CHAPTER 4: FEEDING RECOMMENDATIONS FOR INFANTS AND TODDLERS

INTRODUCTION

This chapter will address the following American College of Graduate Medical Education competencies: patient care, medical knowledge, interpersonal and communication skills, and professionalism.

Patient Care: Early feeding routines may be influenced by preexisting family eating patterns and food choices, economic status, cultural norms, and the family’s nutritional knowledge and skills. The multiple influences on infant and toddler feeding require that the health care provider have a family-centered and nonjudgmental approach to nutritional guidance. This chapter will help the pediatric health care provider assess feeding in an infant or toddler and partner with the family to achieve evidence-based healthy feeding goals.

Medical Knowledge: This chapter will help the pediatric health care provider understand nutrition, child development, and the psychosocial and behavioral aspects of feeding essential to helping the family lay the groundwork for a healthy lifestyle for their child.

Interpersonal and Communication Skills: This chapter will help pediatric health care providers create an atmosphere which supports dialogue with families about their feeding practices in a nonjudgmental way that fosters trust and promotes effective communication.

Professionalism: This chapter will help the pediatric health care provider “meet families where they are” with respect and compassion while working with them toward achieving healthy nutrition for their child.

INFANCY RISK FACTORS FOR OBESITY

Infancy is a period of rapid growth during which the achievement of normal growth creates a healthy framework for the rest of childhood. It is vital that families understand healthy feeding, because this can set the stage for positive food-related behaviors, healthy food preferences, and family relationships centered on a healthy food environment.

Maternal body mass index (BMI) is a strong predictor of childhood obesity.¹ Infants born to mothers who are overweight or have obesity have greater body fat than those born to normal-weight women and are twice as likely to have obesity by age 2.² Exclusively breast-fed infants of overweight women have been found to have larger head circumferences and increased fat mass at 2 weeks of age. At 3 months, fat mass of infants with mothers who were overweight was increased compared to infants whose mothers had normal weight even though there was no difference in weight for length or head circumference between groups.²

Gestational diabetes affects 20% to 25% of women with obesity and 3% to 15% of women overall. Maternal obesity seems to be an independent risk factor for gestational diabetes, and is also correlated with having a ...