Feeding Infants and Children from Birth to 24 Months Summarizing Existing Guidance (2020) / Chapter Skim
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Appendix B: Abstracted Recommendati
Appendix B: Abstracted Recommendati
Pages 207-324
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From page 207... ...
• TABLE B-1 Recommendations Related to Exclusive Breastfeeding • TABLE B-2 Recommendations Related to Continuation of Breastfeeding • TABLE B-3 Recommendations Related to Supplementary Formula Feeding of Breastfed Infants • TABLE B-4 Recommendations Related to Duration of Infant Formula Use • TABLE B-5 Recommendations Related to Type of Infant Formula • TABLE B-6 Recommendations Related to Toddler Milks and Follow-On Formulas • TABLE B-7 Recommendations Related to Milk and Milk-Based Products • TABLE B-8 Recommendations Related to Fluids: Water, Juice, Sugar-Sweetened Beverages, and Other Nonmilk Beverages 1 The tables in this appendix contain recommendations directly from the provided citation. Recommendations have been edited for style, which did not affect their content.
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From page 208... ...
208 FEEDING INFANTS AND CHILDREN FROM BIRTH TO 24 MONTHS • TABLE B-9 Recommendations Related to Substances to Avoid or Limit • TABLE B-10 Recommendations Related to Variety and Healthy, Nutritious Foods • TABLE B-11 Recommendations Related to Fruits and Vegetables • TABLE B-12 Recommendations Related to Vegetarian and Vegan Diets • TABLE B-13 Recommendations Related to Foods Associated with Food Allergy and Celiac Disease • TABLE B-14 Recommendations Related to Iron and Iron Fortified Formula • TABLE B-15 Recommendations Related to Vitamin D • TABLE B-16 Recommendations Related to Iodine • TABLE B-17 Recommendations Related to Supplementation • TABLE B-18 Recommendations Related to Dietary Fat • TABLE B-19 Recommendations Related to Bottle Use and Propping • TABLE B-20 Recommendations Related to Cup Use • TABLE B-21 Recommendations Related to Safety of Foods and Feeding Practices • TABLE B-22 Recommendations Related to Introduction of Complementary Foods (CFs) • TABLE B-23 Recommendations Related to Food Consistency and Texture • TABLE B-24 Recommendations Related to Meal Frequency • TABLE B-25 Recommendations Related to Hunger and Satiety Cues • TABLE B-26 Recommendations Related to Responsive Feeding Practices
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APPENDIX B 209 The tables begin on the next page.
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From page 210... ...
, and exclusive literature search or predominant breastfeeding for approximately 6 months is considered a desirable goal.b RWJF-HER Pérez-Escamilla et al., For the first 6 months (or until the introduction of solid food) , most Narrative review 2017 babies only need breast milk (or formula)
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From page 211... ...
Breastfeeding preferred; Narrative review; Breastfeeding, 2012 alternatively, expressed mother's milk or donor milk.e Could not be mappedf New Zealand Ministry Ministry of Health, Give only breast milk until the infant is ready for and needs extra Narrative review of Health 2012g food; this will be at around 6 months of age. NHMRC (Australian NHMRC, 2012h Encourage exclusive breastfeeding for around 6 months.
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From page 212... ...
k Ministry of Health, 2008. l Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organiza tion, Duration of Exclusive Breastfeeding and Age of Introduction of Complementary Foods, p.
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From page 213... ...
ESPGHAN Fewtrell et al., 2017 Continued breastfeeding is recommended along with the introduction of Systematic complementary foods.c literature search RWJF-HER Pérez-Escamilla et al., It is fine to continue breastfeeding beyond 1 year if desired by parent Narrative review 2017 and child. continued 213
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From page 214... ...
cow milk. f,g 2007 Eating Well Canada; CPS; with Canada's Food Dietitians of Canada; Guideh HC Support breastfeeding for up to 2 years or beyond, as long as mother Narrative review and child want to continue.f AAP AAP Section on Exclusive breastfeeding for about 6 months, to continue for at least the Narrative review; Breastfeeding, 2012 first year and beyond for as long as mutually desired by mother and Could not be child.d mappedi NHMRC (Australian NHMRC, 2012j Continue breastfeeding while introducing appropriate solid foods until Other national government)
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From page 215... ...
Narrative review PAHO/WHO PAHO/WHO, 2003 Continue frequent, on-demand breastfeeding until 2 years of age or Technical beyond.o consultations and documents NOTE: AAFP = American Academy of Family Physicians; AAP = American Academy of Pediatrics; AAPD = American Academy of Pediatric Dentistry; AHA = American Heart Association; CHPP = Child Health Promotion Programme; CPS = Canadian Paediatric Society; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; HC = Health Canada; NHMRC = National Health and Medical Research Council; NICE = National Institute for Health and Care Excellence; PAHO = Pan American Health Organization; RCPCH = Royal College of Paediatrics and Child Health; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SACN = Scientific Advisory Committee on Nutrition; WHO = World Health Organization. a Although not stated in this excerpt, this recommendation is intended for infants considered to be at high risk for allergic disease, having either a personal history of atopy or a first-degree relative with atopy.
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n Department of Health, 1994. o Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organiza tion, Maintenance of Breastfeeding, p.
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From page 217... ...
A breastfeeding mother who is considering supplementing breast milk with infant formula to settle an infant should be given advice on settling the infant in other ways. This should include advice on increasing the mother's supply of breast milk or introducing appropriate complementary foods if the infant is developmentally ready.
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From page 218... ...
Breastfeeding Health Canada et al., For an older infant or young child who is not breastfed or receiving Narrative review Committee for 2014 breast milk: Advise that, for most healthy young children, there is no Canada; CPS; indication for the use of commercial formulas beyond one year of age.a Dietitians of Canada; For an older infant or young child who is not breastfed or receiving Could not be HC breast milk: Recommend commercial infant formula until 9–12 months mapped of age.a New Zealand Ministry Ministry of Health, If the infant is not breastfed, then an infant formula should be used Narrative review of Health 2012b until the infant is 1 year of age. For vegan infants who are not breastfed or are partially breastfed, the use of a commercial soy-based infant formula during the first 2 years of life is recommended.
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From page 219... ...
Cow Narrative review Committee for 2015 milk, goat milk, soy beverage, rice beverage, or any other beverages Canada; CPS; should not be given to young infants.c Dietitians of Canada; Recommend cow milk–based, commercial infant formula for an infant Narrative review HC who is not exclusively fed breast milk. Soy-based infant formula is indicated only for those infants who have galactosemia or who cannot consume dairy-based products for cultural or religious reasons.c 219 continued
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From page 220... ...
New Zealand Ministry Ministry of Health, If the infant is not breastfed, then an infant formula should be used Narrative review of Health 2012f until the infant is 1 year of age. For vegan infants who are not breastfed or are partially breastfed, the use of a commercial soy-based infant formula during the first 2 years of life is recommended.
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From page 221... ...
. NOTE: AAFP = American Academy of Family Physicians; AAP = American Academy of Pediatrics; CPS = Canadian Paediatric Society; HC = Health Canada; NHMRC = National Health and Medical Research Council; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; WHO = World Health Organization.
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From page 222... ...
NOTE: CPS = Canadian Paediatric Society; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; NHMRC = National Health and Medical Research Council; PUFA = polyunsaturated fatty acid; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research.
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From page 223... ...
It should not be used as the main search drink before 12 months of age, although small volumes may be added to complementary foods.c RWJF-HER Pérez-Escamilla et al., Cow milk should not be offered before the child turns 1 year old Narrative review 223 2017 because it may cause intestinal bleeding. continued
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From page 224... ...
Cow milk should not be given as the main drink to infants under 12 Systematic reviewi months; however, small amounts may be used in the preparation of solid foods. Foods can be introduced in any order provided iron-rich nutritious Systematic review; foods are included and the texture is suitable for the infant's stage of narrative reviewj development.
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From page 225... ...
Narrative review New Zealand Dental New Zealand Dental Discuss healthy eating and remind parents to choose nutritious and Could not be mapped Association; New Association, 2008 tooth-friendly snacks.… Cow milk should not be given before a child Zealand Ministry of is 12 months old. Whole milk is recommended for children aged 1 to Health 2 years.
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From page 226... ...
As toddlers transition from getting guidelines most of their daily calories and nutrient needs from liquids (e.g., breast milk, formula, cow milk) to eating more solid foods, less milk is needed to meet daily calcium and caloric needs.
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From page 227... ...
. ESPGHAN Domellöf et al., 2014 Unmodified cow milk should not be fed as the main milk drink to Narrative review infants before the age of 12 months, and intake should be limited to < 500 mL daily in toddlers.d Breastfeeding Health Canada et al., Encourage continued breastfeeding, or offering 500 mL per day of Narrative review; Committee for 2014 homogenized (3.25% milk fat)
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From page 228... ...
reportk New Zealand Ministry Ministry of Health, If the infant is not breastfed, then use an infant formula as the milk Narrative review of Health 2012l source until the infant is 1 year of age. After 1 year, cow milk may be introduced.
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From page 229... ...
For 12- to 24-month-olds, individual needs will depend on the and toddler feeding amount of solid food consumed. As toddlers transition from getting guidelines most of their daily calories and nutrient needs from liquids (e.g., breast milk, formula, cow milk)
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From page 230... ...
should be replaced search by water or, in the latter case, with unsweetened milk drinks/ products with lactose up to the amount naturally present in milk and unsweetened milk products.o NOTE: AAP = American Academy of Pediatrics; CACFP = Child and Adult Care Food Program; CPS = Canadian Paediatric Society; DGA = Dietary Guidelines for Americans; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; HC = Health Canada; NHMRC = National Health and Medical Research Council; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SACN = Scientific Advisory Committee on Nutrition; SSB = sugar-sweetened beverage; WHO = World Health Organization; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children. a This table does not include milk-based infant formulas or human milk.
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From page 231... ...
j Portions of this recommendation could be mapped to a systematic review prepared for this guideline document; other portions appeared to be related to a narrative review of the evidence. Using the NHMRC system, the strength-of-evidence rating related to this recommendation was Grade D (risk associated with cow milk)
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From page 232... ...
SACN SACN, 2018 Breast milk, infant formula, and water should be the only drinks Narrative review offered after 6 months of age. AAP Heyman et al., 2017 Families should be educated that, to satisfy fluid requirements, human Narrative review milk and/or infant formula is sufficient for infants and low-fat/nonfat milk and water are sufficient for older children.
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From page 233... ...
New Zealand Dental New Zealand Dental Emphasize water/full-fat cow milk as drinks of choice. Could not be mapped Association; New Association, 2008 Zealand Ministry of Health continued 233
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From page 234... ...
. WHO WHO, 2005 Nonbreastfed infants and young children need at least 400–600 A background mL/day of extra fluids (in addition to the 200–700 mL/day of water document and that is estimated to come from milk and other foods)
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From page 235... ...
should be replaced search by water or, in the latter case, with unsweetened milk drinks/ products with lactose up to the amount naturally present in milk and unsweetened milk products.o RWJF-HER Pérez-Escamilla et al., If you decide to offer 100% fruit juice to your toddler, limit intake to Narrative review 2017 no more than 4 oz per day and offer it with a cup, not a bottle. AAP; AAPD AAPD, 2016 To decrease the risk of developing early childhood caries, AAPD Narrative review encourages professional and at-home preventive measures that include avoiding frequent consumption of liquids and/or solid foods containing sugar, in particular … sugar-sweetened beverages (e.g., juices, soft drinks, sports drinks, sweetened tea)
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From page 236... ...
Do not offer tea, herbal teas, coffee, soft drinks, cordials, or other Narrative review beverages. New Zealand Ministry Ministry of Health, Fruit juices or sweet drinks are not recommended for infants and Narrative review of Health 2012h toddlers.
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From page 237... ...
ESPGHAN Fewtrell et al., 2017 No sugar or salt should be added to complementary foods and fruit Systematic literature juices or SSBs should be avoided.n search Fidler Mis et al., 2017 Sugar-containing beverages and foods (SSBs, fruit juices, fruit-based Systematic literature smoothies, and sweetened milk drinks/products) should be replaced search by water or, in the latter case, with unsweetened milk drinks/ products with lactose up to the amount naturally present in milk and unsweetened milk products.o continued 237
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From page 238... ...
New Zealand Ministry Ministry of Health, Fruit juices or sweet drinks are not recommended for infants and Narrative review of Health 2012h toddlers. Infants need only milk (breast milk or infant formula)
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From page 239... ...
New Zealand Ministry Ministry of Health, Coffee, tea, herbal teas, caffeine-containing beverages, smart or energy Narrative review of Health 2012h drinks, carbonated beverages, and alcohol are not recommended for infants and toddlers. Do not give infants and toddlers alcohol, coffee, cordials, juice, Narrative review soft drinks, tea (including herbal teas)
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From page 240... ...
Limit the amount of juice offered so as to avoid documents displacing more nutrient-rich foods.t Caffeinated Beverages RWJF-HER Lott et al., 2019c 0–5 years: Do not consume caffeinated beverages. Narrative review New Zealand Ministry Ministry of Health, Coffee, tea, herbal teas, caffeine-containing beverages, smart or energy Narrative review of Health 2012h drinks, carbonated beverages, and alcohol are not recommended for infants and toddlers.
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From page 241... ...
Breastfeeding Health Canada et al., Discourage the use of homemade, evaporated milk formula. Cow Narrative review Committee for 2015 milk, goat milk, soy beverage, rice beverage, or any other beverages Canada; CPS; should not be given to young infants.v,w Dietitians of Canada; Health Canada et al., For an older infant or young child who is not breastfed or receiving Narrative review HC 2014 breast milk: Advise that soy, rice, or other plant-based beverages, whether or not they are fortified, are inappropriate alternatives to cow milk in the first 2 years.d New Zealand Ministry Ministry of Health, For vegetarian and vegan toddlers, provide plenty of liquids each day, Narrative review of Health 2012h as water, breast milk, cow milk, or plant-based milks only (and no more than 500 mL of milk per day)
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From page 242... ...
are inappropriate alternatives to breast milk, formula, or pasteurized whole cow milk in the first 2 years of life. NOTE: AAP = American Academy of Pediatrics; AAPD = American Academy of Pediatric Dentistry; AHA = American Heart Association; CPS = Canadian Paediatric Society; DGA = Dietary Guidelines for Americans; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; GP = general practitioner; HC = Health Canada; mg = milligrams; mL = milliliters; NHMRC = National Health and Medical Research Council; NICE = National Institute for Health and Care Excellence; PAHO = Pan American Health Organization; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SACN = Scientific Advisory Committee on Nutrition; SSB = sugar-sweetened beverage; UK = United Kingdom; WHO = World Health Organization.
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From page 243... ...
. t Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organiza tion, Nutrient Content of Complementary Foods, p.
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From page 244... ...
AAPD AAPD, 2017 AAPD supports the recommendation of national and international DGA, WHO, and AHA organizations to reduce the consumption of sugar to less than 10% of total energy intake and, to reduce children's risk of weight gain and dental caries, sugar intake should be less than 5% of total energy intake (less than 16 g of sugar for children aged 4–8) .e ESPGHAN Fewtrell et al., 2017 No sugar or salt should be added to complementary foods, and Systematic literature fruit juices or SSBs should be avoided.f search Fidler Mis et al., 2017 Intakes of free sugars should be reduced and minimized with Systematic literature a desirable upper limit of < 5% energy intake in children and search adolescents aged ≥ 2–18 years.
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From page 245... ...
. AAP; AAPD AAPD, 2016 To decrease the risk of developing early childhood caries, AAPD Narrative review encourages professional and at-home preventive measures that include avoiding frequent consumption of liquids and/or solid foods containing sugar, in particular: a.
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From page 246... ...
Do not dip pacifiers or bottle teats in sugar, jam, honey, or any Could not be mapped other sugary substance. New Zealand Ministry Ministry of Health, Do not dip pacifiers or bottle teats in sugar or honey.
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From page 247... ...
New Zealand Dental New Zealand Dental If a pacifier is used, advise parents not to dip the pacifier in sugar, 2008 New Zealand Association; New Association, 2008 honey, or any other sweetened drinks. Ministry of Health Zealand Ministry of guidelinesp Health Remind parents that if sugar foods are eaten they should be taken 2005 NHS Scotland at mealtimes instead of as snacks.
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From page 248... ...
AHA Gidding et al., 2005 Improving nutritional quality after weaning: Introduce healthy Narrative review foods and continue offering if initially refused; do not introduce foods without overall nutritional value simply to provide calories. NOTE: AAP = American Academy of Pediatrics; AAPD = American Academy of Pediatric Dentistry; AHA = American Heart Association; CHPP = Child Health Promotion Programme; CPS = Canadian Paediatric Society; DGA = Dietary Guidelines for Americans; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; g = grams; GP = general practitioner; HC = Health Canada; NHMRC = National Health and Medical Research Council; NHS = National Health Service (United Kingdom)
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From page 249... ...
Health Canada. Adapted and reproduced with permission from the Minister of Health, 2020.
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From page 250... ...
ESPGHAN Fewtrell et al., 2017 Recommendations on specific types of complementary foods should Systematic literature take into consideration traditions and feeding patterns in the search population. Infants should be offered a varied diet including foods with different flavors and textures including bitter-tasting green vegetables.a RWJF-HER Pérez-Escamilla et al., During the transition to family food, continue to expose your baby Narrative review 2017 to healthy food including plenty of vegetables and fruits, and avoid offering unhealthy food such as sugar-sweetened beverages, sweets, salty food/snacks, and fried food/snacks that are high in added sugars, calories, and/or salt.
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From page 251... ...
Narrative review HC Encourage progress toward a variety of textures, modified from family foods, by 1 year of age.e Recommend a regular schedule of meals and snacks, offering a variety Narrative review; of foods from the four food groups.e 2007 Eating Well with Canada's Food Guidef Recommend iron-rich meat, meat alternatives, and iron-fortified cereal Narrative review as the first complementary foods. Encourage parents and caregivers to progress to introduce a variety of nutritious foods from the family meals.e continued 251
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From page 252... ...
(For vegetarian and vegan infants and toddlers) : Once an infant has Narrative review started complementary foods, the variety should be increased to ensure an additional intake of nutrients, especially energy, protein, iron, calcium, and vitamin B12.
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From page 253... ...
The variety of complementary foods should be increased to ensure Narrative review an additional intake of nutrients, especially iron. Iron-fortified infant cereals are suitable starter foods, and absorption can be enhanced if the infant is also given foods containing vitamin C
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From page 254... ...
milk, fermented milk or yogurt, and expressed breast milk (heat treated if the mother is HIV positive) .j Feed a variety of foods to ensure that nutrient needs are met.
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From page 255... ...
Provide diets with adequate fat content.… Avoid giving drinks with low nutrient value, such as tea, coffee, and sugary drinks such as soda. Limit the amount of juice offered so as to avoid displacing more nutrient-rich foods.k NOTE: AHA = American Heart Association; CHPP = Child Health Promotion Programme; CPS = Canadian Paediatric Society; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; HC = Health Canada; NICE = National Institute for Health and Care Excellence; PAHO = Pan American Health Organization; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SACN = Scientific Advisory Committee on Nutrition; SIAIP = Italian Society of Pediatric Allergology and Immunology; SIGENP = Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition; UK = United Kingdom; WHO = World Health Organization.
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From page 256... ...
. k Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organiza tion, Nutrient Content of Complementary Foods, p.
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From page 257... ...
Infants should be offered a varied diet including foods with different flavors and textures including bitter-tasting green vegetables.a RWJF-HER Pérez-Escamilla et al., During the transition to family food, continue to expose your baby Narrative review 2017 to healthy food including plenty of vegetables and fruits, and avoid offering unhealthy food such as sugar-sweetened beverages, sweets, salty food/snacks, and fried food/snacks that are high in added sugars, calories, and/or salt. Feed your baby only healthy food that provides plenty of vitamins, Narrative review minerals, and fiber, including fresh vegetables, fruits, and age appropriate whole grain products.
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From page 258... ...
It is also important to promote the daily consumption of fruits and vegetables. New Zealand Ministry of Health, Dried fruit is not recommended as a snack between meals because it 2008 New Zealand Ministry of Health 2012c sticks to teeth and is cariogenic.
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From page 259... ...
Limit the amount of juice offered so as to avoid displacing more nutrient-rich foods.h NOTE: AAP = American Academy of Pediatrics; DRI = Dietary Reference Intake; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; GP = general practitioner; PAHO = Pan American Health Organization; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SIAIP = Italian Society of Pediatric Allergology and Immunology; SIGENP = Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition; UK = United Kingdom; WHO = World Health Organization. a Recommendation was noted as being relevant to European infants, typically in relatively affluent populations with access to clean water and good health care.
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From page 260... ...
NHMRC (Australian NHMRC, 2012c To prevent iron deficiency, iron-containing nutritious foods are Narrative review government) recommended to be the first foods.
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From page 261... ...
For vegan infants who are not breastfed or are partially breastfed, the use of a commercial soy-based infant formula during the first 2 years of life is recommended. For toddlers who do not have cow milk or milk products, calcium- Narrative review fortified milk alternatives can provide calcium.
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From page 262... ...
Foods containing the precursor of the essential fatty acid linolenic Narrative reviewg acid should be included in strict vegan diets (flaxseed, canola, nut oils, and soya products)
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From page 263... ...
Isolated soy protein–based formula has no advantage over cow milk Narrative reviewj protein-based formula as a supplement for the breastfed infant, unless the infant has one of the indications noted previously -- (a) for infants with galactosemia and hereditary lactase deficiency (rare)
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From page 264... ...
Avoid giving drinks with low nutrient value, such as tea, coffee, and sugary drinks such as soda. Limit the amount of juice offered so as to avoid displacing more nutrient-rich foods.l NOTE: µg = microgram; AAP = American Academy of Pediatrics; AND = Academy of Nutrition and Dietetics; CPS = Canadian Paediatric Society; DGA = Dietary Guidelines for Americans; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; n-3 LCPUFA = omega-3 long-chain polyunsaturated fatty acid; NHMRC = National Health and Medical Research Council; PAHO = Pan American Health Organization; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; WHO = World Health Organization.
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From page 265... ...
. l Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organiza tion, Nutrient Content of Complementary Foods, p.
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From page 266... ...
There is lack of evidence that partially or extensively hydrolyzed Narrative review formula prevents atopic disease in infants and children, even in those at high risk for allergic disease. There is no evidence that delaying the introduction of allergenic foods, Narrative review including peanuts, eggs, and fish, beyond 4–6 months prevents atopic disease.
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From page 267... ...
SACN SACN, 2018 Advice on complementary feeding should state that foods containing Narrative review peanut and hen egg can be introduced from around 6 months of age and need not be differentiated from other solid foods. The deliberate exclusion of peanut or hen egg beyond 6–12 months of age may increase the risk of allergy to the same foods.
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From page 268... ...
ESPGHAN Fewtrell et al., 2017 Allergenic foods may be introduced when complementary food is Systematic literature commenced any time after 4 months (17 weeks) .b search Gluten may be introduced between 4 and 12 months of age.
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From page 269... ...
Other Enquiring About solid foods should be introduced before peanut-containing foods to Tolerance Triale show that the infant is developmentally ready. The [Expert Panel]
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From page 270... ...
. These food items include dairy products such as yogurt or cow milk protein formula, eggs, soy, wheat, peanut butter, fish, and shellfish.
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From page 271... ...
NOTE: AAP = American Academy of Pediatrics; BRAFO = Benefit-Risk Analysis for Foods; CD = celiac disease; CDA = celiac disease autoimmunity; COT = Committee on Toxicity of Chemicals in Food, Consumer Products, and the Environment; CPS = Canadian Paediatric Society; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; IgE = immunoglobulin E; LEAP = Learning Early About Peanut Allergy; NIAID = National Institute of Allergy and Infectious Diseases; NIH = National Institutes of Health; RCPCH = Royal College of Paediatrics and Child Health; RCT = randomized controlled trial; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SACN = Scientific AdvisoryCommittee on Nutrition; SIAIP = Italian Society of Pediatric Allergology and Immunology; SIGENP = Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition; SPT = skin prick test; T1DM = type 1 diabetes mellitus. a Using GRADE, the strength of the evidence for the recommendation was rated as Moderate ("further research is likely to have an effect on the quality of the body of evidence and may cthe hange the recommendation")
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From page 272... ...
Formula-fed infants who may be at higher risk for iron deficiency (e.g., owing to low socioeconomic status; maternal anemia; low intake of iron-rich complementary foods; or living in an indigenous community that may be challenged by poverty, food insecurity, high consumption of evaporated milk or cow milk, and a high burden of H pylori infection)
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From page 273... ...
ESPGHAN Fewtrell et al., 2017 All infants should receive iron-rich complementary foods including Systematic literature meat products and/or iron-fortified foods. The strategy used will search depend on the population, cultural factors, and available foods but can include iron-fortified foods or infant formulas, foods naturally rich in iron such as meat, or iron supplements.e Vegan diets should only be used under appropriate medical or dietetic Systematic literature supervision to ensure that the infant receives a sufficient supply of search vitamin B12, vitamin D, iron, zinc, folate, n-3 LCPUFA, protein, and calcium, and that the diet is sufficiently nutrient and energy dense.
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From page 274... ...
: If you choose to formula feed, it is recommended Narrative review that you give your baby formula fortified with iron and zinc. Breastfeeding Health Canada et al., Recommend meat, meat alternatives, and iron-fortified cereal as an Narrative review Committee for 2015 infant's first complementary foods.f Canada; CPS; Continue to recommend a variety of iron-rich foods.
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From page 275... ...
Use cow milk–based formulas until 12 months of age. (Note: All Systematic review 275 infant formulas available in Australia are iron fortified.)
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From page 276... ...
Infants and toddlers may need iron supplements under certain Narrative review circumstances, for example, if an infant is diagnosed with iron deficiency or has been exclusively breastfed for a prolonged period. The variety of complementary foods should be increased to ensure Narrative review an additional intake of nutrients, especially iron.
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From page 277... ...
Iron DRIsm When infants are given complementary foods, red meat and vegetables with higher iron content should be introduced early. To augment the iron supply, liquid iron supplements are appropriate if iron needs are not being met by the intake of formula and complementary foods.
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From page 278... ...
Diets that do not contain animal-source foods (meat, poultry, fish, or eggs, plus milk products) cannot meet all nutrient needs at this age unless fortified products or nutrient supplements are used.p NOTE: AAFP = American Academy of Family Physicians; AAP = American Academy of Pediatrics; ABM = Academy of Breastfeeding Medicine; CPS = Canadian Paediatric Society; DRI = Dietary Reference Intake; EFSA = European Food Safety Authority; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; HC = Health Canada; IDA = iron deficiency anemia; mg/d = milligrams per day; mg/ kg = milligrams per kilogram; mg/L = milligrams per liter; n-3 LCPUFA = omega-3 long-chain polyunsaturated fatty acid; n-3 PUFA = omega-3 polyunsaturated fatty acid; NHMRC = National Health and Medical Research Council; NICE = National Institute for Health and Care Excellence; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SACN = Scientific Advisory Committee on Nutrition; WHO = World Health Organization.
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From page 279... ...
Using the NHMRC system, the strength-of-evidence rating related to this recommendation was Grade D (risk associated with cow milk)
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From page 280... ...
, breastfed and partially breastfed infants should be supplemented with 400 IU of vitamin D per day beginning in the first few days of life and continued until the infant has been weaned and is drinking at least 1 L/day of vitamin D–fortified infant formula or cow milk.
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From page 281... ...
New Zealand Ministry Ministry of Health, Infants who are exclusively or partially breastfed (who receive less Narrative review of Health 2013 than 500 mL of formula per day, based on current NRVs; NHMRC 2006) and have one or more of the risk factors above may benefit from vitamin D supplementation.i It would be reasonable to wait until breastfeeding is well established Narrative review in full-term, high-risk infants, such as until 6 weeks of age, before introducing vitamin D supplementation.
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From page 282... ...
Nutrition for healthy term infants: Recommendations from birth to six Months. Health Canada.
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From page 283... ...
WHO WHO Secretariat et al., Pregnant and lactating women have no need for iodine supplements, Could not be mapped 2007 nor do children aged 0–24 months require them. Indeed, the amount of iodine stored in the thyroid of a child at birth, when added to the iodine intake from the mother's breast milk, is likely to be sufficient to meet a child's need for iodine for the first 6 months of life and even up to 24 months of age.
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From page 284... ...
. If adequate narrative review amounts of animal-source foods are not consumed, these fortified foods or supplements should also contain other micronutrients, particularly zinc, calcium, and vitamin B12.i PAHO/WHO PAHO/WHO, 2003 Vegetarian diets cannot meet nutrient needs at this age unless nutrient Technical supplements or fortified products are used.j consultations and documents Use fortified complementary foods or vitamin-mineral supplements for Technical the infant, as needed.k consultations and documents
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From page 285... ...
. j Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organiza tion, Nutrient Content of Complementary Foods, p.
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From page 286... ...
. Breastfeeding Health Canada et al., Explain to parents and caregivers that nutritious, higher-fat foods are Narrative review Committee for Canada; 2014 an important source of energy for young children.b CPS; Dietitians of Canada; HC
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From page 287... ...
. If animal-source foods are consumed, up to 5 g of additional fats or oils may be needed.g PAHO/WHO PAHO/WHO, 2003 Provide diets with adequate fat content.h Technical consultations and documents NOTE: CPS = Canadian Paediatric Society; HC = Health Canada; NHMRC = National Health and Medical Research Council; PAHO = Pan American Health Organization; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SSB = sugar-sweetened beverage; WHO = World Health Organization.
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From page 288... ...
ESPGHAN Fewtrell et al., 2017 By 12 months, infants should drink mainly from a cup or training cup Systematic literature rather than a bottle.a search RWJF-HER Pérez-Escamilla et al., Be cautious about the volume of formula or expressed breast milk Narrative review 2017 given at each feed. Studies have shown that bottle size matters.
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From page 289... ...
in a baby bottle or no-spill training cup … baby bottle use after 12–18 months.b Breastfeeding Health Canada et al., Warn of the risk of choking if infants are left alone while feeding. Narrative review Committee for 2015 Explain the dangers of propping a bottle.c Canada; CPS; Health Canada et al., For an older infant or young child who is not breastfed or receiving Narrative review Dietitians of Canada; 2014 breast milk: Recommend avoiding prolonged bottle feeding and giving HC bottles at night.d NHMRC (Australian NHMRC, 2012e As with breastfeeding, bottle feeding according to need is appropriate.
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From page 290... ...
New Zealand Dental New Zealand Dental Advise parents to hold the baby while bottle feeding and not to put Could not be mapped Association; New Association, 2008 baby to bed with a bottle. Zealand Ministry of If bottle feeding, advise parents to use only expressed breast milk or Could not be mapped Health infant formula.
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From page 291... ...
Nutrition for healthy term infants: Recommendations from six to 24 months. Health Canada.
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From page 292... ...
Use a cup to offer water.c AAP; AAPD AAPD, 2016 To decrease the risk of developing early childhood caries, AAPD Narrative review encourages professional and at-home preventive measures that include avoiding frequent consumption of liquids and/or solid foods containing sugar, in particular … sugar-sweetened beverages (e.g., juices, soft drinks, sports drinks, sweetened tea) in a baby bottle or no-spill training cup.d
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From page 293... ...
NOTE: AAP = American Academy of Pediatrics; AAPD = American Academy of Pediatric Dentistry; AHA = American Heart Association; CPS = Canadian Paediatric Society; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; GP = general practitioner; HC = Health Canada; NHMRC = National Health and Medical Research Council; NICE = National Institute for Health and Care Excellence; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; UK = United Kingdom.
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From page 294... ...
Nutrition for healthy term infants: Recommendations from six to 24 months. Health Canada.
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From page 295... ...
RWJF-HER Pérez-Escamilla et al., Do not offer your child unpasteurized juice, milk, or dairy products. FoodSafety.gov 2017 Breastfeeding Health Canada et al., Promote safe food preparation and storage to prevent foodborne Narrative review Committee for Canada; 2014 illness.
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From page 296... ...
are inappropriate alternatives to breast milk, formula, or pasteurized whole cow milk in the first 2 years of life. Honeyf RWJF-HER Pérez-Escamilla et al., Honey should not be given to children under 12 months old because it Narrative review 2017 may cause a serious condition known as botulism.
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From page 297... ...
SACN; COT SACN and COT, 2018 Advice on complementary feeding should state that foods Systematic review;h containing peanut and hen egg need not be differentiated from other BRAFO methodology complementary foods. Complementary foods should be introduced in age-appropriate*
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From page 298... ...
Children under 5 years old must not be given whole nuts, as they can choke on them.i SACN; COT SACN and COT, 2018 Advice on complementary feeding should state that foods containing Systematic review;h peanut and hen egg need not be differentiated from other complementary BRAFO methodology foods. Complementary foods should be introduced in age-appropriate*
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From page 299... ...
recommendations Hard, small, round, and/or sticky solid foods are not recommended Could not be mapped because they can cause choking and aspiration. New Zealand Ministry Ministry of Health, Be aware of foods that are more likely to cause choking.l Narrative review of Health 2012k Offer toddlers a variety of nutritious foods from each of the major Narrative review food groups each day.
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From page 300... ...
.m PAHO/WHO PAHO/WHO, 2003 Gradually increase food consistency and variety as the infant gets Technical consultations older, adapting to the infant's requirements and abilities. Infants can and documents eat puréed, mashed, and semisolid foods beginning at 6 months.
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From page 301... ...
reportq NOTE: AAP = American Academy of Pediatrics; BRAFO = Benefit-Risk Analysis for Foods; CACFP = Child and Adult Care Food Program; CHPP = Child Health Promotion Programme; COT = Committee on Toxicity of Chemicals in Food, Consumer Products, and the Environment; CPS = Canadian Paediatric Society; DGA = Dietary Guidelines for Americans; HC = Health Canada; NHMRC = National Health and Medical Research Council; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SACN = Scientific Advisory Committee on Nutrition; UK = United Kingdom; WHO = World Health Organization; WIC = Special Supplemental Nutrition Program for Women, Infants, and Children. 301 continued
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From page 302... ...
. n Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Orga nization, Food Consistency, p.
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From page 303... ...
Infants at risk of iron depletion (exclusively breastfed infants born to Systematic reviewa mothers with low iron status, or with early umbilical cord clamping [< 1 min after birth] , or born preterm, or born small for gestational age or with high growth velocity)
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From page 304... ...
ESPGHAN Fewtrell et al., 2017 Complementary foods (i.e., solid foods and liquids other than breast Systematic literature milk or infant formula) should not be introduced before 4 months but search should not be delayed beyond 6 months.c
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From page 305... ...
Combining new food items that are more difficult to accept by babies, such as some vegetables, with food they are already familiar with can help your baby accept and learn to like vegetables more readily. Breastfeeding Health Canada et al., Recommend meat, meat alternatives, and iron-fortified cereal as an Narrative review Committee for 2015 infant's first complementary foods.d Canada; CPS; Dietitians of Canada; HC 305 continued
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From page 306... ...
. The beginning of the introduction of solid foods at 6 months of age remains a desirable goal also in Western societies and for exclusively breastfed infants, although it would be advisable to introduce solid foods together with breast milk before such age.
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From page 307... ...
Cow milk products including full-fat yogurt, cheese, and custard may be given, but not cow milk as a main drink before 12 months. Introduce solid foods at around 6 months to meet the infant's Systematic reviewj increasing nutritional and developmental needs.
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From page 308... ...
To augment the iron supply, liquid iron supplements are appropriate if iron needs are not being met by the intake of formula and complementary foods. WHO WHO, 2005 Gradually increase food consistency and variety as the infant gets A background older, adapting to the infant's requirements and abilities.
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From page 309... ...
i Portions of this recommendation could be mapped to a systematic review prepared for this guideline document; other portions appeared to be related to a narrative review of the evidence. Using the NHMRC system, the strength-of-evidence rating related to this recommendation was Grade D (risk associated with cow milk)
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From page 310... ...
. o Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organi zation, Duration of Exclusive Breastfeeding and Age of Introduction of Complementary Foods, p.
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From page 311... ...
Prolonged use of puréed foods should be discouraged, and infants should be eating lumpy foods by 8–10 months at the latest. By 12 months, infants should drink mainly from a cup or training cup rather than a bottle.a Recommendations on specific types of complementary foods should Systematic literature take into consideration traditions and feeding patterns in the search population.
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From page 312... ...
Breastfeeding Health Canada et al., Ensure that lumpy textures are offered no later than 9 months. Narrative review Committee for Canada; 2014 Encourage progress towards a variety of textures, modified from CPS; Dietitians of family foods, by 1 year of age.c Canada; HC Promote offering finger foods to encourage self-feeding.c Narrative review Recommend iron-rich meat, meat alternatives, and iron-fortified cereal Narrative review as the first complementary foods.
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From page 313... ...
Infants can document and eat puréed, mashed, and semisolid foods beginning at 6 months. By narrative review 8 months most infants can also eat finger foods (snacks that can be eaten by children alone)
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From page 314... ...
remember that feeding times are periods of learning and love -- talk to children during feeding, with eye-to-eye contact.i NOTE: CPS = Canadian Paediatric Society; ESPGHAN = European Society for Paediatric Gastroenterology, Hepatology and Nutrition; HC = Health Canada; NHMRC = National Health and Medical Research Council; PAHO = Pan American Health Organization; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; SACN = Scientific Advisory Committee on Nutrition; SIAIP = Italian Society of Pediatric Allergology and Immunology; SIGENP = Italian Society of Gastroenterology, Hepatology and Pediatric Nutrition; WHO = World Health Organization. a Recommendation was noted as being relevant to European infants, "typically in relatively affluent populations with access to clean water and good healthcare." b Alvisi et al., 2015, is licensed under CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)
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From page 315... ...
. i Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organiza tion, Responsive Feeding, p.
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From page 316... ...
Following a regular schedule will help your child learn when and what to expect to eat during the day. Breastfeeding Health Canada et al., Recommend a regular schedule of meals and snacks, offering a variety Narrative review; Committee for Canada; 2014 of foods from the four food groups.a 2007 Eating Well with CPS; Dietitians of Canada's Food Guideb Canada; HC Recommend gradually increasing the number of times per day that Narrative review complementary foods are offered while continuing to breastfeed.a AHA Gidding et al., 2005 Parent, guardian, and caregiver responsibilities for children's nutrition: Narrative review Control when food is available and when it can be eaten (nutrient quality, portion size, snacking, regular meals)
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From page 317... ...
If energy density or amount of food per meal is low, or the child is no longer breastfed, more frequent meals may be required.d NOTE: AHA = American Heart Association; CPS = Canadian Paediatric Society; HC = Health Canada; PAHO = Pan American Health Organization; RWJF-HER = Robert Wood Johnson Foundation-Healthy Eating Research; WHO = World Health Organization. a © All rights reserved.
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From page 318... ...
It is also important to promote the daily consumption of fruits and vegetables. Breastfeeding Health Canada et al., Encourage responsive feeding based on the child's hunger and satiety Narrative review Committee for Canada; 2014 cues.c CPS; Dietitians of Canada; HC
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From page 319... ...
minimize distractions during meals if the child loses interest easily; (e) remember that feeding times are periods of learning and love -- talk to children during feeding, with eye-to-eye contact.d PAHO/WHO PAHO/WHO, 2003 Practice responsive feeding, applying the principles of psychosocial Technical consultations care (Engle et al., 2000; Pelto et al., 2003)
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From page 320... ...
. e Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organiza tion, Responsive Feeding, p.
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From page 321... ...
Remember that it may take more tries for your baby to learn to like Narrative review vegetables than other healthy food like fruits. Continue offering a variety of vegetables and other healthy food, and let your child decide when she or he is ready.
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From page 322... ...
Breastfeeding Health Canada et al., Encourage parents and caregivers to be role models and instill lifelong Narrative review; Committee for 2014 healthy eating habits.b 2007 Eating Well with Canada; CPS; Canada's Food Guidec Dietitians of Canada; Promote offering finger foods to encourage self-feeding.b Narrative review HC NHMRC (Australian NHMRC, 2012d As with breastfeeding, bottle feeding according to need is appropriate. Could not be mapped government)
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From page 323... ...
. Improving nutritional quality after weaning: Introduce healthy foods Narrative review and continue offering if initially refused; do not introduce foods without overall nutritional value simply to provide calories.
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From page 324... ...
. h Reprinted from Guiding principles for complementary feeding of the breastfed child, Pan American Health Organization/World Health Organi zation, Responsive Feeding, p.
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Key Terms
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