods that the rest of the family eats.

70
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

71
Questions Continued

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

72
Questions Continued

• I would feel comfortable teaching others in my
  community about infant nutrition.
• Disagree 1 2 3 4 5 Agree

73
Fax us your evaluation!!!!

• 780-495-7338