Childhood nutrition

Infants, toddlers and school children need to satisfy their energy and nutrient requirements for normal growth, development and activity through eating a varied and balanced diet.

Expected growth in childhood

The 50th centile birthweight for children in the UK is 3.5kg (7 pounds). This means that in 100 babies, 50 will be born at that weight. Weight, length (or height in the over 2’s) and head circumference is plotted routinely on growth charts by healthcare professionals. These growth charts have 9 centile lines. Centiles are not a measure of what is ‘normal’. They are useful for monitoring a child’s growth parameters over time.

During the first 5-7 days of life there is often some weight loss due to babies slowly increasing their milk intake (and mum’s gradually producing more milk in the breast). Birthweight is usually regained by 10-14 days. After this, average weight gain is as follows:

200g (6-7 ounces) per week for the first 3 months
150g (5 ounces) per week for the second 3 months
100g (3-4 ounces) per week for the third 3 months
50-75g (1.5-2.5 ounces) per week for the fourth 3 months

Please note that this is a guide only and babies can grow above or below this range. If babies or children deviate significantly from their ‘usual’ centile line referral to a Paediatric Dietitian or Paediatrician may be necessary.

In the first year of life, babies increase their length by approximately 25cm. Average growth continues at approximately 2kg (4 pounds) per year and 10 cm per year steadily declining to 6cm per year until the growth spurt at puberty.

Infants: breastfeeding

Breastfeeding is the ideal way to feed infants and is considered to fully meet a healthy baby’s nutritional needs until 6 months of age (WHO 2003) at which point complementary foods should be introduced in addition. In the UK 73% of mothers start breastfeeding and there are numerous advantages to feeding this way:

Reduced incidence of gastrointestinal, respiratory and urinary tract infections
Improved longterm cardiovascular health
Improved cognitive development
Lower risk of allergy in those with a family history
Potential reduced risk of obesity in adulthood

The composition of breastmilk is uniquely designed to fit each stage of baby’s development. In the first few days following the birth of a baby the mother’s breasts produce colostrum which is a nutrient rich golden fluid packed full of immunoglobulins. This is produced in low volumes (as baby takes very little at this stage) and provides maternal immunity against infection. Around day 3 the breast milk changes in its constituents and the volume produced by the breast increases. The energy content of the breast milk also increases and the nutritional content can vary to meet the individual infants nutrition and fluid requirements.

Breastmilk contains all of the essential nutrients necessary for growth and development. It cannot be replicated. These nutrients include:

Water
Protein – protein accounts for 75% of the nitrogen-containing compounds
Fat – essential fatty acids and long-chain polyunsaturated fatty acids
Carbohydrate – the principal carbohydrate of human milk is lactose.
Minerals, vitamins, and trace elements.

Breast milk also contains important non-nutritional components, such as antimicrobial factors, digestive enzymes, hormones and growth factors that are important for passive protection against infections and immune-mediated diseases and modulate immunological development.

Feed your baby as often and for as long as she likes. This is called demand or responsive feeding.

PLEASE READ THE SECTION BREASTFEEDING: THE BASICS and THE FIRST FEW DAYS to give a more comprehensive practical overview of this method of feeding.

Infants: Formula Feeding

Types of Infant Formula

Infants who are not breastfed should be given an approved infant formula based on modified cow’s milk protein. This should be continued until 12 months of age. Choosing an infant formula can be a minefield for parents who are bombarded with information from formula companies. The marketing of these products can be confusing and many parents are left unsure which to choose, how much to spend, and whether their child needs a ‘special’ milk.

The majority of infant formula available in the UK come from 4 main nutritional companies. Infant formula milks available must comply with government regulation based on EU directives. The milks available from these 4 companies are listed in Table 1.

Infant formula is usually based on processed cow’s milk and is treated to make it suitable for babies. There are a number of brands in the shops that meet the required legal standards. There is no evidence to suggest that changing brands does any good or harm. However, if you think a particular brand of milk disagrees with your baby, try another. The midwife or health visitor should be able to discuss this with parents.

Infant formula can be either whey dominant or casein dominant depending on the balance of proteins it contains.

Those formula milks which are closest in composition to breastmilk are called First infant formula and they are whey dominant (60:40 whey:casein).

First infant formula can be used from birth until the baby is 12 months. For most babies this is the one and only type of formula required until the age of 1 year.

Milks with a higher casein:whey ratio (80:20) are marketed for hungry babies (hungry milk formula). This is based on the proposal that casein slows down emptying from the stomach and keeps baby fuller for longer. There is no scientific or medical evidence that these milks satisfy hunger any more than demand feeding with First milk formula. Casein dominant milks contain a higher renal solute load which are solutes that require the kidneys to excrete from the body. The hungry baby on a whey dominant formula should be offered a larger volume of milk rather than changing to a casein dominant formula.

There is no rationale for giving a baby hungry milk.

Follow-on formula is designed for babies over the age of 6 months. They are also casein dominant and have higher levels of protein, minerals and some vitamins than first infant formula.

The use of these formula is rarely required unless the child has a poor intake of solids.

Formula manufactured from other proteins is not suitable unless given under medical advice and supervision. Unmodified cow’s milk, goat’s milk and sheep’s milk are also unsuitable as they are too high in sodium and protein and do not provide enough iron to meet the infant’s needs.

Types of milk to avoid: not all milk is suitable for feeding babies. The following milks should never be given to a baby under the age of one year:

condensed or evaporated milk
dried milk
sheep’s milk
goat’s milk
rice, oat or almond milk drinks

Once a baby reaches 6 months of age parents can use small amounts of full fat cow’s milk in the preparation of foods and for cooking. After the age of one year, the baby can be given full fat cow’s milk as a drink and formula milk can be discontinued.

Please do not give semi skimmed cow’s milk until age 2 years and skimmed milk can be given from age 5 years providing the child is growing well and eating a varied diet.

There are some instances where infants may require specialised infant formula. These milks may contain increased quantities of energy or protein, may have their proteins partially or fully digested, have different types of fat or have reduced electrolytes. These milks are not available to buy over the counter in the UK and should only be prescribed by an appropriately qualified healthcare professional. Infants prescribed these milk will require regular monitoring by a suitably qualified healthcare professional.

There are many other milks on the market such as Goodnight milks, Toddler milks, Comfort milks, Anti reflux milks and Lactose free milks. These milks are available to buy in supermarkets even though the use of some should be carried out under medical supervision. In Table 1 there is a description of each milk available from the 4 most well known companies.

How much milk should I give?

Birth to 6 months

Healthy infants should be fed on demand and offered adequate breast or formula milk to satisfy their hunger. Healthy infants will naturally regulate their feeding and will take enough milk to meet their needs, and it is recommended that parents learn to recognise feeding cues given by their infants. An infant’s milk requirements may vary from day to day, but most full-term infants will need to be fed every 2-3 hours, day and night, in the early weeks of life. Parents should bottle-feed in the same way that they are encouraged to breastfeed, offering one-to-one contact and meeting each individual infant’s needs, being responsive to baby’s cues. Babies should be allowed to feed on demand and not be encouraged to ‘finish the bottle’.

Bottle-fed babies should be initially offered about 20ml formula milk/kg on the first day, divided into eight feeds, with the volume gradually increased over the following days to appetite, so that they are having about 150ml/kg by 7-14 days.

Most babies will need 150-180ml/kg/day of infant formula until they are 6 months old, although this will vary for the individual baby.

From 6 months

At around 6 months parents should start offering complementary foods (known in the UK as weaning).

By 7-9 months of age, infants should be getting increasing amounts of nutrients from food, and the amount of formula milk consumed should be around 600ml a day.

By 10-12 months of age, the amount of milk consumed should be around 400ml per day as food takes over as the main source of energy and nutrients. Once formula intake decreases below 500ml per day parents should give vitamin drops. Your health visitor can give you advice on vitamin drops and tell you where to get them. You’re entitled to free vitamin drops if you qualify for Healthy Start.

Further information on weaning will be provided in the Complementary Feeding section. Vitamin supplementation will also be discussed further in this section.

Table 1

There are 4 main manufacturers of Infant Milk Formula in the UK. Each of these manufacturers offer various milks. This table provides an easy to follow explanation of each milk and its use.

Please note we have no affiliation with any manufacturer and are completely impartial regarding each. In the description and where appropriate we have included opinion from the British Dietetic Association, First Steps nutrition and other relevant health authority bodies regarding the use of each product. All milk products below meet all the required compositional criteria for infant formula in the UK. The milks listed are accurate at February 2017.

* The organic status of HiPP Organic Milks distinguishes it from most other infant milks on the UK market. However, it is important to note that there are limits on the level of any individual pesticide residue that may be present in infant formula and follow- on formula and specific upper limits for toxic pesticides.

There are a range of Toddler/Growing Up milks and Good Night milks available in the UK.

Good night milks are casein dominant and contain thickeners. There is no evidence to support the suggestion that they help babies settle at bedtime.

Growing Up milks, also called Toddler milks are offered by infant milk manufacturers as an alternative to, or to complement full fat cow’s milk from the age of 1 year. They provide higher quantities of some micronutrients but are typically lower in iodine, calcium and riboflavin as well as being sweeter than cow’s milk. They are three times more expensive than cow’s milk and are not recommended by healthcare professionals.

Making up Powdered Infant Formula

A babies immune system isn’t as strong as an adult’s. That’s why all bottles, teats, and other feeding equipment needs to be washed and sterilised before each feed. This will reduce the risk of baby getting an infection.

Table 2: Guidelines on the safe preparation and storage of powdered infant formula milks

General Recommmendations