Written by Claudia Botzet, former SDSU Extension Nutrition Field Specialist.
Infants have higher energy needs per-pound of body weight than any other age group. The factors that influence the energy needs of infants include weight, growth rate, physical activity (such as rolling, crawling and jumping in a jumper), digestion of food, sleep cycle, temperature and climate, and health status. When infants are first born, it is recommended by the American Academy of Pediatrics and the Academy of Nutrition and Dietetics to exclusively breastfeed (providing only breastmilk) until about 6 months of age. If breastmilk is not available, an iron-fortified infant formula should be substituted into the diet. There are many factors that influence the decision to use formula instead of breast milk, such as medical reasons, complications during pregnancy and labor, insufficient production of breastmilk, family support, and occupation.
Nutrition of Breastmilk
Breastmilk (abbreviated as BM) is composed of nutrients and bioactive compounds that adapt over the lactation period to provide the infant with complete nutrition for development. The nutrients in BM are more easily absorbed and utilized by the infant compared to formula. The composition of milk varies by the mother’s nutritional status and length of her breastfeeding journey. BM for a newborn differs from that of a 9-month-old, as it adapts and changes its nutrient composition to the needs of the growing infant. In general, mature BM is composed of about 87% to 88% water, 7% carbohydrates, 3.8% fat, and 1% protein. BM also contains beneficial bacteria, which support and protect the infant’s developing immune system, lowering the risk for contracting an infection or disease. The American Academy of Pediatrics recommends providing a vitamin D supplement to breastfed infants. Often the mother will take a vitamin D supplement, as the nutrients pass through the breastmilk. In addition, mothers may be recommended to stop taking a vitamin D supplement and switch to an iron supplement for the changing nutrients needs of the infant. Please see your infant's health care provider before consuming supplements while breastfeeding.
If breastmilk is not accessible, infant formula should be used. Infant formula provides good nutrition for the infant. When it comes to infant feeding strategies, always remember, “fed is best.”
"Fed is best."
~ Christie del Castillo-Hegyi, B. Jody Segrave-Daly, and Lynnette Hafken
Nutrients for Infant Development
Protein
The average recommended protein intake from birth to 6 months is 2.2 grams of protein per kilogram of body weight. The recommendation decreases to 1.6 grams of protein per kilogram of body weight for 6 months to 1 year old. The amount of protein infants need is determined by weight, growth rate, physical activity, digestion of food, sleep cycle, temperature and climate, and health status. However, protein needs reflect body composition more than energy needs, because active muscles require more protein for maintenance. Infants who are breastfed or consume the recommended amounts of infant formula will have an adequate protein intake.
Fat
There are no specific recommendations for fat intake for infants. Like protein, infants will get enough fat if they are breastfed or consume the recommended infant formula. Fat provides energy to the infant's liver, brain, and muscles 9including the heart).
Vitamins and Minerals
Other nutrients to be aware of when feeding infants include the following:
- Vitamin D: Needed for bone maturation and mineralization with calcium. Deficiency can cause Rickets (a condition that causes bone pain, poor growth, and soft and weak bones, which can lead to deformities in children).
- Sodium: A major component of extracellular fluid (the fluid that surrounds cells) and regulated fluid balance in the body.
- Zinc: Essential for metabolism, cellular growth, and immune function.
- Fluoride: Aids in forming strong teeth.
- Iron: Makes hemoglobin (a red blood cell that carries oxygen to all parts of the body). Supports neurological development.
Foods to Avoid and Limit When Feeding Infants
- Honey
Feeding infants honey before 12 months of age can cause a serious food poisoning called botulism. The infants' gastrointestinal (abbreviated as GI) tract and immune system are not mature enough to fight off the dangerous bacteria Clostridium botulinum. - Unpasteurized Drinks and Foods
Unpasteurized drinks and foods, such as juices, milks, cheeses, and yogurt, may put your child at risk for severe diarrhea and illness. Like honey, the infant’s GI tract and immune system is not mature enough to fight off certain bacteria and contaminations in these products.
- Foods and Drinks With Added Sugar
In addition to added sugars, artificial sweeteners are also not recommended for infants under 2 years of age. To learn how to read labels and look for added sugars, check out Lets’ Break Down the Nutrition Facts Label and Healthy Beverage Guidelines from Infants to Five Years. - Caffeine
There is no established safe limit of caffeine for children under two.
What About Milk and Water?
When infants are 6 to 12 months old, breast milk or formula should continue to be a priority over water. When infants start eating solids, you can offer a small bottle of water during mealtime. Infants should not consume more than 4 to 8 ounces of water a day before 12 months.
Cow's milk should not be offered to an infant before 12 months of age. It has too many proteins and minerals for a baby’s kidneys to handle. The Dietary Guidelines for Americans recommend children ages 12 months to 23 months (about 2 years) get 1 2/3 to 2 cups of dairy a day. This amount is not just cow's milk, but includes cheese, yogurt, and other dairy products offered to the infant. After 12 months of age, you can offer vitamin-D-fortified whole milk at mealtimes to help get the recommended amount of dairy.
See Introducing Solid Foods to Infants for information on this next life stage.
In Summary
There are a variety of ways infants can be fed and still meet their nutritional needs. May it be breastfed or infant formula, infants can still grow healthy and strong. Make sure to always speak with your dietitian or health care provider before making changes to your infant's diet.
References
- Su Yeong Kim & Dae Yong Yi. Components of Human Breast Milk: From Macronutrient to Microbiome and microRNA.
- Katriona Lyons & Colleagues. Breast Milk, a Source of Beneficial Microbes and Associated Benefits for Infant Health.
- NHS. Rickets and Osteomalacia Overview.
- Centers for Disease Control and Prevention. Foods and Drinks to Avoid or Limit.
- The Fed is Best Foundation.
- Centers for Disease Control and Prevention. Cow’s Milk and Milk Alternatives.
