Study sheet: Infant and Young Child Nutrition

📋 Course Outline

1. Growth From Birth to Three Years
2. Breastfeeding Benefits and Contraindications
3. Breastfeeding Practices and Milk Expression
4. Infant Formula and Bottle Hygiene
5. Diversification and Texture Progression
6. Food Neophobia and Meal Composition
7. Food Safety and Baby-Led Weaning
8. Age-Based Food Introduction
9. Menu Planning and GEMRCN Goals
10. Energy and Nutrient Requirements

📖 1. Growth From Birth to Three Years

★ Must-know

• At birth, an infant measures approximately 50 cm and weighs 3.3 kg.

• Average weight doubles by the fifth month, triples by 12 months, and quadruples by 2 years.

Further detail

• Average daily weight gain is (WHO 2006, Organisation mondiale de la santé, 22e édition, 2021):
  • 20–30 g from 0–3 months
  • 15–20 g from 3–6 months
  • 10–15 g from 6–9 months
  • 5–10 g from 9–24 months

📐 Formula — Head circumference at 1 year is estimated by $T/2 + 10$, where T is the birth head circumference measurement according to the course.

💡 Memory Hook

Weight ×2 at 5 months, ×3 at 12 months, ×4 at 2 years

📖 2. Breastfeeding Benefits and Contraindications

🔑 Key Concepts & Definitions

• Breast milk : meets the infant’s nutritional, immunological, and affective needs for growth and adapts to the child’s needs and rhythm

📝 Essential Points

• Breastfeeding is recommended until at least 6 months and is associated with lower infection risk, lower risk of type 2 diabetes and obesity, lower allergy risk, and lower risk of sudden infant death.

• Situations requiring assessment include:

  • galactosemia
  • phenylketonuria
  • HIV infection
  • certain medications
  • drug or alcohol use
  • some oral malformations

💡 Memory Hook

Breastfeeding supports immunity and bonding, whereas its contraindications require individualized care

📖 3. Breastfeeding Practices and Milk Expression

★ Must-know

📌 Breastfeeding should be offered on demand without fixed times or quantities, with the infant put to the breast soon after birth and not forced to finish.

• 🔄 Lactation support involves: placing the infant at the breast quickly, breastfeeding frequently and regularly, avoiding unnecessary supplementary bottles and pacifiers, supporting positioning, hydration, rest, confidence, and emotional calm

Further detail

• During the first weeks, approximately 6–7 feeds per 24 hours and feeds lasting about 15–20 minutes every 2–3 hours are common, but individualization is required.

📌 Expressed breast milk should be placed directly in a bottle, refrigerated below 4°C for up to 4 days or frozen at −18°C for up to 4 months, and transported in a cool box.

💡 Memory Hook

Early, frequent feeding → improved milk production

📖 4. Infant Formula and Bottle Hygiene

🔑 Key Concepts & Definitions

• Infant preparation : a food intended for infants during the first months of life that alone meets their nutritional needs until suitable complementary feeding begins

📝 Essential Points

• A bottle is prepared with one level scoop of infant formula per $30\,\text{mL}$ of low-mineral or suitably labeled tap water.

• Formula age ranges are:

  • first-age formula: birth to 4–6 months
  • second-age formula: 6–12 months
  • growing-up milk: 1–3 years

📐 Formula — The estimated daily milk volume is $\text{child’s weight in grams}/10 + 250\,\text{mL}$; for a 7 kg child, this gives 950 mL per day.

💡 Memory Hook

Measure, prepare, refrigerate, clean

📖 5. Diversification and Texture Progression

★ Must-know

📌 Complementary feeding should begin between 4 completed months and 6 completed months.

• 🔄 Texture progression follows:
  1. smooth purée
  2. mashed food
  3. minced food
  4. pieces

📌 Infant milk should be maintained until 3 years, with approximately 500 mL of infant milk per day, while lipids and iron must be adequately provided.

Further detail

• Allergens may be introduced during the opening window from 4 completed months to 6 completed months, even when there is a family history of allergy.

💡 Memory Hook

Smooth purée → mashed → minced → pieces

📖 6. Food Neophobia and Meal Composition

🔑 Key Concepts & Definitions

• Food neophobia : refusal of new foods or new food forms, especially between 18 and 24 months

★ Must-know

• To reduce food neophobia, adults should model eating, offer small repeated tastings without pressure, make meals playful, allow finger exploration, and progress gradually through textures.

Further detail

• The family rhythm includes:

  • breakfast
  • lunch
  • snack
  • dinner

• Around 12 months, the child generally transitions toward growing-up milk and a diet with progressively more pieces.

💡 Memory Hook

Respectful exposure differs from forcing the child to finish

📖 7. Food Safety and Baby-Led Weaning

🔑 Key Concepts & Definitions

• Baby-led weaning : the introduction of solid foods from 6 completed months so that the child grasps food independently and self-regulates intake

📝 Essential Points

📌 Honey is prohibited before 1 year because of the risk of infant botulism, while raw or undercooked meat is prohibited before 10 years and raw milk or raw-milk cheese before 5 years.

• Baby-led weaning requires:
  • head and trunk control in sitting
  • hand-to-mouth coordination
  • interest in family foods
  • developmentally adapted size and texture
  • respect for satiety signals
  • constant supervision

📌 Baby-led weaning may improve autonomy and motor development, but it can cause choking if unsupervised and may provide insufficient energy when the child eats little; it must not replace breast milk or formula before 12 months. — ESPGHAN, 2025

💡 Memory Hook

DME promotes autonomy, but unsupervised pieces increase choking risk

📖 8. Age-Based Food Introduction

★ Must-know

• From 4–5 months, foods are introduced as smooth purées; from 6–8 months, textures progress toward mashed foods and small pieces; from 1–3 years, all textures are progressively offered according to age and ability.

📌 Water is the only recommended beverage, while sugary drinks, juices, coffee, tea, energy drinks, and light drinks should be avoided or limited.

Further detail

• From 6–12 months, meat, fish, or egg portions increase progressively from approximately 10 g per day to 20 g and then 30 g according to age and development.

• Added fats should be provided daily, generally as one teaspoon of oil or occasionally one small knob of butter before 1 year and two teaspoons of oil or two small knobs of butter from 1–3 years.

💡 Memory Hook

Milk first, smooth foods at 4–6 months, textures and portions progressively increase

📖 9. Menu Planning and GEMRCN Goals

★ Must-know

• GEMRCN objectives include: increasing fruit, vegetable, and starchy-food consumption, reducing added simple sugars, balancing fatty acids, controlling protein intake, covering iron needs, adapting texture and shape to age and chewing ability

📌 Menus should favor simple, minimally processed foods, avoid added salt and sugar, limit additives and processed products, and prohibit raw animal products, raw fish, raw shellfish, and vegetable drinks.

Further detail

• Fish should be offered twice weekly, including one oily fish, while wild fish and bioaccumulating fish should be limited or prohibited according to the recommendation.

💡 Memory Hook

Age-appropriate textures and balanced foods → fewer choking risks and better nutrient coverage

📖 10. Energy and Nutrient Requirements

★ Must-know

• For children under 1 year, the course gives an energy reference of 385 kJ/kg/day, equivalent to approximately 90 kcal/kg/day.

📐 Formula — Henry’s equation estimates daily energy needs as $0.255 \times P - 0.141$ MJ/day for boys and $0.246 \times P - 0.0965$ MJ/day for girls, where P is body mass in kilograms.

• Protein should provide 7–15% of energy intake from 0–1 year and 6–15% from 1–3 years, while fat should provide 50–55% from 0–5 months and 45–50% from 6 months to 3 years.

• Vitamin D recommendations are 10 µg/day from 0–12 months and 15 µg/day from 1–3 years, while calcium recommendations are 200 mg/day from 0–6 months, 280 mg/day from 6–11 months, and 450 mg/day from 1–3 years.

• Iron recommendations are 0.3 mg/day from 0–5 months, 11 mg/day from 6–11 months, and 5 mg/day from 1–2 years; iron absorption is approximately 50% from breast milk versus 5–10% from cow’s milk.

Further detail

• Recommended energy intake averages 3,900 kJ at 1 year, 4,500 kJ at 2 years, and 4,900 kJ at 3 years when averaged across boys and girls.

• Vitamin C intake is recommended at 20 mg/day from 0–3 years and supports non-heme iron absorption, antioxidant protection, calcium fixation, and immune function.

📊 Synthesis Tables

Milk Types by Age

Milk	Age range	Key guidance
Breast milk	At least to 6 months	Meets nutritional, immunological, and affective needs
First-age formula	Birth to 4–6 months	Used before complementary feeding
Second-age formula	6–12 months	At least 500 mL/day is maintained in the course
Growing-up milk	1–3 years	Introduced around 12 months