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Nutrition for Healthy Term Infants is the new national statement on nutrition for infants from birth to 24 months, developed collaboratively by the Canadian Paediatric Society, Dietitians of Canada and Health Canada.
The document summarizes the existing scientific literature on infant nutrition and presents principles and recommendations to help health care professionals promote optimal, evidence-based nutritional care for infants in Canada. Collaboration between the three key organizations involved in infant nutrition has produced unified messages for health professionals to deliver to the public.
For the first year of life four major topics are discussed: Breastfeeding, Alternate Milks, Other Fluids in Infant Feeding and Transition to Solid Foods. Safety Issues Around Feeding is presented next, followed by Nutrition in the Second Year of Life. The final section covers Other Issues in Infant Nutrition, and includes topics such as food allergies, colic, constipation, dietary fat, dental caries, gastroenteritis, diabetes, iron deficiency anemia and vegetarian diets. An extensive reference list of more than 200 citations is provided.
The Summary of Principles and Recommendations will be published in the official journals of the Canadian Paediatric Society (Paediatrics & Child Health, March/April 1998) and Dietitians of Canada (Canadian Journal of Dietetic Practice and Research, June 1998). The complete document can be downloaded from all three of the collaborating organizations’ web sites or a hard copy of the Statement, in either official language, can be obtained from the Canadian Paediatric Society, Dietitians of Canada or Health Canada.
Nutrition for Healthy Term Infants offers multidisciplinary health professionals the most current scientific tool for advising parents and positively influencing the nutritional environment provided to infants in Canada.
The Canadian Paediatric Society Nutrition Committee, Dietitians of Canada and Health Canada collaborated on the preparation of this statement on nutrition for healthy term infants from birth to 24 months of age. This statement is intended for the use of health care professionals. It provides information that is basic to communicating consistent messages about infant nutrition to parents and caregivers across Canada. It is not designed, however, to be an all-encompassing practical guide to infant feeding. The recommendations in this statement are based on available scientific evidence. However, many studies on infant nutrition are not based on randomized trials because they are neither possible nor ethical in many circumstances. In the absence of solid science, accepted practice and its rationale is presented. Throughout the document, we have attempted to clearly distinguish those recommendations based on science versus those based on common practice. A summary of the principles and recommendations found in the document is presented below.
Breastfeeding is the optimal method of feeding infants. Breastfeeding may continue for up to two years of age and beyond.
Active public health, hospital, community and work-place support of breastfeeding will increase initiation rates and duration of breastfeeding.
Breastfeeding is rarely contraindicated. Neither smoking nor environmental contaminants are necessarily contraindications to breastfeeding. Moderate, infrequent alcohol ingestion, the use of most prescription and over-the-counter drugs and many maternal infections do not preclude breastfeeding.
Vitamin D deficiency is a health concern in Canada. Infant formulas and milks are fortified with vitamin D. Breastfed infants should also receive extra vitamin D in the form of a supplement.
If an infant is not breastfed, or is partially breastfed, commercial formulas are the most acceptable alternative to breast milk until nine to 12 months of age.
The use of nutritionally incomplete alternate milks as the sole source of nutrition for infants is inappropriate. Pasteurized whole cow’s milk, however, is an important component of a mixed infant diet after nine months of age. For infants unable to take cow’s milk products, continue commercial soy formula until two years of age.
Tap water, well water meeting established standards of safety and commercially bottled water, except mineral or carbonated water, are generally suitable for infants. Limit the use of ‘fruit juice’ to avoid interfering with the intake of nutrient-containing foods and fluids. Herbal teas and other beverages are of no known benefit to an infant and may be harmful.
Infants between four and six months of age are physiologically and developmentally ready for new foods, textures and modes of feeding. By one year of age, the ingestion of a variety of foods from the different food groups of Canada’s Food Guide to Healthy Eating is desirable.
Foods provided to infants must be free of pathogens, appropriate in size and texture, nutritionally sound and fed safely.
Healthy eating is important in the second year to: (a) provide the energy and nutrients needed to grow and develop; (b) develop a sense of taste and an acceptance and enjoyment of different foods; and (c) instill attitudes and practices which may form the basis for lifelong health-promoting eating patterns.
Whenever possible, allergies to food should be prevented.
Treatment of proven food allergies involves avoidance of foods known to cause symptoms.
Dietary manipulations have had limited success in the treatment of colic.
In infancy, true constipation is infrequent.
Dietary fat is an important source of energy and the only source of essential fatty acids.
Prevalence of dental caries is lower where infants and children have access to fluoridated water and where long-term exposure of teeth to nutrient-containing liquids is avoided. Excessive fluoride intake can cause dental fluorosis.
Manage mild to moderate dehydration associated with gastroenteritis with oral rehydration therapy (ORT). Prevent malnutrition.
The exact role of early infant nutrition as a possible etiological factor for infants genetically at risk for diabetes has not been proven.
Iron deficiency is preventable through appropriate feeding choices.
Nutritional needs can be met by most well-planned vegetarian diets. For vegetarian diets that are limited in variety and nutritional quality, professional advice regarding supplements is appropriate.
A joint statement of The Canadian Paediatric Society, Dietitians of Canada and Health Canada
Representatives of the organizations are Dr Stanley Zlotkin, Department of Gastroenterology and Nutrition, The Hospital for Sick Children, Faculty of Medicine, University of Toronto, Toronto, Ontario (Canadian Paediatric Society, 100-2204 Walkley Road, Ottawa, Ontario K1G 4G8. Telephone 613-526-9397, fax 613-526-3332, web site www.cps.ca); Ms Donna Secker, Clinical Dietitian, The Hospital for Sick Children, Toronto, Ontario (Dietitians of Canada, 480 University Avenue #604, Toronto, Ontario M5G 1V2. Telephone 416-596-0857, fax 416-596-0603, web site www.dietitians.ca); Louise Aubrey, Marie Labrèche, Rosemary Sloan, Christina Zehaluk, Ottawa, Ontario (Health Canada, Publications, Health Canada, Ottawa, Ontario K1A 0K9. Telephone 613-954-5995, fax 613-941-5366, web site www.hc-sc.gc.ca)
The recommendations in this Clinical Practice Guideline do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.