Adequate amounts of breast milk meet the nutrient needs of most infants for the first 6 months of life. However, there is not universal agreement on the optimal duration of exclusive breast feeding and the precise timing or the order of introduction of complementary foods. Internationally, recommendations from most health agencies state that the ideal feeding of infants is exclusive breast feeding for the first 6 months of life with appropriate introduction of foods from 6 months onward including partial breast feeding through 2 years of age or beyond. When assessing intakes of infants fed marketed formulas, it must be kept in mind that intakes of most nutrients will exceed the new DRI values for AI given that these are based on the composition of human milk. In many cases, the greater concentration of nutrients in infant formula is appropriate due
to lower digestibility or bioavailability of nutrients from cow milk- or soy-based protein in formulas compared to human milk.
The introduction of complementary foods, especially solids and eventually finger foods, is important for infants to develop normal oral and motor skills related to eating and to attain adequate intakes of nutrients that may be low in breast milk (e.g., protein or iron). In a report by the March of Dimes, three common inappropriate complementary feeding practices were delineated: (i) introducing foods too early or too late, (ii) introducing foods of low nutrient density, and (iii) feeding contaminated foods. It is noted in the report that early introduction of foods may reduce the intake of breast milk due to limited gastric capacity of very young infants or precipitate an allergic reaction in infants with a family history of food allergy or atopy. By delaying introduction of foods beyond 6 months, there is increasing risk of deficiencies of nutrients known to be relatively low in breast milk and yet essential to support rapid growth of infants, such as iron and zinc. The choice of first foods is important so that they contain adequate energy and micronutrients to meet the needs of infants. For example, reduced-fat cow milk (skim 2%, and 1% fat) should not be fed to infants before 2 years of age. Excessive amounts of fruit juices or 'empty calorie' fast foods should not be fed to infants. To achieve adequate intakes of micro-nutrients such as iron, choice of nutrient-fortified foods (e.g., iron-fortified infant cereal or other weaning food) may be required in areas where natural sources of micronutrients are not available. Finally, both solid and liquid foods offered to infants need to be free of contamination since the transmission of infections through food is thought to be a primary cause of diarrhea in young infants, particularly in developing countries.
The March of Dimes report (2002) outlined three key recommendations for ensuring optimal nutrition of term-born infants through breast-feeding and complementary feeding practices. The rationale for each recommendation and suggestions for implementation strategies on a global basis are provided in the report. The three key recommendations are as follows:
Recommendation 1: Promote and support exclusive breast feeding for 6 months, with the introduction of complementary foods and continued breast feeding thereafter—up to 2 years of age or longer as mutually desired by the mother and infant.
Recommendation 2: Promote and support programs to ensure that pregnant women and breast feeding mothers receive adequate nutrient intakes.
Recommendation 3: Promote the appropriate introduction of safe, nutritionally adequate, and develop-mentally appropriate complementary foods.
The recommendations from the March of Dimes report are universally applicable and will ensure that infants attain nutrient intakes that match the nutrient requirements as set out in dietary standards such as the DRI reports.
See also: Amino Acids: Chemistry and Classification; Metabolism. Ascorbic Acid: Physiology, Dietary Sources and Requirements. Breast Feeding. Calcium. Carbohydrates: Requirements and Dietary Importance. Complementary Feeding. Electrolytes: Water-Electrolyte Balance. Fats and Oils. Fatty Acids: Omega-3 Polyunsaturated. Folic Acid. Infants: Nutritional Requirements. Iron. Lactation: Dietary Requirements. Magnesium. Phosphorus. Protein: Requirements and Role in Diet. Vitamin A: Biochemistry and Physiological Role. Vitamin B6. Vitamin D: Rickets and Osteomalacia. Vitamin E: Metabolism and Requirements. Vitamin K. Zinc: Physiology.
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