The basic requirement of nutrition for infants and young children (0-36 months) is to satisfy growth and avoid nutrient deficiencies. Good nutritional status of children can help prevent acute and chronic diseases and is beneficial to their physical growth and neuropsychological development. Due to different levels of genetics and metabolism, the nutritional needs of children vary greatly from one individual to another. Appropriate nutrition and feeding not only improves growth and development in early life, but also is important for health in later life (e.g., prevention of obesity, cardiovascular disease, etc.). Countries around the world have developed feeding guidelines to address the special nutritional needs of infancy and early childhood, but for a long time, feeding guidelines for infants and young children (e.g., age of infant food introduction, first food introduced, multivitamin supplementation, number of meals, and amount of milk after introduction of other foods, etc.) have varied in different parts of China. Therefore, this feeding recommendation was developed to provide a reference for standardizing the contents and behaviors of pediatrics and child health care work and guiding infant and young child feeding in various places. Ning Peng, Department of Pediatrics, Songyuan Hospital of Traditional Chinese Medicine (TCM) I. Selection of food for infants and young children (a) Liquid food (milk) 1. Breastmilk: Breastmilk is the most ideal natural food for infants, and it has an irreplaceable role in the healthy growth and development of infants. Healthy and nutritionally balanced mother’s milk can provide all the nutritional requirements needed by a full-term baby for normal growth up to 6 months. 2. Formula: Unprocessed animal milk is not suitable for the level of digestive tract, immune function, and kidney development of human infants. Formula milk should be preferred when breastfeeding is not possible or when infants are gradually weaned from breast milk. Use is selected according to age. Preterm infants should be breastfed as much as possible. For very low birth weight infants, it is advisable to use preterm infant formula designed according to the physiological characteristics of preterm infants, in order to supplement the nutrient deficiencies of preterm infants’ mother’s breast milk (for details, please refer to the “Recommendations on Feeding Preterm/Low Birth Weight Infants”). 3. Liquid whole milk, yogurt: can be consumed after infancy. 4. Therapeutic formulas: Special therapeutic formulas can be used for certain diseases in infants. (1) Deeply hydrolyzed protein formula powder or free amino acid formula powder: Infants diagnosed with cow’s milk allergy should be breastfed for as long as possible, up to 12-18 months of age; if breastfeeding is not possible, infants should be preferred to deeply hydrolyzed protein formula powder or free amino acid formula powder, and follow up with specialists every 3-6 months to adjust the treatment time. Partially hydrolyzed protein formula, soy formula and goat’s 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 period of time; for infants with secondary lactose intolerance caused by acute diarrhea, it can be used until 2-4 weeks after healing. (3) Other special powdered formula: according to the nature of the disease, different special powdered formula can be used, such as tyrosinemia, low tyrosine powdered formula, typical phenylketonuria, low phenylalanine milk powder should be used. （Semi-solid and solid foods Semi-solid and solid foods are foods other than milk that are suitable for infants’ nutritional needs and development of eating skills. Semi-solid foods are foods for the first stage of infancy and are often referred to as transition foods, breastfeeding foods, once called complementary foods or weaning foods. Stage 1 foods are specially prepared baby products or homemade, nutrient-rich, pureed (mushy) foods, mostly plant foods, including iron-fortified rice cereals, pureed fruits, and pureed vegetables from roots, tubers, or squash. Solid foods are second stage foods for infants, with food varieties close to adult foods to provide the nutrient needs of infants; the hardness or size of foods should be increased moderately to adapt to the development of chewing and swallowing functions of infants, such as minced, crumbled, finger or strip soft foods, including fruits, vegetables, fish and meat, and eggs. (iii) Common family (adult) foods Infants begin to learn to eat with adults in the late stage of life. Around 2 years old, infants can eat common family-prepared foods with adults, but attention should be paid to soft texture and lightness. Feeding methods 1. Breastfeeding: suitable for infants with perfect sucking and swallowing ability. Considering the physiological maturity of the digestive system and growth and development, infants should be exclusively breastfed for at least 4 months after birth. It is recommended to breastfeed the infant until 12 months of age while introducing other foods to meet the infant’s growth and developmental needs. 2. Partial breastfeeding: Breastfeeding and formula feeding at the same time is partial breastfeeding. In clinical practice, depending on the age of the infant, the purpose of supplemental formula milk is different. For example, if 4-6 months old infants have insufficient breast milk and need to supplement formula milk, each breastfeeding first empty breasts (both sides) and then supplement the insufficient part of the breast milk with formula milk, the amount of milk supplemented by the infant’s appetite and the amount of breast milk, i.e., “how much to make up for the lack of how much”; this method helps to stimulate the secretion of breast milk. 6 months of age after breast milk can not maintain the normal growth and development rate of infants, the need for supplemental breast milk. After 6 months of age, when breastmilk cannot maintain the normal growth and development rate of infants, supplemental formula is needed to maintain the normal growth level of infants. Formula milk feeding: when breastfeeding is not possible due to various reasons, formula milk is used exclusively to feed infants, which is called formula milk feeding. Feeding implementation 1. Early breastfeeding: 2 weeks after birth is the key period to establish breastfeeding, the baby’s first sucking time after birth is the key to the success of the establishment of breastfeeding, it is advisable to start the first sucking as early as possible (<1h). 2. Promote milk secretion: 0-2 months old infants suckle frequently on the nipple, breastfeed on demand, empty the breast every time they breastfeed, and the mother's emotional relaxation can promote the mother's milk secretion. 3. Estimation of milk production: Breast milk or formula milk is the main source of nutrition for infants <6 months old. Because the amount of breast milk secretion is not easy to obtain, when the infant's weight gain is satisfactory, sleep condition is good and urine output is normal (>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 (80-95kcal/kg/day, 1kcal=4.184kJ), and the specifications of dairy products. Although other foods have been introduced for infants >6 months of age, breast milk or formula remains an important source of nutrition for infants (usually total milk intake is around 800ml/d). 4. Food preparation and preservation: Ensuring that food, utensils, and water are clean and hygienic during the preparation and preservation of food for infants and young children is key to minimizing infant infections. Therefore, before food preparation, food utensils should be sterilized, hands should be washed, and food should be eaten as soon as it is made; leftover food should be kept in the refrigerator, and it is advisable to heat it up to avoid contamination when it is eaten again. Prepare milk according to the instructions strictly, to avoid too much water to dilute the milk or too much milk powder to make the milk too thick, which may cause malnutrition or kidney damage to the infants. 5. Fluid quantity: Infants within 6 months of age can obtain sufficient fluid quantity from breast milk and other foods. To minimize gastrointestinal burden, avoid giving infants too much extra water or juice. Infants urinate 6-7 times a day, which suggests that fluid intake is basically sufficient. In late infancy and when the food of young children is close to that of adults, appropriate amounts of water or juice (<200 ml/d) can be given, especially in summer. There are individual differences in the amount of water consumed, so there is no need to force. Drinking water or fruit juice 1h before meal is not recommended to avoid affecting children's appetite. 6. Disease status of the mother and breastfeeding contraindication: the mother is infected with human immunodeficiency virus (HIV), suffering from serious diseases (such as chronic nephritis, diabetes mellitus, malignant tumors, mental illness, epilepsy, or cardiac insufficiency, etc.), the presence of radioactive substances in the work environment, the acceptance of antimetabolites, chemotherapeutic drugs, or during the treatment of some special medications, drug addiction or drug abuse, herpes simplex virus infection, active tuberculosis should be discontinued. Breastfeeding should be discontinued when there is active tuberculosis. Infants of mothers with hepatitis B virus surface antigen (HbsAg), hepatitis B virus e antigen (HbeAg), and hepatitis B virus core antibody (anti-HBc) positivity ("triple positive") should be immunized, and mothers should not breastfeed. Breastfeeding mothers with acute infectious diseases can express milk, after pasteurization (62-65 ℃ for 30min) and then feed. Mothers who are HBsAg-positive, HBeAg-positive, or chronic carriers of hepatitis B virus (HBV), or seropositive for cytomegalovirus (CMV) can continue to breastfeed; mothers with thyroid disease can breastfeed safely, but the mother's thyroid function needs to be measured regularly; mothers infected with tuberculosis can breastfeed if they have no clinical symptoms after treatment. When the mother is CMV seropositive, if the milk is frozen or heat sterilized, the CMV load in the milk can be reduced. With the gradual maturation of the infant's digestive system and the needs of growth and development, pure milk (breastmilk or formula milk) feeding can no longer satisfy all the energy and nutrient needs of infants, and the infant's food needs to be converted to adult solid food. If other foods are introduced appropriately, not only can they meet the nutritional needs, but they can also cultivate infants' love for various kinds of food and their self-feeding ability. 1. The time to introduce other foods: infants weigh more than 6.5-7.0 kg at 4-6 months of age, suggesting that the development of the infant digestive system has been more mature, such as the development of enzymes, the development of the ability to chew and swallow, the eruption of teeth, etc.; there has been the development of the vertical neck, hand-to-mouth movements and other actions, so that the introduction of other foods can be initiated. The "critical window" for food introduction is 4-6 months of age. It is recommended that infants should not be introduced to other foods earlier than 4 months of age, nor later than 8 months of age, but more often between 4 and 6 months of age. Principles of introduction: (1) Order of introduction: The principle of introducing the first other foods should be foods that can supplement iron nutrition, are easy to digest and are not easily allergic. Iron-fortified cereals are often the first food introduced. Other foods of the first stage, such as pureed fruits, pureed vegetables of roots and tubers, or melons and beans, etc., should follow. Stage I foods for infants mainly help to train infants' chewing and swallowing skills and stimulate the development of the sense of taste, and can be supplemented with a small amount of vitamins and mineral nutrients, and the intake should not affect the total energy intake of infants or change the rate of growth; 7-8 months of age after the gradual change to the infant's second stage of food, until the transition to adult food; in order to ensure that the main nutrients and high energy density, 7-12 months of age, infants should still maintain the amount of breast milk ( To ensure major nutrients and high energy density, infants 7-12 months of age should still maintain the amount of milk (about 800 ml/d), and the intake of other foods varies greatly among individuals, so as not to affect the intake of milk. For young children, the amount of milk intake should be limited to the amount that does not interfere with the intake of staple foods (at least 500 ml/d). (2) Gradual adaptation: It takes time for infants to adapt to a new food, so it is advisable to try each food 10-15 times (5-7 d) until the infant gradually accepts it before trying another new food. The introduction of a single food can stimulate the development of the infant's sense of taste, and can also help to monitor the infant's adverse food reactions, especially food allergies. The amount of new food should be from small to large, i.e. from 1 spoon at the beginning, gradually increase the amount, i.e. "from small to large, from one to many", and replace 1-2 times of breastmilk after 6-7 months of age. (3) Change of food texture: the texture of food for infants should be changed with age to promote the development of oral function of infants. For example, when infants are 4-6 months old, pureed food should be used to train the coordinated oral movements and swallowing ability; 7-9 months old, crushed food should be used to help infants learn to chew and increase the energy density of food; after 12 months of age, the same type of food can be attempted as that of other family members, and food that can easily cause choking should be avoided before the age of 3 years old, such as peanuts, melons, and other nutty foods. (4) Cultivation of eating skills: The level of development of eating skills of infants is related to the cultivation of eating habits and growth and development of young children. For example, infants learn to take food from a spoon when they are 4-6 months old; they train to drink from a cup when they are 7-9 months old; they train to grasp food with their hands when they are 10-12 months old. Finger foods can help infants eat, increase their interest in eating, and help them to coordinate their eye and hand movements and cultivate their independent eating ability. In addition to breastfeeding on demand in the early stage of infancy, after 3-4 months of age, it is appropriate to gradually nurse or eat regularly, and after 4-6 months of age, no more food should be eaten at night, so as to introduce other foods and cultivate good eating and sleeping habits. The number of meals at regular intervals is related to the age of infants and young children, gastric capacity, energy density of food, and the amount of food eaten at each meal, and generally meals are eaten 5-6 times/d. The duration of each meal for children is 20-25 min (<30 min), and food should not be eaten between meals (Table 1). 1. Infants: (1) 0-3 months of age: breastfeeding on demand is preferred; after 3 months of age, feeding is gradually timed; (2) 4-6 months of age: regular breastfeeding, about every 3-4 hours, 5-6 times/d; after 4 months of age, nighttime breastfeeding can no longer be practiced; (3) 7-12 months of age: regular meals, 5-6 times/d, consisting of 4-5 times of milk and 2 times of cereals. (2) Young children: two main meals, 2-3 milk and nutritious snacks, and controlled snacks between meals. 1-2 year olds should eat in separate meals and be encouraged to eat on their own; after 2 years of age, children should eat independently. Children should decide the amount of food to be eaten by themselves and not be forced to eat; they should not play, watch TV or be chased by their parents when eating; and fixed meal times and places help children to establish good eating habits. Children can eat appropriate formula or liquid whole milk or yogurt. Different foods contain different nutrients and other substances beneficial to health. No single food can supply all the nutrients needed by human beings, therefore, food diversity is the first and foremost condition to ensure balanced nutrition. Energy intake should normally be met first, followed by protein. The macronutrient energy ratios are 8-15% for protein, 55-60% for carbohydrates, 45-50% for fat (0-6 months of age), 35-40% (6-12 months of age) and 30-35% (12-24 months of age). Insufficient milk or starchy food can cause insufficient protein intake, so it is recommended to increase the intake of animal food. Animal food contains high quality protein and rich in micronutrients such as minerals and vitamins, and the bioavailability from dairy, meat and eggs is high; at the same time, animal food contains more fat and has high energy density; it is also the only source of vitamin B12. After 6 months of age, the nutrients obtained from other foods gradually increase, such as energy from 50% of the total energy gradually increased to 70%; the composition of other nutrients are as follows: protein 20%-45%, vitamin A5%-30%, vitamin B150%-80%, vitamin B250%-65%, vitamin B675%-88%, calcium 60%, zinc 85%, and iron about 100%. The following are some examples of foods that can be used in the diet of older infants and toddlers. To larger infants and toddlers to convert food should be used high energy density, high protein easy to digest food; water-based food energy density is low, and can increase the burden on the stomach and intestines, so should not be eaten often, such as gruel, soup, broth and so on. Breast milk is the source of iron nutrition for infants aged 0-6 months, and iron rich foods (including iron-fortified formula milk, rice flour, etc.) or supplemental elemental iron 1-2mg/(kg.d) should be introduced in time after 4-6 months of age. Young children should pay attention to the balance and nutrition of food, and their daily diet should include animal food (e.g. meat, poultry, fish, eggs, etc.); sufficient fat intake (5-10g) and a variety of vegetables and fruits. Dairy and animal foods are rich in zinc. Milk and milk products can meet the calcium nutritional requirements for infant growth and development. Dairy, animal foods, orange fruits and orange vegetables are rich in vitamin A or carotene; green leafy vegetables, soybeans and dairy products provide richer B vitamins. Appropriate outdoor activities can promote the synthesis of vitamin D (VitD) in the skin, and VitD supplementation should include the VitD content of foods, sun exposure, VitD preparations, and VitD-fortified foods (see "Recommendations for the Prevention and Treatment of Vitamin D-Deficiency Rickets in Children" for more information). Previous studies have shown that micronutrients can also meet the needs of children when their food is sufficient in protein and energy, suggesting that a balanced diet contains all vitamins and micronutrients and does not need to be supplemented. Nutritional assessment includes physical growth evaluation, dietary analysis, clinical manifestations and laboratory tests. Regular evaluation of growth and development, growth level, growth rate and proportionality are better monitoring indicators. Different micronutrients have different distribution in the body, different metabolism and regulation pathways, and the detection methods are complicated. Simple detection of serum level cannot reflect the status of micronutrients in the body. The feeding of infants and young children should be individualized, and nutritional intake should be judged according to the physiological maturity of the child, while observing the tolerance of infants to different types and textures of food and adjusting the feeding plan. Chinese Journal of Pediatrics, July 2009, Volume 47, Issue 7