The basic requirements of nutrition for infants and young children (0-36 months) are to meet growth and avoid nutrient deficiencies. A good nutritional status of children helps prevent acute and chronic diseases, and is beneficial to their physical growth and neuropsychological development. The nutritional needs of children vary greatly among individuals due to genetic and metabolic levels. Proper nutrition and feeding practices not only improve growth and development early in life, but also have important implications for health later in life (e.g., prevention of obesity, cardiovascular disease, etc.). Feeding guidelines have been developed worldwide to address the special nutritional needs of infants and toddlers, but for a long time, feeding guidelines for infants and toddlers (e.g., age of infant food introduction, first food introduced, multivitamin supplementation, number of meals, and amount of milk after introduction of other foods) have differed across China. Therefore, this feeding recommendation was developed to provide reference for standardizing the content and behavior of pediatrics and child health care and guiding infant and toddler feeding around the world.
First, the choice of food in infancy and early childhood
(A) liquid food (milk)
1, breast milk: breast milk is the most ideal natural food for infants, the healthy growth and development of infants have an irreplaceable role. Healthy, nutritionally balanced mother’s milk can provide all the nutritional needs needed for the normal growth of a full-term child up to 6 months of age.
2. Formula: Unprocessed animal milk is not suitable for human infants’ digestive tract, immune function, or kidney development levels. Formula should be preferred when breastfeeding is not possible or when infants are gradually weaned from breast milk. Use is selected according to age. Premature infants should be breastfed as much as possible, and for very low birth weight infants it is appropriate to use formula for preterm infants designed according to the physiological characteristics of preterm infants to supplement the lack of nutrients in the mother’s milk of preterm infants.
3.Liquid whole milk and yogurt: available after infancy.
4.Therapeutic formula: Special therapeutic formula can be used for certain diseases of infants.
(1) Deeply hydrolyzed protein formula powder or free amino acid formula powder: infants diagnosed with milk allergy should be breastfed for as long as possible, which can be until 12-18 months of age; if breastfeeding is not possible infants should prefer deeply hydrolyzed protein formula powder or free amino acid formula powder, and follow up every 3-6 months to a specialist to adjust the treatment Timing. Partially hydrolyzed protein formula, soy formula and goat milk should not be used to treat cow’s milk allergy.
(2) Lactose-free formula: infants with congenital lactose intolerance should use lactose-free formula for a long time; for infants with acute diarrhea resulting in secondary lactose intolerance can be used until 2-4 weeks after healing.
(3) other special formula powder: according to the nature of the disease can be used to choose different special formula powder, such as tyrosinemia choose low tyrosine formula powder, classic phenylketonuria should use low phenylalanine milk powder.
(B) semi-solid, solid food
Semi-solid and solid foods are foods other than milk, which are suitable for infants’ nutritional needs and development of eating skills. Semi-solid foods are first-stage foods for infants and are often referred to as transition foods, milk replacement foods, and were once called complementary foods or weaning foods. Phase I foods are specially prepared infant products or homemade nutrient-rich, pureed (pureed) foods, mostly plant-based, including iron-fortified rice flour, fruit purees, and vegetable purees of roots and tubers or squash and beans. Solid food is the second stage of food for infants, and the variety of food is close to adult food to provide infants’ nutrient needs; the hardness or size of food should be moderately increased to adapt to the development of infants’ chewing and swallowing functions, such as minced, crumbled, finger-shaped or strip-shaped soft food, including fruits, vegetables, fish and meat, and eggs.
(C) Common family (adult) food
Infants begin to learn to eat with adults in the late stages, and around the age of 2, young children can eat ordinary home-prepared food together with adults, but should pay attention to soft texture and lightness.
Second, feeding methods
1. Breastfeeding: Suitable for infants with perfect sucking and swallowing ability. From the consideration of the physiological maturity of the digestive system and growth and development, infants should be exclusively breastfed after birth at least 4 months of age. While introducing other foods to meet the growth and development needs of infants, it is recommended to breastfeed infants until 12 months of age.
Partial breastfeeding: Breast milk and formula feeding at the same time is partial breastfeeding. In clinical practice, depending on the age of the infant, the purpose of supplementing formula is different. If the amount of breast milk is not enough to supplement formula for 4-6 months old infants, each nursing first suck the empty breast (both sides) and then make up the insufficient part of breast milk with formula, the amount of milk taught by the infant’s appetite and the amount of breast milk, that is, “how much is missing to make up the amount”; this method helps stimulate breast milk secretion. After 6 months of age, when breast milk cannot maintain the normal growth rate of infants, formula milk should be supplemented to maintain the normal growth level of infants.
3.Formula feeding: When breastfeeding cannot be done for various reasons, formula feeding is used exclusively for infants.
Feeding implementation
1.Early breastfeeding: 2 weeks after birth is a critical period for the establishment of breastfeeding, the first sucking time after birth is the key to the successful establishment of breastfeeding, it is advisable to start as early as possible.
2.Promote milk secretion: Frequent sucking of the nipple, breastfeeding on demand, emptying of the breast every time of breastfeeding and emotional relaxation of the mother can promote mother’s milk secretion in small infants of 0-2 months old.
3, milk estimation: breast milk or formula is the main source of nutrition for infants <6 months of age. Because the amount of breast milk is not easy to obtain, when the infant has satisfactory weight gain, good sleep condition and normal urine output (>6-7 times/d), it can indicate that the amount of breast milk is sufficient. Infant formula intake can be estimated based on the infant’s body weight, energy requirements for feeding and dairy product specifications. Although infants >6 months of age have been introduced to other foods, breast milk or formula is still an important source of nutrition for infants (usually about 800 ml/d of total milk).
4. Food preparation and preservation: Ensuring the cleanliness and hygiene of food, eating utensils and water during the preparation and preservation of infant food is the key to reducing infant infections. Therefore, before the preparation of food should be disinfected eating utensils, hand washing, ready to eat; remaining food refrigerator storage, re-eating should be heated to avoid contamination. Prepare the formula milk strictly according to the instructions, avoiding too much water to dilute the milk or too much milk powder to cause malnutrition or kidney damage to the infant.
5.Liquid quantity: Infants within 6 months of age can get sufficient amount of liquid from breast milk and other foods. To reduce the gastrointestinal burden, avoid giving infants too much water or juice. The infant’s daily urine 6 to 7 times indicates that the fluid intake is basically sufficient. In late infancy and in young children, when food is close to that of adults, water or juice may be appropriate.