Patient Presentation
A 6-month-old male came to clinic with his parents for his well child care. He was bottle-feeding and gaining appropriate weight. The father had many questions about feeding and if canned vegetables could be used for feeding his child. He was already taking some fortified rice cereal without problems. The social history showed that the parents were young, both working and also receiving government assistance through supplemental food and healthcare programs.
The pertinent physical exam showed a healthy male with normal development and growth parameters in the 10-50%. The diagnosis of a healthy boy was made. The parents were counseled that canned foods were usually not recommended because they often contained added sugar, salt and preservatives. The physician talked some about how to prepare baby foods and that certain foods should not be used because of the increased risk of nitrate contamination. The father remarked, “that’s a lot of work and there’s not a lot of canned vegetables that you could use anyways.” The family was given a handout about homemade baby foods and the social worker gave information about local food pantries. At 9 months, the family still had financial concerns but the father was happy that he had received a raise in wages and felt more confident to see hiss son growing well.
Discussion
Parents want the best for their children and questions about nutrition are at the top of the list. Parent may want to prepare their own baby food because of beliefs about nutritional adequacy, contamination, or for providing another expression of emotional support for the infant. Because home preparation is so widely variable, it can be difficult to determine if children are being provided overall appropriate nutrition. “In a European study, investigators found that many home-prepared complementary foods were low in energy, fat, protein, iron and zinc. In addition, nutrition content was more variable than for infants fed commercial baby foods, despite mothers’ intention to provide a more nutritious diet by preparing foods at home.” This knowledge however does not preclude appropriate home preparation for some or all of the infants needs.
Parents also often ask about nutritional supplements, and studies show about 30-40% are giving their children some type of nutritional supplement. Most children do not need supplements but those at risk include:
- Children with chronic diseases
- Children living in socially deprived situations including those suffering from abuse or neglect
- Children on special medical management diets including obesity management
- Children with lack of normal physiologic growth
- Children consuming a vegetarian diet without adequate intake of dietary products. For more information see, What Types of Foods Should Vegetarians Eat to Maintain Proper Nutrition?
- Children with inadequate appetites such as anorexia
- Children consuming fad diets
Learning Point
Home prepared baby foods are safe as well as certain principles are followed:
- Foods need to be soft and easily swallowed, therefore usually requiring cooking, mashing and straining to remove any large or fibrous particles. Corn is not recommended because it is virtually impossible to remove the fiber to make it safe for infants.
For older infants food should be < 1/4 inch cube in size - Foods should not have salt, sugar, fat, seasonings or preservatives added.
- Certain foods should not be home prepared or used. For infant baby food:
- Beets, turnips, carrots, and collard greens may contain high amounts of nitrates. Spinach may be similar. Nitrates levels vary depending on the food, season, producer etc. Also water contamination may be a more significant contributor to nitrates than the actual food.
- Honey may contain Clostridium botulinum spores and is not recommended in children < 1 year.
- Raw or partially cooked eggs are never recommended because of the risk of Salmonella.
- Food preparation equipment, surfaces, and utensils need to be carefully cleaned. Meticulous food preparation should be followed.
- Food storage with appropriate temperature control needs again to be meticulously maintained.
- Reheating foods should be to body temperature. Some authorities do not recommend microwaving infant food because of the risk of “hot spots” in the food or excessive temperature overall in the food. The American Academy of Pediatrics recommends that if microwaving is used, that the foods be thoroughly stirred to even out the temperature of the food and to test before serving to the child.
- Home canned foods are not recommended because of the risk of improper canning. Canned food should not be used if outdated, dented, rusted, bulging, leaking or does not have a label.
If canned foods are used rinsing of the food before preparation is begun is recommended.
Culturally appropriate foods should be encouraged as long as they follow the guidelines above. Soy products such as tofu are often used in Asian cultures, and many dried beans and peas are used in Asia, Africa and South and Central America for example.
Food allergy is a separate topic and there is some data to support exclusively breastfeeding infants until at least 6 months, but delaying complementary food until later does not necessarily decrease food allergies or problems attributed to them such as eczema.
Questions for Further Discussion
1. What are the common first complementary foods for infants in your practice location?
2. What other foods are not recommended for infants in your practice location because of nitrates or other potential contaminants?
3. How do you screen for food insecurity in your families?
Related Cases
- Disease: Infant and Toddler Nutrition
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: General Pediatrics | Nutrition / Dietetics | Social Services
- Age: Infant
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Infant and Newborn Nutrition
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
United States Department of Agriculture Food and Nutrition Service. A Guide for Use in the Child Nutrition Programs. Chapter 12.
Available from the Internet at http://www.fns.usda.gov/tn/Resources/feeding_infants.pdf#xml=http://65.216.150.153/texis/search/pdfhi.txt?query=A+Guide+for+Use+in+the+Child+Nutrition+Programs&pr=FNS&prox=page&rorder=500&rprox=500&rdfreq=500&rwfreq=500&rlead=500&rdepth=0&sufs=0&order=r&cq=&id=4ea887fc11 (rev. 2001, cited 2/2/12).
Kleinman RE. edit. American Acadmey of Pediatrics. Pediatric Nutrition Handbook. 6th edit. 2009;131-34, 155-56, 287-288.
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
17. A therapeutic and ethically sound relationship with patients is created and sustained.
20. Respect, compassion, and integrity; a responsiveness to the needs of patients and society that supercedes self-interest; accountability to patients, society, and the profession; and a commitment to excellence and on-going professional development are demonstrated.
22. Sensitivity and responsiveness to patients’ culture, age, gender, and disabilities are demonstrated.
25. Quality patient care and assisting patients in dealing with system complexities is advocated.
Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital
Pediatric Education 