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Pediatrician applies cold stethoscope to baby's back

It used to be, new parents received most of their information on child-rearing from their parents, well-meaning friends and, of course, their trusted healthcare professional. These days, they’re bombarded with all sorts of conflicting advice from all corners of the internet. So, it’s no wonder by the time they see you for an appointment they’re often confused, overwhelmed or somewhat anxious. Lucky for them, you're poised to reassure them and set them on the right path, no doubt, fielding some rather interesting questions along the way.

At Good Feeding we’re here to support you as the Healthcare Professional in your efforts to guide parents in their decision-making, by providing you with up-to-date research on the latest trends in infant nutrition. Of course, you may know some of the information provided, so at the least it’s a simple refresher, but we hope it will be a useful resource in helping you support today’s modern parent.

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The window of opportunity 

A window of opportunity is a favorable instance in time that is not to be missed. With reference to infant nutrition, there are two major windows of opportunity; the first is one that appears well before the infant makes an appearance into the world.

Prenatal exposure to food plays a significant role in the development of taste and flavor receptors, and it’s this early exposure that has a great influence on the food habits that are formed in early childhood. Early prenatal exposure has also been shown to affect the experiences a child has with food that carries across through to adulthood (Source) When we refer to flavor, it's the detection of aromatic stimulus in utero that is being referred to, which is distinctly different to taste. 

The journey into the world of flavors begins even before birth. (Source) Changes in the flavor properties of the amniotic fluid are modified by foods that the mother eats during her pregnancy. Evidence shows that strong flavors in particular, such as garlic, cumin, anise and even carrot are transferred into the amniotic fluid. Aromas of alcohol and nicotine may also be detectable in the amniotic fluid (Source)

GF Pregnancy Nutrition 685 x 400

Somewhere between the 13th to 15th week of pregnancy, babies develop taste buds and they begin to detect these flavors and odors, especially the strong ones. When they start to swallow amniotic fluid after approximately the sixth month of gestation (Source) these taste receptors become more pronounced.

While sweet, umami and salty flavors are typically preferred and sour and bitter tastes rejected, there is a possibility that these preferences can be altered by prenatal exposure to them (Source) Learning about flavor begins in utero and continues once an infant is exposed to breast milk or formula, which is the second window of opportunity that presents itself for altering flavor preferences.

Whether it be breast milk or formula feeding that is chosen as nourishment once the infant is born, the impact each may have on flavor preference needs to be considered.

When it comes to breast milk, selective dietary choices made by the mother during and after pregnancy not only leads to variability in the flavor of breast milk from one feed to another, but breast milk provides a huge opportunity to exposes the baby to a range of flavors and odors.

Formula feeding may provide more consistent aromas, however, would vary according to different brands. Hypoallergenic and fermented formulas may have a more bitter or sour taste, for example, while antidiarrheal formulas have a saltier taste (Source)

Reinforcing a child’s flavor experiences during their breast- or bottle-feeding years can encourage food acceptance and promote healthy eating. (Source)

Flavor training throughout an infant’s life is an essential part of their development, and as mentioned above, may be carried into adulthood. What parents consistently say is that nutritional status of their infant is of utmost importance, however they may not be aware of a small window of opportunity they have to specifically target and shape a child's flavor preferences.

This opportunity, from age 4 to 7 months, is a time in which flavor training is more important than nutrition when it comes to exposure to solid-or pureed-foods. Between 6-7 months, the challenge becomes balancing flavor training with growing nutrition needs that must be met with foods other than breast milk or formula

Research shows that infants exposed to a wide variety of flavors in breast milk - through different foods eaten by the mother - around this age, show a higher acceptance to foods with similar flavor profiles when complementary feeding is introduced (Source). Infants that are formula-fed generally display a lower acceptance to new foods upon first introduction when compared to breast-fed infants, likely due to the more consistent flavors in these products (Source).

GF Pregnancy 685 x 400

Flavor training continues from 4 to about 14 months, in which repeated exposure to new foods, such as a variety of vegetables, can help babies develop a taste for them, and also reduce neophobia. Neophobia is typically prevalent in children aged 2 to 5 years old (Source). It is a time in which a child may suddenly reject food that they had once accepted (Source).

Interestingly, food neophobia may come about as a result of food not ‘smelling right’ to the child, instead of being associated with the taste of the food (Source).

There are two points to consider, that may be helpful when it comes to successful flavor training.

  1. Introducing complementary foods to a baby at around 4 months is not intended to provide nutrition or replace breast milk or formula. It is important to capitalize on the 4 to 5 month period so that by 5 to 6 months, when nutrition is important (in particular when it comes to the intake of minerals such as iron and zinc), flavor training has the baby well on the road to eating a range of different foods that are not only sweet in taste (Source).
  2. During the ages 4 to 7 months, it is important to introduce new foods that are not masked by sweet purees. This ‘tactic’ that often - in error - aims to target nutrient intake, may increase flavor preference to sweet foods and reduce the acceptance of new foods (Source). The new consensus appears to be that with the introduction of complementary foods, it should be a ‘vegetable first’ approach (Source).

It is critical to reiterate the timeframe of food introduction. Introducing solid foods only after the age of 6 months has been linked to a higher risk of allergies and nutrient deficiencies (Source) and so the 4-5 months of age is of great importance.


What’s trending in infant nutrition?

Many parents may seek information from their HCP after being exposed to certain trending topics relating to infant nutrition. Two of the main topics a HCP may be asked - or told about - involve plant-based diets, and how to wean a child. 

A child should absolutely eat many plant-based foods from a young age, but this isn’t a means to promote a ‘veg forward’ approach. A completely plant-based diet may lead to nutrient deficiencies. 

However, according to the Academy of Nutrition and Dietetics “well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.” (Source). Balanced vegan diets meet energy requirements when they are based on a wide variety of plant foods. Focus should be on ensuring nutrients that may be critical, such as protein, fiber, omega-3 fatty acids, iron, zinc, iodine, calcium, vitamin D, and vitamin B12 are included in the diet. The key is to plan the diet in a manner that meets the growing infant’s nutritional needs. (Source) A well balanced vegetarian diet would include complementary foods rich in energy, protein, iron, and zinc. Foods that provide these nutrients in a vegetarian diet may include hummus, tofu, well-cooked legumes, and mashed avocado (Source).

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According to the Academy of Nutrition and Dietetics' influential position statement on vegetarianism in children, meat and seafood can be replaced with milk, soy/legumes, and eggs without any negative effects. In fact, there are many positives associated with this style of eating in children, one of the most important is the evidence that shows a vegetarian or vegan diet may help to combat overweight and obesity (Source). 

These conflicts are around the soundness of nutrition obtained from a diet void of animal products (Source) and the risk of nutrient deficiencies (particularly in iron, zinc, and vitamin B12) that will not be mitigated through supplementation alone (Source).

The next trending topic is baby-led weaning.

When an infant is allowed to lead the introduction of foods through self-feeding, it is believed to increase a trend towards healthy eating behaviors and reduce risk of weight-related diseases. Because the evidence is weak, however, many physicians may be reluctant to recommend it as the practise also poses risks such as undernutrition and choking (Source, Source).

Young pediatrician happy to help her patients

Nutrients and their requirements

Meeting the nutritional requirements of a growing child are essential in the first 1,000 days of life. Nutrients such as long-chain polyunsaturated fatty acids, iron, as well as various vitamins, minerals and proteins are essential for growth, development of the brain, and the establishment and maturation of a healthy gut microbiome. Both the quality and quantity of nutrition taken in during this time is of vital importance to support optimal growth and development. 

Recommended Daily Nutrient Intakes for Children, Age 0–24 months (Source).

Recommended daily nutrient intakes for children, age 0-24 months

Remember, infant cereals are not the only source of iron. Meats, legumes, tofu and vegetables provide iron from whole food sources, as do fish and eggs (Source).


Functions and deficiencies

A broad range of nutrients are needed at every stage of a developing child’s life. As noted by the table above, these requirements change rapidly during those first 1,000 days. Should these requirements not be met, it may have devastating consequences. 

Both functional deficiencies and true deficiencies should be considered. True deficiencies are those that involve limited intake of a certain nutrient, or nutrients. Functional deficiencies may be far less obvious. 

Consider those nutrients that are critical for brain development, such as folic acid, iron and iodine (Source). An infant may be consuming foods rich in these nutrients, however still present with a deficiency. Consideration should be shifted to what else the infant may be eating that could interfere with their absorption. High intakes of dietary fiber may be the culprit (and well-known for its reduction in the absorption rate of iron and zinc), and should be avoided, as a functional deficiency of both these minerals may affect neurodevelopment. (Source)

Additionally, there is no shortage of evidence to support the importance of proteins in neurodevelopment. This macronutrient can be obtained from meat, eggs and fish; food that can be introduced into a baby’s diet over a period of time. (Source) 

GF Meat Egg Fish

An infant’s diet also plays a role in gut health. For instance, while polyunsaturated fatty acids found in breast milk, are often associated with neurodevelopment, the fat in breast milk may also help modulate gut bacteria. Because fat intake tends to decrease with the introduction of solid foods, (Source) it’s important to include foods high in polyunsaturated fatty acids from the beginning. The fat content of human breast milk plays an additional role: modulation of the gut microbiota. Breast milk intake is associated with a higher degree of short chain fatty acid (SCFS) producing bacteria in an infant’s gut, where evidence has positively correlated this in assessment of breastfed infants. SCFAs are critical for a reduced risk of intestinal diseases (Source). Additionally, breast milk is a source of probiotics and prebiotics that are believed to stimulate overall growth and maintenance of an infant’s gut microbiota. One of the most abundant human milk oligosaccharides, called fucosylated glycan, is an important nutrient for the gut microbes, and plays a critical role in immune and metabolic regulation of the host. (Source)(Source) Conversely, infant formula may not contain prebiotics - or they may simply not be in the right amounts - which has an effect on gut microbial colonization and function (Source).

Deficiencies of nutrients during high growth periods may have a considerable impact on health, both at that stage of development when the deficiency occurs and possibly in the long-run into adulthood. Consider these fast nutrition facts; under-consumed nutrients and the most at-risk age and stage of development: 

  • 1 in 4 US children between the ages of 12 and 23 month, do not consume enough iron (Source).
  • Around 500,000 global deaths in children aged 5 years old and younger can be contributed to zinc deficiency. While severe deficiency in developed nations is rare, mild deficiency is not (Source). 
  • Deficiency in the US of vitamin D in infants and toddlers is believed to be between 40% to 50%. Approximately three quarters of children aged 6 months to around 2 years old are estimated to be low in vitamin D (Source).

Parents, education and childhood nutrition

Google; a word that sends shivers down many a HCPs spine. Parents want to do what is best for their child, and in the most convenient manner. Parents, however, may need to be reminded that information needs to be sought from a reliable and safe source, and need to seek appropriate help from HCPs for managing their child’s health and nutrition status. 

HCPs may facilitate and encourage parents to educate themselves on good nutritional principles, giving examples of good quality resources when access to the HPC is not possible. Resources should provide information about the right types and portions of foods that are appropriate for their child’s development level and age along with learning strategies on how to manage their child’s intake appropriately. With this information at hand, parents may be able to make better decisions about their children’s diet starting at the grocery store. Seeking support and being educated appears to be the most helpful strategy that parents can used to combat childhood obesity (Source).

Healthy produce from the local famer's market

Obesity prevention

Parents and caregivers may be the key to combatting the growing obesity epidemic. Parents who are educated about the basic principles of nutrition and food parenting strategies may be able to teach their babies to have an affinity for healthy choices and establish self-regulated feeding habits. By providing parents with practical ideas for first foods and feeding practices, you may have a significant influence on decreasing the risk of your patients developing overweight or obesity in early childhood (Source).


Sensory development

The topic of introducing flavors and aromas has been discussed, and the importance of it in broadening a child’s interest and response to foods, particularly whole foods and those with potent flavors. One more factor needs to be considered, and that’s texture. There is a critical period - a time in which a behavior is permanently altered - in an infant’s life where textures need to be introduced. Taking advantage of this period between 6-7 months old (and possibly up to 12 months), leads to an increase in sensory development and improved acceptance of foods (Source). 

Sensory play activities that include vegetables with different textures being offered to infants may encourage food acceptance and health eating habits throughout life (Source).


Where does development of the microbiome fit in?

The human body is host to millions of microorganisms that live on us and in us, and function synergistically with our own cells to influence health outcomes across the lifespan—and potentially across generations. These microorganisms, referred to as “microbiota” (the organisms) or the “microbiome” (the organisms and their collective genetic makeup) carry out their actions by influencing immunologic, endocrine, and neural pathways (Source).

The newborn gut microbiome is less diverse than that of the adult. During the first three years of life, the development of the gut microbiome is influenced by the gut-brain axis, and by maternal and neonatal exposures, including mode of delivery, antibiotic exposure, and feeding patterns. 

Infants diet is an important external factor that helps shape the microbiome. HCPs can equip moms with information on meeting their growing baby’s nutritional requirements to help establish and maintain the microbiome.


Food for thought

Hopefully, we’ve provided some new information to assist you in your discussions with parents. Naturally, they only want what is best for their child. Being able to provide them with the latest research that targets the online trends they read about may be one of the best tools to be able to put their fears to rest to guide them in their decision-making, and allow them to leave knowing that they have obtained the most appropriate information from their trusted HCP.

Disclaimer: The information provided is the opinion of Good Feeding, it has not been evaluated by healthcare professionals, and is for educational purposes only.  Before starting any new foods or feeding practices, please consult your baby's healthcare professional.

Join our network

We hope you’ve found our health professionals section of benefit. We’d be honored if you would join us to ensure we provide the most relevant and up to date information available.

JOIN US

 



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