CPS Statement: Nutrition for healthy term infants, six to 24 months

CPS Statement: Nutrition for healthy term infants, six to 24 months

The following was adapted from the joint statement on "Nutrition for Healthy Term Infants, Recommendations from Six to 24 Months." Please see the full statement or the CPS Practice Point for the full recommendations from Health Canada, the Canadian Paediatric Society, Dieticians of Canada and the Breastfeeding Committee for Canada.

This document provides health care professionals with evidence-based information to give accurate and consistent advice to Canadian parents and caregivers about nutrition for healthy term infants aged six to 24 months. For information about nutrition from birth to six months, see the PedsCases summary of these guidelines here. This statement is organized into eight key principles:

1) Breastfeeding is an important source of nutrition for older infants and young children as complementary foods are introduced:

Health care professionals should support continued breastfeeding, with appropriate complementary foods for up to two years or beyond. Many mothers feel a stigma about breastfeeding an older infant, so health care professionals can provide support and education.

Benefits of breastfeeding past six months include:

  • A protective effect against obesity later in childhood.
  • Decreased risk of maternal breast and ovarian cancer.
  • Increased bonding between mother and child.
  • Limited evidence of immune factors in breastmilk reduce rates of GI and respiratory infections.

2) Supplemental vitamin D is recommended for infants and young children who are receiving breastmilk:

Young children who are receiving breastmilk should receive 400 units of vitamin D supplementation per day until two years of age. Infants who are formula-fed, or stop breastfeeding do not require vitamin D supplementation as they will get sufficient vitamin D from other sources.

3) Complementary feeding, along with continued breastfeeding provides the nutrients and energy to meet the needs of the older infant:

After six months of age, breastmilk is not sufficent to meet an infant's nutrient needs and complementary foods should be introduced.  From six to 12 months, breastfeeding can provide one half or more of energy needs, and from 12 to 24 months one third of a child's energy can come from breastfeeding.

Caregivers should gradually increase the frequency that they offer complementary foods. Starting with two times per day at six months, they should work towards offering a regular schedule of foods three times per day with snacks by 12 months. 

Infants can be introduced to a variety of foods from the family meal, modified to an appropriate texture and size for the child's age and development.  Infants should be offered lumpy textures by no later than nine months and a variety of textures of food by one year. Introduction of a variety of food textures has been shown to reduce feeding difficulties later in life.

4) Responsive eating promotes the development of healthy eating skills:

Caregivers should be encouraged to feed based on a child's hunger and satiety cues. This type of responsive feeding avoids under- and over-feeding and can help a child develop self-regulation of energy intake. Finger foods should be among the first complementary foods introduced to encourage self-feeding and promote oral and motor development.

Older infants should be offered water from an open cup along with complementary feedings to promote mature drinking skills. The transition from bottle feeding to an open cup should occur by about 12 months. 

5) Iron-rich complementary foods help to prevent iron deficiency:

At about six months of age, an infants iron stores are depleted and rapid growth creates higher iron needs.  Iron deficiency is common and may not be apparent until a deficiency is severe. Iron deficiency anemia can lead to irreversible cognitive delays and should be avoided.  Risk factors for iron deficiency include:

  • Prematurity or low birth weight
  • Introduction of cow milk before 9-12 months of age
  • Excess cow milk intake
  • Diet low in iron-rich foods

From six to 12 months, iron rich foods should be offered at least two times per day, and from 12 to 24 months, iron-rich foods should be offered at each meal. Iron-rich foods include:

  • Meat
  • Meat alternatives (eg. Eggs, tofu or legumes)
  • Iron-fortified cereals

6) Foods for older infants and young children must be prepared, served and stored safely:

Infants and young children should always be supervised during feeding.  Caregivers should avoid offering foods that are hard, small and round, or smooth and sticky due to the risk of aspiration and choking

Children younger than one year should not be given honey due to the risk of infant botulism.

7) From one year, children should begin to have a regular schedule of meals and snacks, following Canada's Food Guide:

A regular schedule of meals and snacks will help young children develop healthy eating habits. Foods should be prepared with little or no added salt or sugar, but restriction of dietary fat is not recommended in children younger than 2 years.

Intake of fruit juices and sweetened beverages should be limited. These drinks are associated with dental decay and the calories can displace a childs appetite for breastmilk or more nutritious foods.

8) Recommendations on the use of breastmilk substitutes:

The statement recognizes that some infants may not be breastfed for personal, medical or social reasons. Health care professionals should inform parents about the importance of breastfeeding, the personal/social/economic costs of formula feeding and the difficulty of reversing the decision not to breastfeed.

For an older infant who is not receiving breastmilk:

  • Recommend commercial infant formula until nine to 12 months of age.
  • Pasteurized homogenized (3.25% M.F.) cow milk should be introduced at nine to 12 months of age. Skim milk is not appropriate for the first two years of life.
  • Advise that soy, rice, or other plant-based beverages are inappropriate alternatives to breastmilk or cow milk in the first two years of life

Caregivers should be discouraged from giving infants a bottle at night due to the increased risk of early childhood caries.

 

Sample menus for children of different ages and dietary needs can be found at the bottom of the original statement.

Last updated by PedsCases: January 13, 2015

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