Caring for Our Children (CFOC)

Chapter 4: Nutrition and Food Service

4.3 Requirements for Special Groups or Ages of Children

4.3.1 Nutrition for Infants

4.3.1.2: Responsive Feeding of Infants by a Consistent Caregiver/Teacher

Content in the STANDARD was modified on 5/30/2018 and 2/9/2023.


Responsive feeding is a give-and-take approach between a caregiver and an infant where the infant communicates hunger and fullness cues and the caregiver responds appropriately to these cues. Caregivers/teachers should feed infants on cue unless the parent/guardian and the child’s primary health care provider give written instructions stating differently.1 Caregivers/teachers should be gentle, patient, sensitive, and reassuring when responding properly to the infant’s feeding cues. Responsive feeding is most successful when caregivers/teachers learn how infants verbally communicate hunger and fullness. Crying alone is not a cue for hunger unless the infant also shows other cues, such as opening the mouth, making sucking sounds, rooting, fast breathing, clenched fingers or fists, and flexed arms or 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 or fullness; just as hunger cues are important in starting a feeding, watching for satiety or fullness cues can limit overfeeding. An infant may communicate fullness by shaking the head or turning away from food.1,3,4 A pacifier should not be offered to an infant before a feeding.

RATIONALE

Responsive feeding is a successful way to meet the infant’s nutritional and emotional needs and to give the infant an immediate response, which helps to make sure the infant trusts the caregiver/teacher and feels secure.5 A caregiver/teacher is more likely to understand how a specific infant communicates hunger and satiety when they give consistent feedings and bond with the child regularly over time. When an infant forms an early relationship with caregivers/teachers for feeding, this helps an infant to develop healthy eating patterns for life.1–4 Responsive feeding may help prevent childhood obesity.6

COMMENTS

ADDITIONAL RESOURCES:

American Academy of Pediatrics

Starting Solid Foods - https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/Starting-Solid-Foods.aspx

TYPE OF FACILITY
Center, Early Head Start, Large Family Child Care Home, Small Family Child Care Home
RELATED STANDARDS
4.3.1.1 General Plan for Feeding Infants
4.3.1.8 Techniques for Bottle Feeding
REFERENCES
  1. Pérez-Escamilla R, Segura-Pérez S, Lott M. Feeding guidelines for infants and young toddlers: a responsive parenting approach. Nutrition Today. 2017;52(5), 223-231. doi: 10.1097/NT.0000000000000234. Published September 2017. Accessed November 10, 2022

  2. 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 10, 2022

  3. 4Cs of Alameda County. Providing care for infants and toddlers. 4calameda.org Web site. www.4c-alameda.org/downloads/rr/providers/PROVCaringforInfantsToddlers.pdf. Published July 2017. Accessed November 9, 2022

  4. U.S. Department of Agriculture. WIC Works Resource System. Guidelines for feeding healthy infants. USDA.gov Web site. https://wicworks.fns.usda.gov/sites/default/files/media/document/Guidelines_for_Feeding_Healthy_Infants_Job_Aid.pdf. Updated September 2018. Accessed November 9, 2022

  5. Head Start Early Childhood Learning & Knowledge Center. Child observation: the heart of individualizing responsive care for infants and toddlers. HHS.gov Web site.  https://eclkc.ohs.acf.hhs.gov/child-screening-assessment/child-observation-heart-individualizing-responsive-care-infants-toddlers/child-observation-heart-individualizing. Updated June 13, 2022. Accessed November 9, 2022

  6. Vandyousefi S, Messito MJ, Katzow MW, Scott MA, Gross RS. Infant appetite traits, feeding practices and child obesity in lowÔÇÉincome Hispanic families. Pediatric Obesity, p.e12913. https://onlinelibrary.wiley.com/doi/full/10.1111/ijpo.12913. Published March 11, 2022. Accessed November 9, 2022

NOTES

Content in the STANDARD was modified on 5/30/2018 and 2/9/2023.