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: Feeding Infants on Cue by a Consistent Caregiver/Teacher
Caregivers/teachers should feed infants on cue unless the parent/guardian and the child’s primary health care provider give written instructions stating otherwise (1). Caregivers/teachers should be gentle, patient, sensitive, and reassuring when responding appropriately to the infant’s feeding cues (2). Responsive feeding is most successful when caregivers/teachers learn how infants externally communicate hunger and fullness. Crying alone is not a cue for hunger unless accompanied by other cues, such as opening the mouth, making sucking sounds, rooting, fast breathing, clenched fingers/fists, and flexed arms/legs (1,2). Whenever possible, the same caregiver/teacher should feed a specific infant for most of that infant’s feedings (3). Caregivers/teachers should not feed infants beyond satiety; just as hunger cues are important in initiating feedings, observing satiety cues can limit overfeeding. An infant will communicate fullness by shaking the head or turning away from food (1,4,5).
A pacifier should not be offered to an infant prior to being fed.
Responsive feeding meets the infant’s nutritional and emotional needs and provides an immediate response to the infant, which helps ensure trust and feelings of security (6). A caregiver/teacher is more likely to understand how a particular infant communicates hunger/satiety when consistent, reliable feedings and interactions are done regularly over time. Early relationships between an infant and caregivers/teachers involving feeding set the stage for an infant to develop eating patterns for life (1-5). Responsive feeding may help prevent childhood obesity (5-7).
TYPE OF FACILITYCenter, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS22.214.171.124 General Plan for Feeding Infants
126.96.36.199 Techniques for Bottle Feeding
Blaine RE, Davison KK, Hesketh K, Taveras EM, Gillman MW, Benjamin Neelon SE. Child care provider adherence to infant and toddler feeding recommendations: findings from the Baby Nutrition and Physical Activity Self-Assessment for Child Care (Baby NAP SACC) Study. Child Obes. 2015;11(3):304–313
Pérez-Escamilla R, Segura-Pérez S, Lott M, on behalf of the Robert Wood Johnson Foundation HER Expert Panel on Best Practices for Promoting Healthy Nutrition, Feeding Patterns, and Weight Status for Infants and Toddlers From Birth to 24 Months. Feeding Guidelines for Infants and Young Toddlers: A Responsive Parenting Approach. Guidelines for Health Professionals. Durham, NC: Healthy Eating Research; 2017. http://healthyeatingresearch.org/wp-content/uploads/2017/02/her_feeding_guidelines_brief_021416.pdf. Published February 2017. Accessed November 14, 2017
Zero to Three. How to care for infants and toddlers in groups. 4. Continuity of care. https://www.zerotothree.org/resources/77-how-to-care-for-infants-and-toddlers-in-groups#chapter-38. Published February 8, 2010. Accessed November 14, 2017
US Department of Agriculture, Special Supplemental Nutrition Program for Women, Infants, and Children. Infant hunger and satiety cues. https://wicworks.fns.usda.gov/wicworks/WIC_Learning_Online/support/job_aids/cues.pdf. Updated October 2016. Accessed November 14, 2017
Buvinger E, Rosenblum K, Miller AL, Kaciroti NA, Lumeng JC. Observed infant food cue responsivity: associations with maternal report of infant eating behavior, breastfeeding, and infant weight gain. Appetite. 2017;112:219–226
Early Head Start National Resource Center. Observation: The Heart of Individualizing Responsive Care. Washington, DC: Early Head Start National Resource Center; 2013. https://eclkc.ohs.acf.hhs.gov/sites/default/files/pdf/ehs-ta-paper-15-observation.pdf. Accessed November 14, 2017
Redsell SA, Edmonds B, Swift JA, et al. Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood. Matern Child Nutr. 2016;12(1):24–38
Content in the STANDARD was modified on 05/30/2018.