Infant Nutrition: The Basics

Edited by Michelle Asselin

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For parents or guardians, understanding optimal nutrition for infant development can be a daunting task. Which formula should be used? What if I choose to breastfeed? When should solid foods be introduced? Which vitamins and minerals are important for development? This guide aims to streamline some important recommendations, so that you can stress less and get back to enjoying time with your baby!

Formula

If your baby is formula fed, there can be an overwhelming number of formulas to choose from. In general, infant formula contains protein, carbohydrates, fat and some vitamins and minerals.

There are special formula types that can be considered in certain situations:

1. Lactose free formulas: For infants who have had a recent stomach bug or diarrhea. They still contain traces of lactose, so are not recommended in cases of established lactose intolerance. Example: Enfamil A+ Lactose Free

2. Soy based formulas: For infants with lactose intolerance, or those who are following a vegetarian or vegan diet. They are not recommended for infants with cow’s milk allergy. Example: Similac Isomil

3. Thickened formulas: For infants who frequently spit up, but may cause constipation and colic. Thickening formula at home is not recommended over purchasing commercially available products. Example: Enfamil A+ Spit Up

4. Formula with proteins partially broken down: For infants who have stomach issues/need help digesting formula. Example: Enfamil A+ Gentlease

5. Formula with proteins mostly broken down: For infants with intolerances to cow’s milk or soy protein. Example: Nutramigen

6. Formula with proteins completely broken down: For infants with severe allergies or poor absorption. Example: Puramino

It is important to consult your infant’s pediatrician or family doctor when considering a special formula type to make sure it is the most appropriate for your baby.

Formula formats include:

• Powder: Takes effort to mix well, cheapest ($) *most common*

• Concentrated Liquid: Prepared by mixing equal parts water and formula, more expensive ($$)

• Ready-to-use Liquid: Does not need to be prepared, most expensive ($$$)

Breastfeeding

This guide will only briefly mention breastfeeding in the context of proper infant supplementation. For more detailed information about breastfeeding, check out this resource from the Canadian Pediatric Society.

If you are breastfeeding your baby, they will need daily vitamin D supplementation to prevent vitamin D deficiency and to promote healthy bones. Infant formulas are often already fortified with vitamin D, so formula fed babies do not require supplementation.

Babies need 400 IU of vitamin D per day. Vitamin D is available as drops (1 drop = 400 IU).

Solid Foods

When to introduce solid foods? --- Around 6 months

This time does not have to be exact. It is better to take cues from your baby to determine when they are ready for solid food such as, holding food in their mouth without pushing it out, showing an interest in food, sitting up without support, and seeming hungrier than usual.

What should the first foods be? --- A source of iron

Iron-fortified infant cereal (such as rice, barley, oat or wheat cereal) is a common starting point. Pureed meat, egg yolk, and well-cooked beans, lentils, or chickpeas can also be a good source of iron.

Iron is very important for brain development. If babies have low iron, this can lead to poor brain function and motor development and may negatively impact their growth. This is why we need to incorporate iron rich foods into a baby’s diet!

How should foods be introduced? --- Gradually

New foods should be introduced in a small amount (approximately 1 teaspoon), starting in a liquid form, and increasing in thickness and quantity gradually. It can be helpful to change the taste and textures of the foods to introduce your baby to a wide variety of different flavours. In the early stages, solid food does not replace the need for breastmilk or formula and should be used in small amounts in addition to the regular feeding routine.

After introducing iron rich foods, pureed vegetables and fruits (such as carrots, squash, sweet potatoes, apples, pears, bananas, etc.) can be added every few days. Between 6-9 months, dairy products (e.g., yoghurt, cheese) can be introduced, and at 9-12 months, whole cow’s milk can be introduced. This milk can replace breastmilk/formula if tolerated by the baby.

Around 8-10 months, babies can gradually transition from pureed foods to small portions of whatever the family is eating (chopped very small, finger foods). This process will be gradual, where the baby transitions from pureed food to a combination of family food and baby food, to eventually mostly solid foods by the time they are one year old.

How should commonly allergenic foods (e.g., peanuts) be introduced? --- Earlier is better

Traditionally, it was recommended to delay introducing common allergy-causing foods (such as milk, egg, and peanuts), but there is recent evidence supporting the idea that earlier introduction of these foods actually reduces the risk of developing allergies.

Some tips for introducing allergy-causing foods:

• Can introduce around 4-6 months of age (wait until 6 months for babies with eczema due to higher risk of allergies)

• Introduce one food at a time and wait to see how your baby tolerates it before introducing another food

• If tolerated, offer a few times a week

In summary, earlier introduction is better to reduce the risk of developing allergies later on! If you have any concerns or questions it is important to get in contact with your infant’s pediatrician or an allergist.

Baby-led weaning, what is it? --- Alternative approach to introducing food

In this approach, babies choose what and how much they want to eat. It is thought that this type of introduction promotes self-regulation, creates familiarity with more foods and textures earlier on, and may contribute to less pickiness later in life.

Take-Home Message

There is a wealth of existing information about nutrition for infants that can be challenging to sort through. The recommendations outlined above are based on evidence to help guide your approach to optimal nutrition for your baby’s growth and development. You may know pharmacists as the care providers who give you information about your medications, but they are also knowledgeable about nutrition and work to improve you (and your baby’s) overall health and wellbeing!

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References

1. Richard C, Nakhla N. Infant Nutrition. CTMA. Updated April 2022. Accessed December 16, 2022. https://myrxtx.ca

2. Canadian Pediatric Society. Feeding your baby in the first year. Updated January 2020. Accessed December 16, 2022. https://www.caringforkids.cps.ca/handouts/feeding_your_baby_in_the_first_year

3. Domellöf M, et al. Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr. 2014; 58:119-29. doi: 10.1097/MPG.0000000000000206

4. Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015;372(9):803-13.

5. Natsume O, Kabashima S, Nakazato J, et al. Two-step egg introduction for prevention of egg allergy in high-risk infants with eczema (PETIT): A randomized, double-blind, placebo-controlled trial. Lancet 2017;389(10066):276-86.

6. Taylor RW, Williams SM, Fangupo LJ, et al. Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight: A Randomized Clinical Trial. JAMA Pediatr. 2017;171(9):838–846. doi: 10.1001/jamapediatrics.2017.1284

7. Brown A, Jones SW, Rowan H. Baby-Led Weaning: The Evidence to Date. Curr Nutr Rep. 2017;6(2):148–156. doi: 10.1007/s13668-017-0201-2