Caloric requirements

1. 0-3 months - 116kcal./kg./d
2. 3-12 months- 100kcal./kg./d

1. 40-50% fat
2. 40% carbohydrates
3. 10% protein

1. 0-12 months- breast milk or cow protein based formula
2. 4-6 months- introduction of solid foods
3. Breast milk supplies adequate nutrition for the first 6 months of life except for Vit. D which should be supplemented
4. High fat content of diet should continue throughout the first 2 years to insure adequate CNS growth and development.

1. Supplies adequate calories
2. Need Vitamin D supplementation, 400 IU/d, especially in dark skinned infants with inadequate sunlight exposure
3. Supplies adequate iron until 6 months of age when the diet should be supplemented with iron fortified cereals. The requirement is 1mg./kg./d
4. Helps protect infant against respiratory and gastrointestinal infections and may enhance immunologic response to vaccines. 
5. If breast feeding curtailed before one year of age, iron fortified formula should be introduced.

1. Recommended when breast milk is not available
2. 20 cal./ounce
3. Supplemented with necessary daily requirements of vitamins and iron (11-12mg./liter)
4. Unmodified cow's milk not recommended for 1st year of life because has high protein content, inadequate iron, low vitamin C, causes loss of blood from the upper GI tract, presents an increased solute load, and has decreased amounts of zinc.
5. Cow's milk used in formula should be paseurized, homogenized, or evaporated. 

1. There is no advantage for using soy based formulas over cow's protein formulas
1. No decreased incidence or severity of colicky symptoms
2. Does not decrease the incidence of the development of atopy
3. Should not use if there is a true milk protein intolerance.
2. Recommended for infants with galactosemia and lactase deficiency
3. 20 cal./ounce

1. May be necessary in rare carbohydrate intolerance syndromes such as lactase deficiency, sucrase-isomaltase deficiency, and glucose-galactose malabsorption
2. In true cow's milk and soy protein allergy and sensitivity, should start hydrolyzed protein or an elemental formula.

1. Vitamin D
2. Iron
1. With the introduction of iron fortified formula and dietary supplementation of iron in cereal, the need for routine testing for anemia at 9-12 months of age, has been questioned.
2. preterm and low birth weight newborns and infants with diets that have inadequate sources of iron, should be tested for anemia. 
Fluoride
1. Currently the AAP does not recommend supplementation with fluoride until the infant is 6 month old and lives in an area with < 0.3ppm of fluoride supplementation in the water supply. 
2. A good history should ascertain whether the infant is getting sufficient water to prevent tooth decay. If not, fluoride supplementation should be suggested. 
3. Many available commercial infant waters are supplemented with fluoride. 

1. The introduction of solid foods should begin between 4-6 months when the child has developed motor skills to be able to eat off a spoon and have adequate motor skills to indicate to the feeder that they are full.
2. Foods should be soft and pureed. 
3. The order of introduction of foods is not important.  Many recommend introducing one food at a time to recognize any food allergies.
4. Usually iron fortified cereal is introduced first. 
5. Prevention of choking should be of paramount importance. 

1. Growth parameters including head circumference, weight, and length and plotting on growth curves to evaluate velocity and comparison to previously established patterns
2. Complete physical examination.
3. Composition of the diet.

Reference

1. Aldous, Michael. Nutritional Issues for Infants and Toddlers. Pediatric Annals February 1999.
2. American Academy of Pediatrics, Committee on Nutrition. Soy Protein-baed Formulas: Recommendations for Use in Infant Feeding. Pediatrics. 1998: 101(1):148-153.
3. Bhatia, Jatinder, Bucher Colleen, and Bunyapen, Chantrapa. Nutrition in Infancy: Implications for Practice. Pediatric Annals. August 1998.
4. American Academy of Pediatrics. Use of Soy Based Formulas in Infant Feeding.  May 2008