Feeding Best Practices by Age

0-6 Months

Infants 0-6 months old have specific needs for nutrition and feeding based on their stage of development. Many aspects of feeding infants directly impact proper growth and development, such as:

Responsive Feeding

Responsive feeding is a technique in which infants are fed when they express hunger, instead of being forced to keep to a feeding schedule. This can be challenging for caregivers who provide care for several infants at one time. While it may be stressful for caregivers, practicing responsive feeding ensures infants are receiving appropriate nourishment for growth and development.

Caregivers should watch for and respond to an infant’s cues for hunger. An infant who is hungry may:

  • Wake and toss
  • Suck on fist
  • Cry and fuss
  • Appear as though they may cry

Similarly, caregivers should be responsive to an infant’s cues for satiety. Infants should be fed until they indicate they are full. Never force an infant to finish the bottle. Signs of satiety or fullness include:

  • Sealing lips together
  • Decrease in sucking
  • Spitting out the nipple
  • Turning away from the bottle

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Bottle Feeding

Infants 0-6 months in care at an orphanage should be fed by bottle. Bottle feeding is an important part of an infant’s development. It is through the interaction with a caregiver during feeding that an infant develops its ability to make social and emotional connections to other people.

Caregivers should hold infants while feeding and feed only one infant at a time. Holding infants allows caregivers to make eye contact and watch carefully for signs of satiety (being full). Additionally, research shows that infants need to be held for proper social development.

Bottles should never be propped for feeding, nor should bottles be allowed in cribs. Infants are at risk for aspirating (choking) on the formula if the bottles are propped. Bottle propping may also lead to long-term problems such as ear infections, orthodontic problems, speech disorders and psychological problems.

Many infants in care have special needs or facial deformities which prevent them from feeding in a “normal” way. To learn more about these specific feeding challenges, click here.

Type of Food

Breast milk is considered to be the best source of nutrition for infants. The World Health Organization (WHO) recommends that infants be exclusively breast-fed for the first six months. However, for orphaned infants, breast milk is not an option. In situations where breast milk is not available, an iron-fortified formula can be used as a substitute. Click here to learn more about formula feeding.

Infants under 6 month of age should not be offered fruit juice. It can contribute to problems such as tooth decay, abdominal pain and bloating, and diarrhea. Additionally, cow milk should not be fed to infants 0-6 months old. Cow milk is difficult for infants to digest and does not provide appropriate amounts of nutrients necessary for early development.

Solid foods should not be introduced to infants before 6 months of age. Introducing solid foods too early may lead to the following problems in infants:

  • Choking
  • May not drink enough formula
  • Digestive system not ready to digest solid foods
  • Increased risk of anemia (low iron)
  • Increased risk of eczema (skin disorder)
  • Increased risk of developing food allergies
  • Disrupted sleep

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Amount and Frequency

Infants’ energy requirements gradually increase as they grow. Between 0 and 6 months, infants need approximately 450- 650 kilocalories per day. While infants this age should be fed based on their cues for hunger and satiety, here are some general formula-feeding guidelines:

0-2 months:

  • 6-10 feedings per day
  • 60-120 ml per bottle
  • 700-800 total ml per day

3-6 months:

  • 6-7 feedings per day
  • 150-180 ml per bottle
  • Up to 1050 total ml per day

How can you know if a baby is getting enough formula each day?

  • The child has 6-7 wet diapers daily
  • The child is consistently gaining weight
  • The child wakes up on its own to feed

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6-12 Months

As infants grow and develop their needs change regarding:

Feeding techniques

When feeding older infants, responsive feeding techniques can still be used. Cues for hunger include:

  • Excitedly moving arms and legs
  • Moving head toward food
  • Reaching toward food
  • Opening mouth when food is seen
  • Crying

Infants 6-12 months old are able to more actively participate in feeding, and are typically ready for solid foods. Infants ready for solid foods can:

  • Sit up without help
  • Hold head up
  • Take food from a spoon and swallow it
  • Turn head to refuse food

At this age, infants may be strong enough to hold their own bottles, and should begin to be weaned from bottles. To learn about weaning, click here. As they transition from liquid to solid foods, infants of this age may also begin to feed themselves.

Here are a few tips to help older infants become successful eaters:

  • Choose foods that are age and ability appropriate
  • 6-8 months: pureed foods
  • 9-11 months: mashed, ground and soft-textured foods
  • 12 months and older: coarsely chopped and bite-sized finger foods
  • Make sure the child is sitting-up while fed. High chairs are best.
  • Never leave the infant along while eating.
  • Quietly talk to and encourage the infant while eating. Make eye contact.

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Types of foods

During this time, infants are at an increased risk for malnutrition because they are growing so rapidly. At this age, infants cannot receive all the nutrients they need to grow and develop from formula alone. This is a critical time to begin introducing complimentary foods. Complimentary foods are nutrient-rich, solid foods that can be supplemented to formula starting around 6 months. For optimal child development, it is important to gradually increase the solidity of food as the child ages. According to current research, delaying the introduction of “lumpy” foods past 10 months may increase the risk of feeding difficulties later on.

Infants 6-12 months old should not receive cow milk. However, infants this age can be introduced to fruit juice. Fruit juice should be served in a cup – never in a bottle – and be limited to 120 ml per day.

Amount and Frequency

Infants between 6 and 12 months must have sufficient energy (kilocalorie) intake in order to grow and develop properly. The WHO recommends approximately 600 kcal/day for 6-8 months, 700 kcal/day for 9-11 months, and 900 kcal/day for 12-23 months. The average infant this age should have 4-5 feedings per day with additional snacks offered 1-2 times per day. Food amount and frequency will ultimately depend on the individual infant, but general recommendations include:

6-8 months

  • Complementary foods: 2-3 times/day
  • Formula: 700-1060 ml/day

9-12 months

  • Complementary foods: 3-4 times/day
  • Formula: 530-880 ml/day

Please see the sections on weaning and complimentary foods for additional recommendations related to diet for infants in this age range.

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12-24 months

It is natural for children 12-24 months old to have a decreased interest in food. Their growth is slowing down, and therefore they have a decreased appetite. Young children tend to be easily distracted during mealtimes, taking interest in things other than eating. To better engage young children in meal times, learn more about:

Feeding techniques

Children 12-24 months old usually have short attention spans and can be picky with their food choices. And so, it is important to be patient and flexible during mealtimes. Try not to enforce a strict feeding schedule with young children. Instead, pay attention to young children’s hunger cues and provide snacks in between meals when needed.

To prevent choking, only feed children 12-24 months old while they are sitting down and supervised by an adult. It is very easy for young children to choke if they eat while walking around. Young children imitate adults, so be a good role model by demonstrating good eating habits. Toddlers are more likely to try unfamiliar foods if they see adults eating them also.

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Types of Foods

Generally speaking, children 12-24 months old are able to eat the same foods as adults. However, they can be very picky about food choices. It is completely normal for young children to refuse all food or only eat certain types of food. This can become stressful for caregivers. However, it is important to be patient and supportive of children during mealtimes. The more you insist that young children eat a certain food, the more likely it is that they will refuse it. Instead of fighting about food, offer a variety of healthy foods at each meal and let young children decide what to eat. Learn more about healthy food choices for young children.

Milk is an important part of a toddler’s diet. It provides calcium and vitamin D to help build strong bones. It is recommended that young children drink whole milk to provide the fats necessary for brain development.

However, drinking too much milk can prevent the absorption of iron and lead to iron deficiency. To prevent iron deficiency, make sure young children are eating a balanced diet by:

  • Limiting milk intake to 16-24 ounces per day
  • Serving iron-fortified cereals
  • Serving iron-rich foods such as meat, poultry, fish and beans
  • Serving iron-rich foods along with foods containing Vitamin C

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Amount and Frequency

Depending on age, size and activity level, children 12-24 months old require 1000-1400 kilocalories per day to grow and develop properly. The average young child should have three meals per day with additional snacks offered 2-3 times per day. Serving sizes for young children are much smaller than adult serving sizes – about ¼ of what an adult eats. Food amount will ultimately depend on the individual, but general recommendations for young children include:

  • 300-450 kcal/day from milk
  • 60-90 kcal/day from fruit juice
  • 550-950 kcal/day table/solid foods:
  • 6 servings of grains
  • 3 servings of vegetables
  • 2 servings of fruit
  • 2 servings of dairy
  • 2 servings of meat and protein

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