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Section 12 - Pediatric Dietary Needs

Purpose: In order to adequately prepare for the influx of pediatric patients that may result from a disaster involving children, hospitals must also consider the requirements for providing age-appropriate food and potable water to this population while they are patients or visitors in the facility. The Pediatric Dietary Needs section provides nutritional guidelines for hospitals that do not typically provide pediatric in-patient services. The recommendations in this section include:

Pediatric dietary recommendations for healthy children and children with special needs; and sample disaster menus for children including menus for special dietary needs.
The disaster menus focus on foods that require little to no preparation and are both easy and inexpensive to store.

Section Contents

General Guidelines
Table 12.1-Pediatric Dietary Recommendations
Table 12.2-Sample Pediatric Disaster Menu: A sample diet for pediatric patients listing foods that require a minimal amount of preparation or power supply to maintain food temperatures
Table 12.3-Pediatric Nutrition Guidelines for Primary Health Care Providers
References
Resources

General Guidelines:

NYSDOH recommends that hospitals maintain access to a 5-day food and drinking water supply for use during an emergency. It is also recommended that hospitals develop a network of resources for supplies of food and water if the routine supplier is unavailable or unable to meet the demand.

The nutritional supplies recommended for both healthy children and those with special dietary needs are listed in Table 12.1.

Table 12.1-Pediatric Dietary Recommendations¹
Age	0 to 6 months	6 months to 1 year	1 to 2 years	2 years and above
Healthy Children	These children are breast-fed or formula-fed by bottle only. Comments: If the mother is not available to breastfeed, the first choice is to give breast milk by bottle. Some breast-fed children may not immediately take bottle-feeding. Continue to feed: eventually the child will feed from the bottle. Recommendation: Ready-to-feed formula is preferred since it is immediately ready for use and requires no refrigeration or preparation. Powdered baby formula may be used as long as a safe water supply is available. Powdered formula will have a longer shelf life than ready-to-feed formula. There should be milk-based, soy-based and hypoallergenic formula available.	6-9 months- baby cereal, jarred baby food or mashed table food is appropriate, along with formula or breast milk. 9-12 months- soft, bite-sized pieces of food (i.e., vegetables, mashed potatoes and meats) along with formula or breast milk.	This age group eats table food. Young children will need soft, bite-sized foods. Avoid foods that can cause choking such as hot dogs, grapes and chunks of meat unless cut in pea-sized pieces. Hydration: Water, Pedialyte See sample menu below.	This age group eats table food. Young children will need finger foods. Avoid foods that can cause choking such as hot dogs or grapes for youngest children. Hydration: Water, Pedialyte See sample menu below.
Children with Special Needs	Patients with feeding tubes: There are 3 types of tube feedings: Nasogastric (N/G), orogastric (O/G), and gastrostomy (G/T). The first 2 are used for acute patients; the third is used for chronic patients. N/G or O/G Tube: Used for both nasogastric and orogastric feedings and are temporary measures, mostly used in pediatric emergency rooms or pediatric in-patient areas for acute feeding issues, gastric decompression, and/or delivery of oral medications such as activated charcoal. G/T Tube: Used with a 60cc syringe, catheter tip and a bolus continuous feed or pump. Infants (0 to 12 months): Infant formula should be used through the tube. 12 months to 18 years of age: Pediatric formulas should be used (i.e., Resource Just for Kids, PediaSure or Nutren Jr.). For adolescents, adult enteral product may be appropriate, based on clinical judgment. (Powdered products similar to Pediasure are now available.) Hydration: Tap or bottled water. Comments: The same feeding pump used for adults can also be used to feed children. Use saline water to clean the area when the feeding tube is inserted into the patient. Change feeding bags every 8 hours and clean prior to adding more formula.
Diabetic Children	The nutritional needs of this group will be determined by the patient's body weight and (insulin) medicine requirements. Recommendation: Patients may require between meal snacks to control blood glucose.

Table 12.2 - Sample Pediatric Disaster Menu
	Day 1	Day 2	Day 3
The following sample diet for pediatric patients lists foods that require the minimal amount of preparation or power supply to maintain temperatures.
	Breakfast	Breakfast	Breakfast
0 to 6 months	Breast milk or milk- or soy-based formula	Breast milk or milk- or soy-based formula	Breast milk or milk- or soy-based formula
6 months to 1 year	Iron fortified baby cereal Jarred baby fruit Breast milk or milk- or soy-based formula	Iron fortified baby cereal Jarred baby fruit Breast milk or milk- or soy-based formula	Iron fortified baby cereal Jarred baby fruit Breast milk or milk- or soy-based formula
>1 year	Cheerios (or substitute) UHT milk (1-2 years) Powdered milk (>2years) Diced canned fruit	Cheerios (or substitute) UHT milk (1-2 years) Powdered milk (>2years) Diced canned fruit	Cheerios (or substitute) UHT milk (1-2 years) Powdered milk (>2years) Diced canned fruit
	Lunch	Lunch	Lunch
0 to 6 months	Breast milk or milk- or soy-based formula	Breast milk or milk- or soy-based formula	Breast milk or milk- or soy-based formula
6 months to 1 year	Jarred baby meat Jarred baby vegetable Jarred baby fruit Breast milk or milk- or soy-based formula	Jarred baby meat Jarred baby vegetable Jarred baby fruit Breast milk or milk- or soy-based formula	Jarred baby meat Jarred baby vegetable Jarred baby fruit Breast milk or milk- or soy-based formula
1 to 2 years	Canned beef stew Jarred baby vegetable Diced peaches Bread/crackers UHT milk	Macaroni and cheese Jarred baby vegetable Diced pears Bread/crackers UHT milk	Tuna or canned chicken Jarred baby vegetable Diced fruit cocktail Bread/crackers UHT milk
>2 years	Cream cheese/jelly sandwich Diced peaches Graham crackers Powdered milk	Macaroni and cheese Diced pears Graham crackers Powdered milk	Peanut butter*/jelly sandwich Diced fruit cocktail Graham crackers Powdered milk
	Dinner	Dinner	Dinner
0 to 6 months	Breast milk or milk- or soy-based formula	Breast milk or milk- or soy-based formula	Breast milk or milk- or soy-based formula
6 months to 1 year	Jarred baby meat Jarred baby vegetable Jarred baby fruit Breast milk or milk- or soy-based formula	Jarred baby meat Jarred baby vegetable Jarred baby fruit Breast milk or milk- or soy-based formula	Jarred baby meat Jarred baby vegetable Jarred baby fruit Breast milk or milk- or soy-based formula
1 to 2 years	Cheese slices-chopped Jarred baby vegetable Applesauce Bread/crackers UHT milk	Canned chicken-chopped Jarred baby vegetable Diced peaches Bread/crackers UHT milk	Cheese ravioli Jarred baby vegetable Baby fruit Bread/crackers UHT milk
>2 years	Cheese sandwich Canned pineapple Graham crackers Powdered milk	Chicken sandwich Diced peaches Graham crackers Powdered milk	Cheese ravioli Mandarin oranges Graham crackers Powdered milk
* Be alert for allergies.

Table 12.3-Pediatric Nutrition Guidelines for Primary Healthcare Providers
Age	Developmental Characteristics	Guidelines	Red Flags
When a child presents with several red flags, it is recommended to refer the caregiver to a registered dietitian (RD) for a nutritional assessment.
Birth to 6 months	Sucks well on nipple² Finishes each feeding within 45 minutes by age 4 months² Signs of hunger in newborns are increased alertness or activity, mouthing or rooting. Crying is a late indicator of hunger³	Exclusive breastfeeding is recommended for the first 6 months for healthy term infants^4,5 Encourage parents to feed whenever baby show signs of hunger³ Encourage parents to hold their baby during feedings and make eye contact⁶ Breastfed or partially breastfed infants drinking less than 1L (32oz) formula daily should receive a daily vitamin D supplement of 400IU (10µg)^4,7 Dark-skinned infants and infants whose mothers enter pregnancy and lactation with low vitamin D status are particularly at risk for developing vitamin D deficiency rickets;⁷ therefore it is important to promote the recommendation for adequate vitamin D to these parents If an infant is not breastfed or is partially breastfed, cow's milk-based iron-fortified infant formulas are the most acceptable alternative^1,4 Hypoallergenic formula should be given if allergy to milk-based formula is suspected⁸ Soy-based formula should be given to infants who cannot take dairy-based products for health, cultural, religious or personal reasons, such as vegan lifestyle or galactosemia⁴ Research has shown that there is no link between iron-fortified infant formula and constipation^8,9 Breastfed infants tend to become leaner than formula-fed infants after 3 to 4 months. This should be anticipated when assessing growth to avoid unnecessary supplementation with formula or early introduction of solids^1,11 Fruit juice, water or any beverages other than breast milk or formula should not be given^1,4,5 To prevent infant botulism, honey should not be given prior to 1 year of age⁴ For the prevention of allergy, the avoidance of solid food for at least 4 months and preferably 6 months is recommended¹⁰	Serial growth measurements have unexpectedly crossed 2 or more centiles downwards (failure to thrive)¹¹ Newborn not being fed whenever they show signs of hunger³ Healthy, full-term breastfed infant: Loses more than 7% of birth weight Does not regain birth weight by 10 days Does not have at least 3 bowel movements each day² Does not have at least 6 wet diapers each day by day 4 with urine that is clear or pale yellow^12,13 During the first 4 months, infant not being fed frequently⁴ Exclusively breastfed infant is not receiving a vitamin D supplement, particularly those at risk^4,7 Infant formula is not iron-fortified⁴ Liquids (including water) or solids other than breast milk or iron-fortified formula are given before 4 months (6 months is recommended)^4,10 Infant is fed using a propped bottle^4,7 Infant cereal is given in a bottle^1,4 Private well water used for infant feeding is not being regularly tested⁴ For the first 4 months, water for infant formula is not brought to a rolling boil for 2 minutes⁴ Infant formula is not being mixed correctly (i.e., correct dilution)¹

Age	Developmental Characteristics	Guidelines	Red Flags
6 to 9 months	At 6 months, babies are physiologically and developmentally ready for solid foods⁴ Sits independently for a short time¹⁴ Drinks from a cup held by an adult¹ Eats soft food from a spoon or adult's fingers² Uses both hands to hold a bottle¹⁴ Prefers parents to feed¹⁴ Plays with spoon¹ Initial refusal of new flavors and textures is common. It may take 3-10 offerings before an infant accepts a new food¹ Finger-feeding can be introduced¹⁴ By 9 months, picks up small items using thumb and first finger (e.g., oat ring cereal)² Some infants have a more sensitive gag reflex and may not tolerate anything but pureed foods at first⁸	Continued breastfeeding is recommended^4,5 If infant is not breastfed or is partially breastfed, cow's milk-based iron-fortified infant formulas are the most acceptable alternative until 9 to 12 months^1,4 For infants unable to take cow's milk products, give commercial soy formula until 2 years⁴ At 6 months, introduce iron-containing foods, such as iron-fortified cereals (see Dietary sources of iron later in this section).^4,5 Introduce vegetables and fruit next. At about 9 months, introduce whole cow's milk and milk products^4,15 Introduce one new food at a time with an interval of 2 to 7 days before introducing another to allow infant to acquire a taste for a new food and make it easier to identify the cause of an allergic reaction^1,15 Start with small serving sizes (1 to 3tsp)¹ Complementary foods should initially be provided 2 to 3 times a day¹⁵ Infants will indicate hunger or satiety. Forced feeding may promote negative associations with eating¹ Mealtime environment should be free of distractions such as television and activities¹⁸ Gradually offer food with more texture, progressing from pureed to mashed consistency and then to soft finger foods of about 1.4-inch pieces^8,15 Offer some breast milk or formula in a cup. Use a cup regularly with meals by 8 months of age⁸ Wait until 1 year of age to introduce egg white to minimize the risk of allergic reactions⁴ Honey should not be given prior to 1 year of age⁴ Coffee, tea, cola and hot chocolate should not be given⁴	Serial growth measurements have unexpectedly crossed 2 or more centiles downwards¹¹ Breastfed or partially breastfed infant drinking less than 32oz (1L) formula not receiving a vitamin D supplement, particularly those at risk^4,7 Infant formula is not being mixed correctly (i.e., correct dilution)¹ Cow's milk is given instead of breast milk or infant formula⁴ Iron-containing foods have not been introduced by 7 months of age^4,16 Infant is not eating willingly or parents imply that they force-feed¹ Infant is drinking more than 4oz (125mL) of fruit juice per day^15,17 Fruit drinks, pop, coffee, tea, cola, hot chocolate, soy beverage, other vegetarian beverages, herbal tea or herbal products, egg white or honey is given⁴ Infant cereal is given in a bottle^1,4 Infant is fed using a propped bottle^1,4

Age	Developmental Characteristics	Guidelines	Red Flags
9 to 12 months	Begins to take an active independent role in feeding⁸ Assists with spoon; some become independent¹⁴ Refining pincer grasp¹⁴ Can hold cup and suck or sip contents, but may spill^1,8,14 More willing to accept lumpy textures, especially when self-feeding⁸ Initial refusal of new flavors and textures is common. It may take up to 10 offerings before infant accepts a new food⁸ Licks food from lower lip¹	Continued breastfeeding is recommended^4,5 Breastfed babies should receive a daily vitamin D supplement until the infant's diet includes at least 400IU (10µg)/day from other dietary sources (see Dietary sources of vitamin D later in this section) or until 1 year of age.^4,7 Between 9-11 months, increase the number of times infants are fed complementary foods to 3 to 4 times a day¹⁵ Parents/caregivers should encourage self-feeding by offering more textured finger/table foods^1,15 Include baby at the table for family mealtimes¹⁸ Mealtime environment should be free of distractions like television and activities¹⁸ Whole (3.25%) cow's milk can complement or replace breast milk or replace formula between 9 to 12 months.^4,15 1% or 2% milk is not recommended until age 2.⁴ Skim milk is inappropriate before age 2⁴ Limit deli and luncheon meats such as hot dogs, bacon and smoked meat¹⁹ Fruit juice offers no nutritional benefits over whole fruit¹⁷ Offer a cup with breast milk, formula, cow's milk, 100% juice or water during meals so that a natural transition from bottle to cup will take place^1,8	Serial growth measurements have unexpectedly crossed 2 or more centiles downwards¹¹ Breastfed or partially breastfed infant drinking less than 1L (32oz) formula not receiving a vitamin D supplement, particularly those at risk^4,7 At 10 months, consistently refuses lumpy or textured foods¹⁶ Infant is not supervised during feeding⁴ Drinks juice in a bottle or a transportable covered cup that allows the baby to consume juice easily throughout the day¹⁷ Fruit drinks, pop, coffee, tea, cola, hot chocolate, soy beverage, other vegetarian beverages, herbal tea or herbal products, egg white or honey is given⁴

Age	Developmental Characteristics	Guidelines	Red Flags
12 to 18 months	Picks up and eats finger foods² Grasps spoon with whole hand¹⁴ Holds cup with 2 hands¹⁴ Holds and tips bottle¹⁴ Compared with the first year of life, a decreased or sporadic appetite is common¹ Unfamiliar foods are often rejected the first time¹	Whole (3.25%) cow's milk can complement or replace breast milk or replace formula. 1% or 2% milk is not recommended until age 2. Skim milk is inappropriate before age 2⁴ If soy formula is given to babies who cannot take dairy-based products, continue until 2 years of age. Soy beverage, rice milk or other vegetarian beverages are not recommended under 2 years of age due to low fat content⁴ At 12 months of age, babies should have a daily intake of 5µg (200IU) of vitamin D⁴ that they can get with 2 cups (500mL) of milk (see Dietary sources of vitamin D later in this section). A supplement may need to be recommended^4,7 Drinking too much milk can lead to iron deficiency. Babies 12 months of age or older should drink 16 to 24oz (500 to 750mL) of milk/day²⁰ Parents should encourage child to feed themselves at the beginning of a meal when they are hungry, but help if they tire later in the meal⁴ The child should be included at family mealtimes¹⁸ Continue to provide 3 to 4 meals a day. Additional nutritious snacks may be offered 1 to 2 times a day¹⁵ By 12 months of age, babies should be eating a variety of foods from each of the 4 food groups of Canada's Food Guide^1,4 If a child is eating according to Canada's Food Guide, is growing well and is healthy, vitamin/mineral supplements are rarely necessary. The nutrient of greatest concern during this period is iron²¹ The development of healthy eating skills is a shared responsibility: parents and caregivers should provide a selection of nutritious, age-appropriate foods and decide when and where food is eaten; babies and children should decide how much they want to eat. Pressuring a child to eat may lead to overeating or the development of aversions to certain foods^1,4,18 Fruit juice offers no nutritional benefits over whole fruit¹⁷ Excessive fruit juice consumption may be associated with diarrhea, flatulence, abdominal distension, tooth decay and poor weight gain^8,18 Fruit drinks and pop are not recommended as they displace nutrient-dense foods and beverages. Encourage parents to offer water¹⁸	Serial growth measurements have unexpectedly crossed 2 or more centiles downwards¹¹ Breastfed child not receiving a vitamin D supplement^4,7 Skim milk is regularly given⁴ Drinking liquids primarily from a baby bottle¹⁶ Not eating a variety of table foods⁴ Consistently refuses lumpy or textured foods¹⁶ At 15 months of age, does not finger/self-feed^4,16,18 Parents not recognizing and responding to the child's verbal and non-verbal hunger cues⁴ Child is not supervised during feeding^4,18 Excessive fluid consumption, e.g., milk (more than 24oz daily),²⁰ juice (more than 4 to 6oz daily),¹⁷ pop and fruit drinks^1,4

Age	Developmental Characteristics	Guidelines	Red Flags
18 to 24 months	Chews broad range of foods¹⁴ Self-feeding predominates¹⁴ Displays curiosity and desire to be independent¹ Food neophobia (fear of the new) increases through early childhood and then declines.²² Unfamiliar foods are often rejected the first time¹ Food likes and dislikes become prominent¹ Tends to go on food jags (refusal of all but 4 or 5 favorite foods over an extended period)¹⁸ In non-controlling, non-coercive conditions, healthy children have the ability to self-regulate the amount of food and energy consumed²³	Small, nutritious, frequent and energy-dense feedings are important to meet nutrient and energy needs⁴ Avoid foods with the potential to cause choking (see Choking and Aspiration below)^1,4,18 Limit deli and luncheon meats such as hot dogs, bacon and smoked meat¹⁹ Parents should role-model healthy eating and introduce age-appropriate table manners⁸ Let the child assume responsibility for how much to eat. Forcing a child to clean their plate may lead to overeating or the development of aversions to certain foods^1,18 15 to 20 minutes is an appropriate length of time to stay at the table¹⁸ If a child is eating according to Canada's Food Guide, is growing well and is healthy, vitamin/mineral supplements are rarely necessary. The nutrient of greatest concern during this period is iron²¹ Limit fluids such as juice and milk between meals¹ Fruit drinks and pop are not recommended as they displace nutrient-dense foods and beverages. Encourage parents to offer water¹⁸	Serial growth measurements have unexpectedly crossed 2 or more centiles downwards¹¹ Not eating a variety of table foods⁴ Skim milk is given regularly⁴ Soy beverage, rice milk, other vegetarian beverages or herbal teas are given⁴ Child is not supervised when eating^4,18 Child does not finger/self-feed^4,16,18 Drinking liquids primarily from a baby bottle¹⁶ Parents pressure or reward child to eat¹⁸ Child 'grazes' on food all day¹⁸ Excessive fluid consumption, e.g., milk (more than 24oz daily),²⁰ juice (more than 4 to 6oz daily),¹⁷ pop and fruit drinks^1,4

Age	Developmental Characteristics	Guidelines	Red Flags
2 to 3 years	By 2 years of age, eats most foods without coughing and choking² By 2 years of age, eats with a utensil with little spilling² By 30 months of age, lifts and drinks from a cup and replaces it on the table² May be resistant to new foods¹⁸ Food preferences increase with frequency of exposure. It may take 5 to 15 exposures to a new food before a child learns to like it^22,24 It is normal for children to lose interest in mealtimes. When hungry, they will focus on eating. When satisfied, their attention turns elsewhere^1,19	Children aged 2 and older can get the nutrients and calories they need for healthy growth and development by following Canada's Food Guide¹⁹ Canada's Food Guide recommends that children aged 2 to 3 eat 2 cups (500mL) of vegetables and fruit each day¹⁹ (see Pesticides on Vegetables and Fruit later in this section for ways to minimize pesticide residues) Offer 2 cups (500mL) of milk or fortified soy beverage daily to help meet the vitamin D requirement¹⁹ Offer a variety of nutritious foods, including some choices that contain fat such as milk and peanut butter¹⁹ Serve small, nutritious meals and snacks and allow the child to ask for seconds^8,19 Structure and routine for eating is important for young children. Grazing between meals and snacks should be limited¹⁸ The amount of food eaten will vary day to day depending on the child's appetite, activity level and whether they are experiencing a growth spurt, or if they are excited or overly tired¹⁹ Let the child assume responsibility for how much to eat. Forcing a child to clean their plate may lead to overeating or the development of aversions to certain foods^1,18,19 Encourage parents to be patient. If an unfamiliar food is rejected the first time, it can be offered again later¹⁹ Food should not be used as a reward^1,18,23 Encourage parents to sit down and eat with the child, provide a pleasant setting and leave the TV off during mealtimes^8,19 A multivitamin is rarely needed for a healthy child who is growing well and following Canada's Food Guide¹⁹ Fruit drinks and pop are not recommended as they displace nutrient-dense foods and beverages. Encourage parents to offer water¹⁸	Serial growth measurements have unexpectedly crossed 2 or more centiles downwards¹¹ BMI-for-age ≤5th percentile or ≥95th percentile¹¹ Drinking liquids primarily from a baby bottle^16,18 Excessive fluid consumption, e.g., milk (more than 24oz daily),²⁰ juice (more than 4 to 6oz daily),¹⁷ pop and fruit drinks^1,4 Child does not self-feed^4,16,18 Parent not allowing the child to decide how much to eat^1,18,19 Parents are using a highly restrictive approach to feeding¹⁸ 'Grazes' on food or beverages throughout the day¹⁸ More than 2 hours of TV-watching daily²⁵

Age	Developmental Characteristics	Guidelines	Red Flags
3 to 6 years (pre-schoolers)	By age 4, looks for adult approval² Food preferences increase with frequency of exposure. It may take 5 to 15 exposures to a new food before a child learns to like it^22,24 It is normal for children to lose interest in mealtimes. When hungry, they will focus on eating. When satisfied, their attention turns elsewhere¹⁹	Serve small, nutritious meals and snacks and allow the child to ask for seconds^8,19 The amount of food eaten will vary day to day depending on the child's appetite, activity level and whether they are experiencing a growth spurt or if they are excited or overly tired¹⁹ Encourage parents to sit down and eat with the child, provide a pleasant setting and leave the TV off during mealtimes^8,19 The use of external cues related to feeding such as prompts or rewards is likely to build resistance, food dislikes and lack of self-regulation^1,18,23 If new food is rejected, offer again.¹⁹ Let the child assume responsibility for how much to eat. Forcing a child to clean their plate may lead to overeating or the development of aversions to certain foods^1,18,19 Encourage parents to involve their child in simple food-related tasks (e.g., making muffins together) to encourage them to try these foods¹⁹ Fruit drinks and pop are not recommended as they displace nutrient-dense foods and beverages. Encourage parents to offer water¹⁸ Limit TV watching to 1 to 2 hours or less daily²⁵	Serial growth measurements have unexpectedly crossed 2 or more centiles¹¹ BMI-for-age ≤5th percentile or ≥95th percentile¹¹ NutriSTEP (parent-administered nutrition screen for 3- to 5-year-olds) score of 26 or greater (i.e., high nutrition risk)²⁶ Parents are using a highly restrictive approach to feeding¹⁸ Does not self-feed^4,16,18 Not eating a variety of table foods from the 4 food groups in Canada's Food Guide¹⁹ Does not eat at regular times throughout the day (breakfast, lunch, supper and 2 to 3 snacks)¹⁸ Drinking liquids primarily from a baby bottle^16,18 Excessive fluid consumption, e.g., milk (more than 24oz daily),²⁰ juice (more than 4 to 6oz daily),¹⁷ pop and fruit drinks^1,4 More than 2 hours of TV-watching daily²⁵

General Risk Factors that Indicate the Intervention of a Registered Dietitian (RD) or other Primary Healthcare Provider

Family is experiencing problems around feeding, mealtimes are unpleasant, and infant/child refuses many foods, or drinks excessive fluids throughout the day so is not hungry at mealtimes. Parents are possibly force-feeding or offering inappropriate amounts of food.
Parents have distorted issues with their own eating and/or body image.
Infant/child has medical problems that make eating or drinking a problem such as swallowing issues, gagging or choking.
Infant/child has other health problems that may be related to diet such as iron deficiency anemia, constipation, obesity, or body image issues.
Family has different beliefs related to foods (e.g., the use of herbal products, exclusion of food groups such as meat and meat alternatives, the use of unsafe products such as unpasteurized milk).
Family is low income. In order for families to access foods that will nourish them, they need to have enough money.
Family has problems with adequate food storage, cooking facilities or provision of adequate amounts of food because of lack of information.

Dietary Sources of Important Nutrients

Dietary sources of iron: Iron-fortified infant cereal, egg yolk, beef, chicken, turkey, lamb, fish, pork, legumes (beans, lentils, chick peas) and tofu.

Iron from meat sources is better absorbed than iron from non-meat sources. However, as a first food, some children may not like the taste or texture of meat and refuse to eat this food. Infant cereal may have a more palatable taste and parents may be more successful starting with this type of food as a first food.

Dietary sources of vitamin D: Fortified cow's milk (88IU in 250mL); fortified infant formula (100IU in 250mL); fortified plant-based beverage (80IU in 250mL); fortified margarine (25IU in 5mL); cooked salmon (103IU in 1oz); and egg yolk (25IU in one egg).⁷

Choking and Aspiration

Hard, small and round, or smooth and sticky solid foods can block a young child's airway. The following foods are not safe for infants and children under 4 years of age: Popcorn, hard candies, gum, cough drops, raisins, peanuts or other nuts, sunflower seeds, fish with bones, and snacks using toothpicks or skewers. The following foods are safer for infants and young children when they are prepared as described: Wieners diced or cut lengthwise, grated raw vegetables or fruit, fruit with pits removed, chopped grapes, and peanut butter spread thinly on crackers or bread. Peanut butter served alone or on a spoon is potentially unsafe because it can stick in the palate or posterior pharynx leading to asphyxia.⁴

Bisphenol A

Bisphenol A (BPA) is an industrial chemical used to make a hard, clear plastic known as polycarbonate which is used in many consumer products including some baby bottles and reusable water bottles. BPA is also found in epoxy resins, which act as a protective lining on the inside of metal-based food and beverage cans. The main source of exposure for infants is from BPA migrating from the lining of cans into liquid infant formula and migrating from the polycarbonate baby bottles into the liquid inside following the addition of boiling water. Exposure levels are close to the levels where potential health effects could occur; therefore, Health Canada is working with infant formula manufacturers to reduce levels of BPA in the lining of infant formula cans and encouraging the development of alternatives. The following is the Government of Canada's advice for parents and caregivers:

Breast milk is the best food for optimal growth. Infant formula is still the best alternative as its nutritional benefits far outweigh the possible risk for BPA exposure.
If using a polycarbonate bottle, water used for formula preparation should be boiled and allowed to cool to lukewarm in a non-polycarbonate container before transferring to baby bottles. This advice is consistent with proper instructions for the preparation of infant formula.
Polycarbonate bottles can be sterilized according to instructions on infant formula labels and can be cleaned in the dishwasher. They should be left to cool to room temperature before adding the infant formula.²⁷

Pesticides on Vegetables and Fruit

A healthy diet rich in vegetables and fruit may help reduce the risk of cardiovascular disease and some types of cancer.¹⁹ To reduce or eliminate pesticide residues on fresh vegetables and fruit, follow these recommendations:

Wash all fresh vegetables and fruit with running water.
Use a small scrub brush to clean the outer skin of vegetables and fruit, if appropriate (for example, before eating apples, potatoes, cucumbers or other produce in which you eat the outer skin).
Peel vegetables and fruit and trim the outer leaves of leafy vegetables, along with washing them thoroughly.²⁸

References

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Resources:

Description: Excellent overview of pediatric nutrition guidelines in table format that lists the developmental characteristics, specific nutrition guidelines and potential problems by age group. It has been prepared by the Health Babies Healthy Children Workgroup of the Ontario Society of Nutrition Professionals in Public Health (OSNPPH), first published June 2003 and revised May 2008.

Description: Overview of pediatric nutrition guidelines that list the developmental characteristics, specific nutrition guidelines and potential problems by age group in text format.

http://nutrition.med.sc.edu/nutrition%20chapters/sec208a.pdf

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