Welcome
Welcome to Snohomish Health District Communicable Disease Outreach Program distance learning course titled:
Infant Toddler Feeding
Course Description:
Infant Toddler Feeding will focus on the most current infant feeding guidelines and the new CACFP meal pattern for infant and toddler meals. Topics include supporting self-regulation during feeding and eating, making a breastfeeding friendly child care and partnering with parents when introducing first foods to babies.
This class can be downloaded and printed out or viewed on your computer screen. When viewed on your computer, you will be able to click on the links that are provided throughout the text.
Requirements:
Completion of this class earns 2 STARS credits. To receive credit you must:
· Read the text carefully and completely.
· Answer all test questions. Do not leave any unanswered.
· Complete the assignment thoughtfully and thoroughly.
· Do test and assignment individually. (Note: it is acceptable to discuss the material as a group, but test/assignment must be done individually. (If assignments appear to have been copied, no credit will be given to either party.)
· Return the STARS evaluation (It is a DEL MERIT requirement that we use the attached evaluation form.)
· Show understanding of the course learning objectives.
Test, assignment and evaluation should be emailed or postmarked on or before November 30, 2017, in order to receive credit. Late assignments cannot be accepted.
Make copies of your test and assignments for your records.
A certificate of completion will be sent to you via email upon successful completion of this course. Please allow a few weeks to receive your certificate. Please clearly print your name and email address on your test.
Please remember to include your STARS ID number on your test in order to receive STARS credit. If you need a STARS ID number, visit http://merit.del.wa.gov for assistance.
Trainer Contact Information:
This course was designed by MERIT approved trainers:
Katy Levenhagen, MS, RDN, Child Care Nutrition Consultant
Please feel free to contact us at any time with questions, concerns, or comments.
Our office hours are M-F 9am to 2pm.
Phone: Katy Levenhagen, Nutritionist 425.252-5407
E-mail:
Core Competencies
This course fulfills the following Core Competencies for Early Care and Education Professionals from Washington State Department of Early Learning:
Content Area: Health, Safety and Nutrition - Level 1, 2
· Responding to the Health Needs of Children – Level 1c – Understand the concepts of cue feeding for infants and fostering the development of self-regulation during meals through toddler years.
· Responding to the Health Needs of Children – Level 2a – Promotes meal time practices that contribute to a child’s social and behavioral development and foster food acceptance.
Content Area: Safety and Wellness - Level 1
· Safety – Level 1a – Practices, models, and fosters safe mealtime practices for infants and toddlers including understanding choke prevention strategies, appropriate hygiene and sanitation procedures, safe facilitation of family style meal service
· Wellness – Level 2a – Understands the strategies for accommodating breastfed babies in child care including, establishing a breastfeeding friendly infant area; ensuring the safe handling of breast milk, working closely with the mother to determine specific feeding needs; including breastfeeding support.
· Resources for all pregnant and breastfeeding Mothers who have children at the center or who are requesting care for their infant.
Scoring of test and activities is as follows:
Section / Points PossiblePart A: Infant Feeding-Multiple Choice / 20
Part B: Infant Feeding-Short Answer / 15
Part C: Infant Feeding Policy – True/False / 20
Part D: Infant Feeding Cues / 18
Part D: Toddler Feeding - Matching / 20
Part E: Toddler Mealtime Practices – Short Answer / 7
Total Points / 100
*A passing score is 75 points.
Table of Contents
Infant Feeding 5
Breastfeeding Promotion and Support 5
Responsive Feeding Practices 7
Introducing Complimentary Foods 11
Best Foods for Babies 12
Infant Feeding Policies 13
Responsive Feeding……………………………………………………………………………………………………………………………………..14
Adding Solid Foods………………………………………………………………………………………………………………………………………15
Bottle Preparation, Storage and Cleaning……………………………………………………………………………………………………16
Toddler Feeding…………………………………………………………………………………………………17
What, How and Tips 18
Mealtime Routines 21
Helping Toddlers Serve Themselves 25
In Closing… 26
References 26
ii
Infant Toddler Feeding
Nurturing, Evolving, Rewarding … Messy!
I. Infant Feeding
Shortly after birth, a baby gets fed, either at the mother’s breast or formula from a bottle. This interaction is one of the first opportunities to establish attachment: that dance like rhythm that fosters trust and security for a baby and begins to establish a foundation for continued feelings of connection to another person. How babies are fed early on may affect their attitudes towards feeding through childhood and maybe even for a lifetime.
How children are fed is as important as what they eat for optimal physical growth and development. This class explores both feeding practices and the nutritional needs of children 0 – 3 years. It will outline most current best practices in infant feeding including breastfeeding, self-regulation, and partnering with parents around introducing first foods for babies.
Accommodating Breastfeeding
The World Health Organization, The National Child Health Institute and The American Academy of Pediatrics recommend breastfeeding as the sole source of nutrition for a baby for the first 6 months. After adding solid foods to a baby’s diet it is recommended to continue breastfeeding until at least 12 months. Many mothers rely on breastfeeding friendly child care so they can return to work or school within a couple months of birth. Because mothers may have mixed feelings about leaving their baby in the care of another person, it is most important for child care providers to assure breastfeeding moms that their breastfed babies are welcome and that they will be well supported to continue nursing their babies.
Benefits of Breastfeeding
Breastfeeding has many health benefits for babies.
1. Breast milk includes antibiotic qualities – the most distinguishing quality of breast milk compared to formula is the immunoglobulins. These are proteins unique to breast milk that cannot be manufactured in formulas. As a babies gut and immune system develop, they benefit from the built-in immunities that breast milk provides. This helps decrease risk of gut bacteria and other viral and bacterial infections during the first few months of life.
2. Breast milk is naturally high in omega-3 fatty acids – These are the fats in breast milk that provide some of the building blocks for brain cells. These are most important because a baby’s brain triples in size during the first year due to brain density formation. A strong attachment and interaction with trusting adults also contributes to brain density. These days, some omega-3 fatty acids are added to formula.
3. Less risk of allergic reaction – Mother’s milk is meant for human babies. The nutrients are appropriately distributed according to a human infant’s needs. Studies show when babies are exclusively fed breast milk for the first 6 months they have a lower incidence of allergic reaction to foods later on in childhood.
4. Less risk of childhood obesity – More and more research is showing a positive correlation between a healthy weight during childhood and longevity of breastfeeding; i.e. the longer and infant is breastfed, the lower the risk that the child will be overweight.
See more information about the benefits and importance of breastfeeding at the National Institute of Child Health and Human Development,
Breastfeeding has benefits for Mom
1. Due to about a 400- 500 kcal increase in calories needed for breastfeeding mothers, they lose their pregnancy weight more quickly.
2. Studies show that women who have breastfed may have lower rates of breast and ovarian cancer, type 2 diabetes and high blood pressure. Healthychildren.org, The American Academy of Pediatrics.
3. Breast milk is readily available and mostly accessible. No need to buy and prepare formula or bottles.
4. Although both breasted and formula fed babies exhibit cues for hunger and fullness, some studies suggest that breastfeeding mothers foster self regulation for their babies more easily than bottle fed babies.
5. Because the nutrients in breast milk change with the age and development of a baby, parents do not have to be concerned with choosing different formulas as babies get older.
Strategies for accommodating breastfed babies (click on the brochure for downloading)
Over the past 50 years breastfeeding rates have increased and more support at every level of prenatal care and early infant care has increased. Health care providers advocate for and support the choice to breastfeed. Hospitals offer lactation consulting soon after birth and many health insurance policies cover nursing and lactation support to breastfeeding mothers for months after they give birth. Washington state has a law protecting women who breastfeed in public from discrimination. Because of its known benefits, making child care a breastfeeding supportive and friendly place is considered a best practice standard. It is recommended to add information about how your child care accommodates breastfeeding babies in your health policy or parent handbook.
Consider including the following items:
Provide a welcoming place to nurse – A separate room, space or quiet corner with a rocking chair and some pillows. Hang photos of babies getting breastfed, as well as babies getting bottle fed. Hang posters advertising that you support breastfeeding.
Develop a trusting relationship with the breastfeeding mother – Let moms know early on how you will partner with them to best care for their baby. Find out Mom’s schedule so you know when to expect her to arrive to nurse during child care hours or at the end of the day. Provide practice days so Mom and baby can get used to being away from each other slowly, and baby gets used to taking a bottle from a new person. Make sure to be specific in your policies. Let them know that you follow a baby’s feeding cues so you will need plenty of bottled breast milk on hand so baby does not go hungry.
Train staff to support breastfeeding – Staff should be aware of the benefits of breastfeeding and a child care’s specific strategies for accommodating breastfed babies and moms. Our own attitudes about feeding babies should not be a factor in helping a parent choose how to feed their babies. It is a myth that breastfed babies are fussier than bottle fed babies. Because they digest breast milk more efficiently, babies receiving breast milk may need to be fed more often. Regardless of the choice to breast feed or bottle feed, all parents should be made to feel welcome and supported.
Store and handle breast milk safely – Follow the WACs for safe storage and preparation of breast milk. Bottles of breast milk MUST be clearly labelled with a child’s full name and date of arrival. (See more in the Policies section to follow.)
Create a positive feeding environment – This is important for all babies. All babies should be fed bottles using responsive feeding practices as the guide. State these in your Infant Feeding Policies. (More on responsive feeding to follow.)
Find out what the AAP says to nursing Moms returning to work about selecting care givers for their babies.
Responsive Feeding – Babies communicate! Cue 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. Feeding infants on cue rather than on a schedule may help prevent childhood obesity and sets the stage for an infant to develop self-regulating eating patterns for life.
The first idea about responsive feeding is to understand that, just like the rest of us, babies have different personalities. Most successful feedings occur when the caregiver gets to know a baby’s temperament. At any feeding they may be easy going, a little uptight or wound up, depending on the day and their comfort level. Overall though, most babies react to feeding in a similar way from day to day. Get to know each baby’s signs for hunger, wanting to engage and for feeling full and wanting to disengage. Some babies have strong cues and others are weaker. The better you are at recognizing and appropriately responding to their signs and signals, the better they will get at letting you know what they are feeling.
When the same caregiver/teacher regularly works with a particular child, that caregiver/teacher is more likely to understand that child’s cues and to respond appropriately
Recognizing Hunger Cues: “Rooting” (as in looking for the nipple), opening and closing the mouth, sucking on fingers or fist, gently folded hands, making eye contact with the care giver.
Recognizing Satiety (Fullness) Cues: turning away from the nipple, increased attention to surroundings, arching the back, keeping mouth closed, shaking the head, clenched fists
Respond to cues sooner than later (follow a 10 second rule whenever possible). Fussiness and crying may mean that other more subtle cues were missed. Because babies are learning about their world as they go, it is important to let them know you speak their language. This happens when their action creates a quick response from you. Getting the same response from you for a specific action from them, reassures them that you are listening!
Healthy Eating Research outlines 3 steps in RESPONSIVE FEEDING (1) the child signals hunger and satiety through gross motor actions, facial expressions, or vocalizations; (2) the caregiver recognizes the cues and responds promptly in a manner that is emotionally supportive, developmentally appropriate and relates directly back to baby’s signal, (3) the child experiences a predictable response to signal
Look at the following photos and titles for examples of the various types of cues babies give to communicate their feeding needs.
Feeding EngagementCues / Feeding Disengagement Cues
Strong Engaged. Hands by face, gazing at Mother. / Subtle disengagement. Spitting nipple out of mouth. Gaze looking away. Needs a break.
Strongly Engaged. Gently sucking, gazing at caregiver. / Subtle Disengagement. Gaze is looking away, arched back. May need a break.
Smiling and watchful as she knows food is coming her way. / Strong disengagement. Arching back, arms up, face turned away. Not interested in feeding.
Relaxed arms, opening mouth, gazing at care giver, showing interest. / Subtle disengagement. Arms up and gaze down. Beginning to show disinterest.
Finger feeding herself. Gaze at the caregiver. Exploring with spoon. “Stay with me.” / Very strong disengagement. Arms up, Fists tightly clenched. Turning whole body away. Time to stop feeding. May prefer finger foods.
Brings food to mouth herself. Thinking about it. Focussed. Strong interest in feeding. / Hand up in stop postion. Head turned away. May not like the food or has had enough. May prefer finger foods.
Do you recognize these cues from the babies you care for? Reflect on what cues make you start and stop feeding.