Encourage mother to drink plenty of fluids. Review the principles of supply and demand: the more an infant feeds, the more milk is produced. Instruct the mother to alternate initial breast for each feeding to facilitate equal emptying of breasts because infants have a more vigorous suck at the first breast.
Discuss feeding frequency: an infant will nurse every 2-3 hours during first few weeks and typically takes 4-5 feedings per day after 3 months. Supplement infant with IU vitamin D daily by 2 months of age with the physician’s approval to prevent deficiency and rickets.* Use refrigerated expressed human milk within 48 hours or freeze for longer storage.
Consult a lactation specialist, as needed. Ensure vegetarian mothers (especially vegan) receive adequate calcium, iron, and B 12.
Don’t supplement with unfortified milks (cow, goat, and so milk) because they are nutritionally incomplete for infants less than 1 year of age. Don’t overly diet. Don’t allow alcohol or caffeine (coffee, most tea, and soft drinks) don’t allow medication or herbal supplements without first discussing with the PMD because they may pass into human milk.
Consult the PMD before making formula changes. Follow formula preparation instructions carefully; use only the scoop provided with the product (scoop sizes vary between products) unless otherwise instructed. Warm bottles using hot running water or in a bowl of warm water for no more than 15 minutes. Use a fresh bottle of formula at each feeding, discarding leftovers.
Store mixed and opened ready-to use formulas in a refrigerator; discard unused refrigerated concentrate and ready-to-use formula after 48 hours and formula prepared from powder after 24 hours. Supplement with fluoride when the infant is 6 months old after first consulting the PMD.
Don’t give a bottle to an infant without checking the temperature. Don’t put an infant to bed with a bottle, which can lead to baby-bottle tooth decay. Don’t leave the infant to feed him- or herself alone or with a propped up bottle.
Don’t provide low-iron formula unless prescribed by PMD, because this may lead to anemia. Don’t heat bottles in a microwave, because they can heat unevenly and burn the baby. Don’t supplement fluoride before age 6 months.
INTRODUCTION OF COMPLEMENTARY FOODS-:
Initiate complementary feedings when the infant can sit with support, has good control of head and neck, leans forward, and can swallow food when fed by a spoon; provide 1-2 teaspoons of new foods, increasing quantity gradually.
Provide rice cereal (single grain cereal) as the first complementary food, because it is least likely to cause an allergic reaction; introduce one new single- ingredient food item every 5-7 days to monitor for allergic reactions. Mix all warmed food thoroughly and check the temperature to avoid burning the infant’s mouth. Limit fruit juice to 4 ounces per day after 6 months of age.
Don’t initiate complementary foods before age 4-6 months. Don’t add salt, spices, or sugar to foods. Don’t give honey or processed foods containing honey to infant until after 1 year of age because this places the infant at risk for botulism.
Don’t add cereal to bottles or use “baby food nursery kits.” Don’t feed infants directly out of baby food jars because germs from the infant’s mouth can contaminate the jar of food where the bacteria will continue to grow.
Don’t force infants to eat new foods they do not like. It can take up to 20 attempts before an infant accepts a new food. Don’t give infants sweets (for example, candy, cake, or cookies) don’t feed egg whites to infants until they are older than 1 year of age due to the possibility of food allergy.
EXCESSIVE JUICE INTAKE:-
Limit the intake of juice to 4-6 ounces per day because excessive quantities cause an osmotic diarrhea. Provide pasteurized 100% fruit juice. Serve juice only in a cup.
Don’t provide juice before 6 months of age or allow the infant to drink juice from a bottle.
Mash or puree foods to decrease the risk of aspiration.
Don’t provide the following foods: nuts, raisins or other small dried fruits, raw carrots, whole or round cut hot dogs, grapes, popcorn, potato chips, or rounded candies.
Assess the required intake as listed: the number of wet diapers (six to eight per day) and stool patterns are helpful in assessing the intake of the breast-fed infant; consult the PMD if patterns are severe or prolonged. Provide referrals to community and government programs to assist with food access if in financial hardship.
Have as base dietary reference intakes (DRI):
Calories: 98-108 kilocalories per kilogram of body weight per day
Protein: 1.5 gram per kilogram of body weight per day
Vitamin D: 5 micrograms per day
Iron: 0.27-11 milligrams per day
Zinc: 2-3 milligrams per day
*In 2008 the AAP doubled the recommended amount of vitamin D for infants, children, and adolescents.
In infants less than 6 months old, base DRI for protein on the adequate intake (mean intake) of the breast-fed infant; therefore, it does not represent an upper limit or in tend to meet the needs of 97-98% of estimated needs, as is the case with the recommended daily allowances (RDA).
Don’t forget to use corrected age when plotting infants who were born prematurely. Don’t forget to use the correct age for weight through 24 months, height through 36 months, and head circumferences through 18 months of age. Don’t provide more than 4 ounces of juice per day or force feed.
IRON DEFICIENCY ANEMIA:-
Start on human milk or iron- fortified formula. Provide iron- fortified rice cereal as the first food followed by weaning foods high in iron; supplement with iron if prescribed by the PMD.
Don’t use formulas low in iron or unfortified milks ( cow, soy, or goat milk).
Ensure proper positioning of the bottle to decrease the amount of air present in the nipple during feeding. Verify that the mixture of formula is correct.
Don’t over feed the infant.
Discuss the normalcy of infants spitting up, and encourage burping. Verify that the mixture of formula is correct.
Don’t over feed or force feed. Don’t provide excessive movement after feeding or lay the infant flat on his or her back after feeding.
Determine adequacy of fluid intake. Verify the mixture of formula is correct. Obtain diet history if taking complementary foods.
Don’t provide juice excessively, which may displace other nutrients.