19.3: Diet for a Small Life

Babies grow at a tremendous rate. If a 120-pound, 5’4” woman grew at the same rate as babies do in their first year, she’d be about 350 pounds and 8’ in a year. Needless to say, newborns need a lot of calories for their body size. An equivalent amount for the baby’s father would be about 8,000 calories a day.

It’s no wonder that newborns spend so much of their waking hours sucking at the breast or bottle. Appropriately, breast milk and infant formula are concentrated sources of calories—about 50% of the calories comes from fat.

Nutrient needs are extraordinary at this stage of life. An infant needs about half the vitamins A and C, and as much vitamin D as the father. The infant-adult comparison of nutrient needs is especially striking when compared per unit of body weight (see Fig. 19-5). Clearly, nutrient deficiencies during this time when infant growth rate is so high can quickly lead to trouble.

The most noticeable result of undernourishment is a stunting of growth. When the undernourishment persists through childhood, the result is a smaller adult. Looking back over the centuries—or even early in this century—we see that our ancestors were much smaller, a reflection of an inadequate diet and other environmental conditions. We see stunted growth even today in poor children and adults living in developing countries. When people immigrate here from those countries, a marked increase in height in the next generation is common, a reflection of our ample food supply, better sanitation, etc.

Figure 19-5: Some nutrient needs are much higher for infants, relative to body weight, than for adults.

Generally speaking, mother’s milk is both an adequate and ideal source of all the infant’s required nutrients during the first 4 to 6 months of life. This assumes, however, that the infant is born well-nourished, and the mother was well-nourished during pregnancy and continues to be so during lactation.

The well-nourished newborn has stores of such nutrients as iron, copper, and vitamin A. Infants meet their nutrient needs from a combination of these body stores and breast milk. For example, infants require a fair amount of iron, and to meet this need they rely both on breast milk and on their liver stores. Vitamin D, however, is often low in breast milk, so vitamin D supplementation is recommended for infants who only get breast milk.

Breast or Bottle?

It’s hard to find a nutritionist who doesn’t emphasize breastfeeding. The psychological and biological advantages of breastfeeding are well documented. For one, breast milk provides immunities against disease, whereas infant formulas do not. Also, breast milk is less likely to cause digestive upsets and allergies. (On the other hand, if a woman can’t breastfeed her child, be assured that science is now able to provide excellent nutrition for the formula-fed baby.)

Advantages of Breast feeding:

• optimal nutrients for infants
• stimulates the immune system
• promotes bonding
• always ready
• at the correct temperature
• sanitary
• inexpensive

In developing countries, infant formula isn’t generally a viable option. Breastfeeding is of tremendous importance where malnutrition and poor sanitation are common. Breast milk is often the only regular source of high-quality protein and other essential nutrients.

Aggressive marketing of infant formula in developing countries has often led to misuse, with disastrous results. It’s easy to understand why such promotional campaigns have strong appeal. Mothers everywhere want what’s most “modern” for their children, and would like them to be as healthy and happy as those pictured in the ads for infant formula.

When free samples of infant formula are given to poor mothers in developing countries, they usually can’t afford to buy more. If they stop breastfeeding while using the free samples, they may stop lactating (producing milk). When breastfeeding is cut short this way, their infants are at high risk of developing protein-calorie malnutrition.

To make matters worse, the mothers often greatly over-dilute the infant formula (thereby diluting the nutrients) to make it go further. Also, when unsanitary water is added to the formula, it can cause diarrhea (a leading cause of infant mortality in these countries).

Sometimes, when the formula is gone (or there was none to begin with), liquids of poor nutritional quality with the appearance of milk (e.g., rice water) are used in the baby bottle. World health organizations are doing what they can to encourage breastfeeding in developing countries.

There are circumstances, however, where infant formula is the better choice, e.g., when the mother is infected with HIV, since the virus can be transmitted through breast milk. But where there’s no food for the infant, risking HIV infection from breast milk is the only choice.

The advantages of breastfeeding over infant formula aren’t so obvious in countries with good sanitation, and where top-quality infant formula is readily available and affordable. There are, of course, instances where breastfeeding is an especially better choice—for an infant who tends to develop allergies, for example.

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Mothers whose diet is inadequate creates a dilemma in administering food-assistance programs in developing countries: Should the emphasis be on feeding the nursing mother, so she can provide more milk for her child, or should the limited resources be used to feed the infant directly?

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Many women have jobs outside the home that make it difficult to breastfeed. A compromise is to breastfeed as long as possible, even if it’s only for a few weeks. Thereafter, she can use infant formula exclusively, or combine formula with breastfeeding (directly or by using a breast pump to obtain milk for use when the mother is away.)

The nursing mother must drink plenty of liquids and eat a good diet to adequately nourish her child. Although the mother’s diet results in some variation in the composition of the milk, the main variation is in the amount produced. When a mother’s diet is inadequate, the main consequence is that she makes less milk.

In addition to eating a good diet, a nursing mother should continue to be cautious about taking in extraneous substances that can pass into her breast milk. For example, small amounts of alcohol can enter the breast milk, and there’s some evidence that this small amount can have an effect on the infant’s developing nervous system. A nursing mother should also limit her caffeine intake to an amount in about 2-3 cups of coffee.

Some flavors in food can pass into the breast milk, perhaps an advance billing for what flavors can be expected when the infant joins in the family meals. On the other hand, some flavors can be a problem if the infant nurses less as a result. If an offending flavor is suspected in breast milk, the mother can try eliminating the food to see if it helps. But she might want to try this more than once to make sure—especially if it means giving up a favorite food.

Balancing Baby Foods and Baby Needs

Infants should be fed breast milk or infant formula through the first year of life. Whole cow’s milk shouldn’t be introduced until the early part of the second year.

The American Academy of Pediatrics’s Committee on Nutrition recommends that solid foods not be introduced until about 6 months of age.⁵ Although studies indicate that infants can tolerate cereals, vegetables, etc., at a few weeks of age, there’s no need for them so early.

In realistic terms, the amount of solids fed at first is very little; it amounts to little more than training infants to accept and swallow solids. But because this learning takes time, many physicians start babies on such foods as early as four months of age.

The addition of solid food becomes necessary at about six months because nutrient needs are beginning to exceed what milk and body stores alone can provide. The solid foods should be mostly cereals, vegetables, and fruits.

There is no pressing nutritional reason to urge a lot of meat on an often reluctant baby. True, meat is rich in protein. But so is milk (given only as breast milk or infant formula for the first year). Two 8-oz. bottles of whole milk a day furnish the entire protein need for babies up to 20 pounds. Three 8-oz. bottles provides enough protein for a 30-pound baby. True, meat also supplies iron and zinc, but the amount of meat a baby eats is so small that meat is unlikely to be a major contributor.

Cereals, vegetables, and fruits supply a lot of nutrients, especially those in short supply in milk. It would, however, take huge quantities of these foods to meet infant RDAs for iron, so baby cereals are heavily fortified. The iron deficiency that’s common in American children often appears at about the time parents discontinue infant cereals.

Should added sugar be eliminated from baby food? A Dietary Guideline is that children below age 2 should avoid foods and beverages with added sugar. Infants are born with an inherent disposition towards sweetness, and a preference for sweets is easy to cultivate—as can be seen by the supermarket array of sugary ready-to-eat breakfast cereals made to appeal to young children.

As for sweetening foods or using sweets to entice children to eat, a most important psychological factor enters here. Patterns of coaxing, rewarding, and emotional upset and relief that center on food add life-long emotional connotations to eating, which can cause trouble later on. Parents should keep in mind that infants—and toddlers—have an inherent ability to regulate caloric intake.⁶