Chapter 4: Nutrition and Food Service
4.3 Requirements for Special Groups or Ages of Children
4.3.1 Nutrition for Infants
18.104.22.168: General Plan for Feeding Infants
The facility should keep records detailing whether an infant is breastfed or formula fed, along with the type of formula being served. An infant feeding record of human (breast) milk and/or all formula given to the infant should be completed daily. Infant meals and snacks should follow the meal and snack patterns of the Child and Adult Care Food Program. Food should be appropriate for the infant’s individual nutrition requirements and developmental stage as determined by written instructions obtained from the child’s parent/guardian or primary health care provider.
The facility should encourage breastfeeding by providing accommodations and continuous support to the breastfeeding mother. Facilities should have a designated place set aside for breastfeeding mothers who want to visit the classroom during the workday to breastfeed, as well as a private area (not a bathroom) with an outlet for mothers to pump their breast milk (1,2). The private area also should have access to water or hand hygiene. A place that parents/guardians feel they are welcome to breastfeed, pump, or bottle-feed can create a positive and supportive environment for the family.
Infants may need a variety of special formulas, such as soy-based formula or elemental formulas, that are easier to digest and less allergenic. Elemental or special hypoallergenic formulas should be specified in the infant’s care plan. Age-appropriate solid foods other than human milk or infant formula (ie, complementary foods) should be introduced no sooner than 6 months of age or as indicated by the individual child’s nutritional and developmental needs. Please refer to standards 22.214.171.124 and 126.96.36.199 for more information.
Human milk, as an exclusive food, is best suited to meet the entire nutritional needs of an infant from birth until 6 months of age, with the exception of recommended vitamin D supplementation. In addition to nutrition, breastfeeding supports optimal health and development. Human milk is also the best source of milk for infants for at least the first 12 months of age and, thereafter, for as long as mutually desired by mother and child. Breastfeeding protects infants from many acute and chronic diseases and has advantages for the mother, as well (3).
Research overwhelmingly shows that exclusive breastfeeding for 6 months, and continued breastfeeding for at least a year or longer, dramatically improves health outcomes for children and their mothers. Healthy People 2020 outlines several objectives, including increasing the proportion of mothers who breastfeed their infants and increasing the duration of breastfeeding and exclusive breastfeeding (4).
Incidences of common childhood illnesses, such as diarrhea, respiratory disease, bacterial meningitis, botulism, urinary tract infections, sudden infant death syndrome, insulin-dependent diabetes, ulcerative colitis, and ear infections, and overall risk for childhood obesity are significantly decreased in breastfed children (5,6). Similarly, breastfeeding, when paired with other healthy parenting behaviors, has been directly related to increased cognitive development in infants (7). Breastfeeding also has added benefits to the mother: it decreases risk of diabetes, breast and ovarian cancers, and heart disease (8).
Mothers who want to supplement their breast milk with formula may do so, as the infant will continue to receive breastfeeding benefits (4,5,7). Iron-fortified infant formula is an acceptable alternative to human milk as a food for infant feeding even though it lacks any anti-infective or immunological components. Regardless of feeding preference, an adequately nourished infant is more likely to achieve healthy physical and mental development, which will have long-term positive effects on health (9).
The ways to help a mother breastfeed successfully in the early care and education facility are (2,6,8):
- If she wishes to breastfeed her infant or child when she comes to the facility, offer or provide her a
- Quiet, comfortable, and private place to breastfeed (This helps her milk to let down.)
- Place to wash her and her infant’s hands before and after breastfeeding
- Pillow to support her infant on her lap while nursing
- Nursing stool or step stool for her feet so she doesn’t have to strain her back while nursing
- Glass of water or other liquid to help her stay hydrated
- Encourage her to get the infant used to being fed her expressed human milk by another person before the infant starts in early care and education, while continuing to breastfeed directly herself.
- Discuss with her the infant’s usual feeding pattern and the benefits of feeding the infant based on the infant’s hunger and satiety cues rather than on a schedule; ask her if she wishes to time the infant’s last feeding so that the infant is hungry and ready to breastfeed when she arrives; and ask her to leave her availability schedule with the early care and education program as well as to call if she is planning to miss a feeding or is going to be late.
- Encourage her to provide a backup supply of frozen or refrigerated expressed human milk; properly label the infant’s full name, date, and time on the bottle or other clean storage container in case the infant needs to eat more often than usual or the mother’s visit is delayed.
- Share with her information about other places or people in the community who can answer her questions and concerns about breastfeeding, such as local lactation consultants.
- Provide culturally appropriate breastfeeding materials, including community resources for parents/guardians that include appropriate language and pictures of multicultural families to assist families in identifying with them.
- Ensure that all staff receive training in breastfeeding support and promotion.
- Ensure that all staff are trained in the proper handling, storing, and feeding of each milk product, including human milk or infant formula.
- Breastfeeding, US Department of Health and Human Services Office on Women’s Health (https://www.womenshealth.gov/printables-and-shareables/health-topic/breastfeeding)
- Feeding Infants: A Guide for Use in the Child Nutrition Programs, US Department of Agriculture (USDA) Food and Nutrition Service (https://wicworks.fns.usda.gov/wicworks/Topics/FG/CompleteIFG.pdf)
- Infant Meal Pattern, USDA (https://fns-prod.azureedge.net/sites/default/files/cacfp/CACFP_infantmealpattern.pdf)
- Strategy 6, Support for Breastfeeding in Early Care and Education, Centers for Disease Control and Prevention (https://www.cdc.gov/breastfeeding/pdf/strategy6-support-breastfeeding-early-care.pdf)
- Updated Child and Adult Care Food Program Meal Patterns: Infant Meals, USDA (https://fns-prod.azureedge.net/sites/default/files/cacfp/CACFP_InfantMealPattern_FactSheet_V2.pdf)
TYPE OF FACILITYCenter, Early Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS188.8.131.52 Written Menus and Introduction of New Foods
184.108.40.206 Preparing, Feeding, and Storing Human Milk
220.127.116.11 Preparing, Feeding, and Storing Infant Formula
18.104.22.168 Introduction of Age-Appropriate Solid Foods to Infants
22.214.171.124 Feeding Age-Appropriate Solid Foods to Infants
Appendix JJ: Our Child Care Center Supports Breastfeeding
Centers for Disease Control and Prevention. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta, GA: US Department of Health and Human Services; 2013. http://www.cdc.gov/breastfeeding/pdf/BF-Guide-508.pdf. Accessed January 11, 2018
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); US Department of Agriculture Food and Nutrition Service. Breastfeeding Policy and Guidance. https://www.fns.usda.gov/sites/default/files/wic/WIC-Breastfeeding-Policy-and-Guidance.pdf. Published July 2016. Accessed January 11, 2018
Darmawikarta D, Chen Y, Lebovic G, Birken CS, Parkin PC, Maguire JL. Total duration of breastfeeding, vitamin D supplementation, and serum levels of 25-hydroxyvitamin D. Am J Public Health. 2016;106(4):714–719
Healthy People 2020. Maternal, infant, and child health. HealthyPeople.gov Web site. https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives. Accessed January 11, 2018
Furman L. Breastfeeding: what do we know, and where do we go from here? Pediatrics. 2017;139(4):e20170150
American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics. 2012;129(3):e827–e841
Gibbs BG, Forste R. Breastfeeding, parenting, and early cognitive development. J Pediatr. 2014;164(3):487–493
Binns C, Lee M, Low WY. The long-term public health benefits of breastfeeding. Asia Pac J Public Health. 2016;28(1):7–14
Danawi H, Estrada L, Hasbini T, Wilson DR. Health inequalities and breastfeeding in the United States of America. Int J Childbirth Educ. 2016;31(1)
Content in the STANDARD was modified on 05/30/2018.