Transcript Cigarette Smoking

Mother and Infant
© 2006 Thomson-Wadsworth
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The woman who is pregnant, or who soon will
be, must understand that her nutrition is
critical to the health of her future child
throughout life
The nutrient demands of pregnancy are
extraordinary
© 2006 Thomson-Wadsworth

Prepregnancy Weight
◦ Before pregnancy, all women, but underweight
women in particular, should strive for appropriate
body weights
 A woman who are underweight or fails to gain
sufficiently during pregnancy is likely to bear a baby
with low birthweight
 Infant birthweight is the most potent single indicator
of an infant’s future health
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Low-birthweight
◦ Weight of less than 5.5 pounds at birth
◦ Used as a predictor of probable health problems in
the newborn and as a probable indicator of poor
nutrition status of the mother before and/or during
pregnancy
◦ Some are premature infants, some have suffered
growth failure in the uterus
◦ 40x more likely to die in the first year of life than a
normal-weight baby
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Low birthweight is associated with
◦ Lower adult IQ and and other brain impairments
◦ Short stature
◦ Educational disadvantages
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Nutrient deficiency coupled with low
birthweight is the underlying cause of more
than half of all deaths worldwide of children
under 5 years of age
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Not all cases of low birthweight reflect poor
nutrition
◦ Heredity, disease conditions, smoking, and drug
(including alcohol) use during pregnancy all
contribute
◦ Even with optimal nutrition and health during
pregnancy, some women give birth to small infants
for unknown reasons
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Obese women are also urged to strive for
healthy weights before pregnancy
◦ The infant of an obese mother may be larger than
normal and may be large even if born prematurely
◦ The large baby may not be recognized as premature
and thus may not receive the special medical care
required
 The baby of an obese mother may be 2x as likely to be
born with a neural tube defect
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Obese women are:
More likely to require drugs to induce labor
Require surgical intervention for the birth
Are more likely to suffer:
◦ Gestational diabetes
◦ Hypertension
◦ Infections after the birth than women of healthy
weight
◦ Greater risk of infants with heart defects and other
abnormalities
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A Note about Critical Periods
◦ Each organ and tissue type grows with its own
characteristic pattern and timing
 The development of each takes place only at a certain
time - the critical period
 Whatever nutrients and environmental conditions are
necessary during this period must be supplied on time
if the organ is to reach its full potential
 If the development of an organ is limited during a
critical period, recovery is impossible
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The effects of malnutrition during critical
periods of pregnancy are seen in
◦ Defects of the nervous system of the embryo
◦ The child’s poor dental health
◦ The adolescent’s and adult’s vulnerability to
infections and possibly higher risks of diabetes,
hypertension, stroke, or heart disease
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The effects of malnutrition during critical
periods are irreversible
◦ Abundant and nourishing food, fed after the critical
time, cannot remedy harm already done
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1st Trimester: no additional energy needed
2nd trimester: ~340 calories/ day
3rd Trimester: ~ 450 calories/ day
◦ Well-nourished pregnant women meet these
demands for more energy several ways
 Some eat more food
 Some reduce their activity
 Some store less of their food as fat
◦ The need for extra calories can be met with an
extra serving from each of the 5 food groups
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What are some factors that place women at
increased nutritional risk?
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To meet the
high nutrient
demands of
pregnancy, a
woman must
make careful
food choices
◦ Her body will
also do its part
by maximizing
nutrient
absorption and
minimizing
losses
© 2006 Thomson-Wadsworth
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Carbohydrate
◦ Fuels the fetal brain and spare the protein needed
for fetal growth
◦ Fiber can help alleviate the constipation that many
pregnant women experience
◦ Ideally 175g/day but no less than ~130g/day
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Protein
◦ DRI recommendation for pregnancy is higher than
for nonpregnant women by 25 grams/day
 Most women in the U.S. need not add protein-rich
foods to their diets
 They already exceed the recommended protein intake for
pregnancy
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Fat
◦ The high nutrient requirements of pregnancy leave
little room in the diet for excess energy from added
purified fats such as oil, margarine, and butter
◦ The essential fatty acids are particularly important
to the growth and development of the fetus
 The brain is composed mainly of lipid material and
depends heavily on long-chain omega-3 and omega-6
fatty acids for its growth, function, and structure
Folate
◦ New cells are laid down at a tremendous pace as
the fetus grows and develops
◦ The number of the mother’s red blood cells must
rise because her blood volume increases
◦ A function requiring more cell division and
therefore more vitamins
◦ Recommendation increases from 400 to 600
micrograms/day
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Folate
◦ Plays an important role in preventing neural tube
defects
 The early weeks of pregnancy are critical periods for
the formation and closure of the neural tube that will
later develop to form the brain and spinal cord
 By the time a woman suspects she is pregnant, usually
around the sixth week of pregnancy, the embryo’s
neural tube has normally closed
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A neural tube defect (NTD) occurs when the
tube fails to close properly
◦ In the U.S., about 30 of every 100,000 newborns
are born with an NTD
◦ When the neural tube fails to close properly and
brain development fails, a rare but lethal defect
known as anencephaly occurs (i.e. the baby is born
without a brain)
 All such infants die shortly after birth
◦ In a more common NTD, the spinal cord and
backbone do not develop normally
◦ The result is spina bifida
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To reduce the risk of NTDs women who are
capable of becoming pregnant should obtain
400 micrograms of folic acid from
supplements, fortified foods, or both
◦ In addition to eating folate-rich foods
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All enriched grain products sold commercially
in the U.S. are fortified with folic acid
◦ This measure has improved folate status in women
of childbearing age and lowered the number of
neural tube defects that occur each year
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Vitamin B12
◦ People who eat meat, eggs, or dairy products
receive all the vitamin B12 they need, even for
pregnancy
◦ Vegans are a high risk group
◦ Folate fortification raises one safety concern
 The pregnant woman needs a greater amount of B12 to
assist folate in the manufacture of new cells
 High intakes of folate complicate the diagnosis of a
vitamin B12 deficiency
 For this reason, folate intakes should not exceed 1
milligram/day
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Calcium
◦ Intestinal absorption doubles early in pregnancy
◦ And the mineral is stored in the mother’s bones
 When fetal bones begin to calcify, the mother’s bone
calcium stores are mobilized, and there is a shift of
calcium across the placenta
 In the final weeks of pregnancy more than 300
milligrams of calcium/day are transferred to the fetus
 Efforts to ensure an adequate calcium intake during
pregnancy are aimed at conserving the mother’s bone
mass while supplying fetal needs
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Most women do not meet the RDA for calcium
and should increase their intakes
◦ In particular, pregnant women under age 25, whose
own bones are still actively depositing minerals,
should strive to meet the DRI recommendation for
calcium by increasing their intake of calcium-rich
foods
 Less preferred, but still acceptable, is a daily
supplement of 600 milligrams of calcium
◦ The DRI recommendation for calcium is the same
for nonpregnant and pregnant women in the same
age group
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Magnesium
◦ Essential for bone and tissue growth
◦ Pregnancy slightly increases the need for
magnesium in the diet
Iron
◦ During pregnancy, the body avidly conserves iron
 Menstruation ceases and absorption of iron increases
up to threefold
 Despite these conservation measures, iron stores
dwindle because the developing fetus draws heavily on
its mother’s iron store up to a supply sufficient to
carry it through the first three to six months of life
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Even women with inadequate iron stores
transfer significant amounts of iron to the
fetus
◦ Iron needs of fetus have priority over mother
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Maternal blood losses are also inevitable at
birth, especially delivery by cesarean section
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Zinc
◦ Required for protein synthesis and cell
development
◦ Severe deficiency during pregnancy predicts low
birthweight
◦ Provided abundantly by protein-rich foods
◦ Absorption may be hindered by other trace
elements or fiber in foods
 For example, iron (and iron supplements) interferes with
zinc absorption
◦ Most supplements for pregnancy provide 30 to
60 milligrams a day
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For the normal-weight woman, the ideal
pattern of weight gain is
◦ about 3.5 pounds total during the first trimester
and
◦ a pound per week thereafter
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Women must gain weight during pregnancy
◦ Fetal and maternal well-being depend on it
◦ Ideally, women begin pregnancy at a healthy weight
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Weight gain for a pregnant teenager must be
adequate to accommodate her own growth
and that of her fetus
Women who are carrying twins must gain still
more
A sudden, large weight gain is a danger
signal
◦ It may indicate the onset of preeclampsia
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An active, physically fit woman experiencing a
normal pregnancy should continue to
exercise throughout pregnancy
◦ Adjusting intensity and duration as the pregnancy
progresses
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Staying active during the course of a normal,
healthy pregnancy
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Improves the fitness of the mother-to-be
Facilitates labor
Helps to prevent or manage gestational diabetes
Reduces psychological stress
Women who remain active during pregnancy
◦ Report fewer discomforts throughout their
pregnancies
◦ Retain habits that help in losing excess weight and
regaining fitness after the birth
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Research shows that water aerobics can
reduce the intensity of back pain during
pregnancy
◦ Other activities considered safe and comfortable for
pregnant women include
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Walking
Light strength training
Rowing
Climbing stairs
◦ The pregnant woman should also stay out of
saunas, steam rooms, and hot whirlpools
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A pregnant adolescent presents a special case of
intense nutritional needs
◦ Young teenage girls have a hard enough time meeting
nutrient needs for their own rapid growth and
development
◦ A pregnant teenager with a BMI in the normal range is
encouraged to gain about 35 pounds
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Many teens enter pregnancy deficient in nutrients
that place both the mother and fetus at risk
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Vitamin A
Vitamin D
Folate
Iron
Calcium
Zinc
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Compared to pregnant adult women, pregnant
teens have more
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Miscarriages
Premature births
Stillbirths
Low-birthweight babies
The greatest risk is the death of the infant
 Mothers under age 16 bear more infants who die within the
first year than do women in any other age group
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Smoking presents risks
◦ Teens are more likely to smoke while pregnant than
older women
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Some choices that pregnant women make or
substances they encounter can harm the
fetus, sometimes severely
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Cigarette Smoking
◦ Parental smoking can kill an otherwise healthy fetus
or newborn
◦ Constituents of cigarette smoke, such as nicotine
and cyanide, are toxic to a fetus
◦ Smoking restricts the blood supply
◦ Limits delivery of oxygen, nutrients & waste removal
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Cigarette smoking slows growth
◦ Retarding physical development of the fetus
◦ May cause behavioral or intellectual problems
later
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Cigarette (and cigar) smoking impair fetal
nutrition and development
◦ Adversely affect the pregnant woman’s nutrition
status
◦ Smokers tend to have lower intakes of dietary
fiber, vitamin A, beta-carotene, folate, and
vitamin C
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A mother who smokes is more likely to have a
complicated birth
◦ Her infant is more likely to be of low birthweight
 The more a mother smokes, the smaller her baby will
be
 Of all preventable causes of low birthweight in the
U.S., smoking has the greatest impact
 Increased Risk for SIDS
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Herbal supplements
◦ Some pregnant women mistakenly consider herbal
supplements to be safe alternatives to medicinal
drugs and take them to relieve nausea, promote
water loss, alleviate depression, aid sleep, or for
other reasons
◦ Some herbal products may be safe
 Almost none have been tested for safety or
effectiveness during pregnancy
◦ Pregnant women should stay away from herbal
supplements, tea, or other products unless their
safety during pregnancy has been ascertained
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Street Drugs
◦ Drugs during pregnancy inflict serious health
consequences:
◦ Drugs cross the placenta & impair fetal growth and
development
 Amphetamines
 Suspected nervous system damage
 Behavioral abnormalities
 Barbiturates
 Drug withdrawal symptoms in the newborn, lasting up to 6 months
 Opiates (including heroin)
 Drug withdrawal symptoms in the newborn
 Permanent learning disability (attention deficit hyperactivity disorder)
 Cocaine
 Uncontrolled jerking motions
 Permanent mental and physical damage
 Marijuana
 Short-term irritability at birth
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Environmental Contaminants
◦ Infants and young children whose mothers were exposed
to environmental contaminants such as lead and
mercury during pregnancy show signs of impaired
cognitive development
 During pregnancy, lead and mercury move across the
placenta
 Inflicting severe damage on the developing fetal nervous
system
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Mercury
◦ FDA and EPA to warn all pregnant women, women who
may become pregnant, lactating mothers, and young
children against eating the following large ocean fish:
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King mackerel
Swordfish
Shark
Tilefish
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The FDA and EPA further advice the same
groups of people to
◦ Eat up to 12 ounces a week of a variety of safer fish
and shellfish such as canned light tuna, salmon,
pollock, catfish, and shrimp
 Children should be given smaller portions
 Albacore “white” tuna has more mercury than canned
light tuna and should be limited to 6 ounces or less
per week
◦ Check local advisories about the safety of fish
caught by family and friends in lakes, rivers, and
coastal areas
 If no advice is available, eat up to 6 ounces per week
of fish from local water, but don’t eat any other fish
during that week
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Foodborne Illness
◦ Vomiting and diarrhea caused by many foodborne
illnesses can leave a pregnant woman exhausted
and dangerously dehydrated
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Listeriosis:
◦ Miscarriage, stillbirth, or severe brain or other
infections to fetuses and newborns
 According to the CDC, pregnant women are “about 20x
more likely than other healthy adults to get listeriosis.”
◦ A woman with listeriosis may develop symptoms
such as fever, vomiting, and diarrhea about 12
hours after eating a contaminated food
 Serious symptoms may develop a week to six weeks
later
 A blood test can reliably detect listeriosis
 Antibiotics given promptly to the pregnant sufferer can
often prevent infection of the fetus or newborn
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Preventive measures pregnant women can
take to avoid listeriosis
◦ Avoid certain Mexican soft cheeses and certain
other cheeses
◦ Use only pasteurized dairy products
◦ Eat only thoroughly cooked meat, poultry, and
seafood
◦ Thoroughly reheat meats until steaming hot
◦ Wash all fruits and vegetables
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Vitamin-mineral megadoses
◦ Many vitamins are toxic when taken in excess, and
minerals are even more so
◦ Vitamin A
 A single massive dose of preformed vitamin A (100x
the recommended intake) has caused birth defects
 Chronic use of lower doses of vitamins A supplements
(3x-4x the recommended intake) may also cause birth
defects
 Additional vitamin A is not recommended during
pregnancy
 The vitamin is prescribed in the first trimester of
pregnancy only upon evidence of deficiency, which is
rare
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Dieting
◦ Dieting, even for short periods of time, is
hazardous during pregnancy
◦ Low-carbohydrate diets or fasts that cause ketosis
deprive the growing fetal brain of needed glucose
and may impair its development
 Such diets are also likely to be deficient in other
nutrients vital to fetal growth
◦ Energy restriction during pregnancy is dangerous
 Regardless of the woman’s prepregnancy weight or the
amount of weight gained the previous month
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Sugar Substitutes
◦ Artificial sweeteners have been studied extensively
and found to be acceptable during pregnancy if
used with the FDA’s guidelines
◦ Pregnant women would be prudent to use
sweeteners in moderation and within an otherwise
nutritious and well-balanced diet
◦ Women with phenylketonuria should not use
aspartame
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Caffeine
◦ Caffeine crosses the placenta, and the fetus has
only a limited ability to metabolize it
◦ No firm limit for caffeine intake is available
 Pregnant women who drink more than three cups of
coffee a day may increase their risk of spontaneous
abortion
 The most sensible course is to limit caffeine
consumption to the equivalent of one cup of coffee or
two 12-ounce cola beverages a day
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Halts delivery of oxygen through umbilical cord
◦ Oxygen is indispensable on a minute-to-minute basis to
the development of the fetus’s central nervous system
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Alcohol slows cell division
◦ Reducing the number of cells produced and inflicting
abnormalities on those that are produced and all of their
progeny
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During the first month of pregnancy, the fetal
brain is growing at the rate of 100,000 new brain
cells a minute
◦ Even a few minutes of alcohol exposure during this
critical period can exert a major detrimental effect
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Alcohol interferes with placental transport of
nutrients to the fetus and can cause
malnutrition in the mother
◦ Then, all of malnutrition’s harmful effects
compound the effects of the alcohol
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Before fertilization, alcohol can damage the
ovum or sperm in the mother- or father-tobe
◦ Leading to abnormalities in the child
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Low Apgar score
◦ A system of scoring an infant’s physical condition right
after birth
◦ Heart rate, respiration, muscle tone, response to stimuli,
and color are ranked 0, 1, or 2
 A low score indicates that medical attention is required to
facilitate survival
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More than 40 identifiable health problems
◦ A cluster of symptoms known as fetal alcohol syndrome
(FAS)
 The cluster of symptoms including brain damage, growth
retardation, mental retardation, and facial abnormalities
seen in an infant or child whose mother consumed alcohol
during pregnancy
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Drinking alcohol during pregnancy threatens
the fetus with
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Irreversible brain damage
Growth retardation
Mental retardation
Facial abnormalities
Vision abnormalities
© 2006 Thomson-Wadsworth
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Gestational Diabetes
◦ Abnormal glucose tolerance appearing during
pregnancy
◦ Can lead to fetal or infant sickness or death
◦ If identified early and managed properly the most
serious risks fall dramatically
◦ More commonly, leads to surgical birth and high
infant birthweight
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Gestational diabetes risk factors
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Racial and ethnic groups prone to gestational
diabetes
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Glucose in the urine
Obesity
Personal history of gestational diabetes
Strong family history of diabetes
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African American
Asian American
Hispanic American
Native American
Pacific Islander
Usually resolves after the infant is born
◦ Some women go on to develop diabetes (usually type 2)
later in life
 Especially if they are overweight
Preeclampsia
◦ A potentially dangerous condition during pregnancy
characterized by edema, hypertension, and protein
in the urine
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Preeclampsia
◦ Afflicts 1 in 20 pregnancies
◦ Usually first pregnancies
◦ Most often during the third trimester
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Preeclampsia affects almost all of the mother’s
organs
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Circulatory system
Liver
Kidneys
Brain
If the condition progresses and she experiences
convulsions, the condition is called eclampsia
Maternal mortality is rare in developed countries
◦ Eclampsia is the most common cause of such mortality
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As the time of childbirth nears a woman must
decide whether she will feed her baby breast
milk, infant formula, or both
◦ These options are the only foods recommended for
an infant during the first four to six month of life
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Adequate nutrition is essential
◦ Nursing produces about 25 ounces of milk a day
 With considerable variation from woman to woman and
in the same woman from time to time
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The volume of breast milk produced depends
on how much milk the baby demands
◦ Not on how much fluid the mother drinks
◦ The nursing mother is advised to drink ≈13 cups of
fluid each day to protect herself from dehydration
Energy requirement for nursing:
 Producing milk costs a woman almost 500
calories/day above her regular need during
the first 6 months of lactation
◦ To provide this energy need, the woman is advised
to eat an extra 330 calories of food each day
 The other 170 calories can be drawn from the fat
stores she accumulated during pregnancy
Maternal Diet Quality:
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A common question is whether a mother’s
milk may lack a nutrient if she fails to get
enough in her diet
◦ The answer differs from one nutrient to the next
◦ In general, the effect of nutritional deprivation of
the mother is to reduce the quantity, not the
quality, of her milk
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There are some important reasons not to
breastfeed:
◦ Some substances impair maternal milk production
or enter breast milk and interfere with infant
development
◦ Some medical conditions also prohibit
breastfeeding
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Alcohol
◦ Alcohol concentration peaks within one hour after
ingestion of even moderate amounts
 May alter the taste of the milk to the disapproval of the
nursing infant
 May drink less milk than normal
◦ Drug addicts, including alcohol abusers, can take
such high doses that their infants become addicts
by way of breast milk
 In these cases, breastfeeding is contraindicated
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Cigarette smoking
◦ Lactating women who smoke produce less milk, with a
lower fat content
 Thus, their infants gain less weight than the infants of
nonsmokers
◦ A lactating woman who smokes transfers nicotine and
other chemicals to her infant via her breast milk
 And exposes the infant to secondhand smoke
◦ Infants who are “smoked over” experience a wide array
of health problems
◦ Poor growth
◦ Hearing impairment
◦ Vomiting
◦ Breathing difficulties
◦ Unexplained death
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Caffeine
◦ Excess caffeine can make an infant jittery and
wakeful
◦ Caffeine consumption should be moderate when
breastfeeding
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If a nursing mother must take medication
known to affect the infant
◦ Then breastfeeding must be put off during
treatment
 Meanwhile, the flow of milk can be sustained by
pumping the breasts and discarding the milk
◦ Oral contraceptives
 One type that combines the hormones estrogen and
progestin seems to
 Suppress milk output
 Lower the nitrogen content of the milk
 Shorten the duration of breastfeeding
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Environmental Contaminants
◦ Some contaminants do enter breast milk
 Others may be filtered out
◦ Formula is made with water
 Formula-fed infants consume any contaminants that
may be in the water supply
◦ With the exception of rare, massive exposure to a
contaminant
 The many benefits of breastfeeding outweigh the risk
associated with environmental hazards in the U.S.
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Maternal Illness
◦ If a woman has an ordinary cold, she can continue
nursing without worry
◦ The infant will probably catch it from her anyway
 Thanks to immunological protection, a breastfed baby
may be less susceptible than a formula-fed baby
◦ With appropriate treatment, a woman who has an
infectious disease such as hepatitis or tuberculosis
can breastfeed
◦ Transmission is rare
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HIV
◦ Can be passed from an infected mother to her infant
during pregnancy, at birth, or through breast milk
 Especially during the early months of breastfeeding
◦ When safe alternatives are available, women who have
tested positive for HIV should not breastfeed their
infants
◦ In developed countries, where feeding inappropriate
or contaminated formulas causes 1.5 million infant
deaths each year, breastfeeding can be critical to
infant survival
 This advantage must be weighed against the 200,000 300,000 infants who become infected with HIV each year by
way of breastfeeding
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The American Dietetic
Association (ADA)
advocates breastfeeding
for the nutritional
health it confers as well
as for the physiological,
social, economic, and
other benefits it gives to
the mother
© 2006 Thomson-Wadsworth

Formula feeding offers an acceptable alternative
to breastfeeding
◦ Nourishment for an infant from formula is adequate
◦ One advantage is that parents can see how much milk
the infant drinks during feeding
◦ Another is that other family members can participate in
feeding sessions
 Giving them a chance to develop the special closeness that
feeding fosters
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Standard formulas are inappropriate for some
infants
◦ For example,
 premature babies require special formulas, and
 infants allergic to milk protein can drink special
hypoallergenic formulas or formulas based on soy protein
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The stomach and intestines are immature at
first
◦ They can digest milk sugar but not starch
◦ At about 4 months, most infants can begin to
digest starchy foods
 Still later, the first teeth erupt, but not until sometime
during the second year can a baby begin to handle
chewy food
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Foods can be introduced into the diet as the
infant becomes physically ready to handle
them
◦ This readiness develops in stages
 A newborn can swallow only liquids that are well back
in the throat
 Later (at 4 months or so), the tongue can move against
the palate to swallow semisolid food such as cooked
cereal
 The infant can sit with support and can control its
head movements
 The infant is about 6 months old
© 2006 Thomson-Wadsworth
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Iron deficiency
◦ Prevalent in children between the ages of six
months and three years
 Due to their rapid growth and the significant place that
milk has in their diet
 Excessive milk consumption (more than 3.5 cups a
day) can displace iron-rich foods and lead to irondeficiency anemia, popularly called milk anemia
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To prevent iron deficiency
◦ Breast milk or iron-fortified formula
 Then iron-fortified cereals
 Then meat or meat alternatives such as legumes are
recommended
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Vitamin C
◦ The best sources are fruits and vegetables
◦ Many fruit juices are naturally rich in vitamin C
 Others may be fortified
 A danger lies in overfeeding juice
 Some babies and young children may fail to grow and
thrive when juice displaces other nutrient- and energydense foods from their diets
 AAP recommendations set upper limits on juice
consumption for infants and children at 4-6 ounces/day
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Physical Readiness for Solid Foods
◦ Foods introduced at the right times contribute to an
infant’s physical development
 When the baby can sit up, can handle finger foods, and
is teething, hard crackers and other finger foods may
be introduced under the watchful eye of an adult
 These foods promote the development of manual
dexterity and control of the jaw muscles
 The caregiver must be careful that the infant does not
choke on them
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Babies and young children cannot safely chew
and swallow the following foods; they can
easily choke on these foods, a risk not worth
taking
 Carrots, cherries, gum, hard or gel-type candies, hot
dog slices, marshmallows, nuts, peanut butter,
popcorn, raw celery, whole beans, whole grapes
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Nonfood items of small size should always be
kept out of the infant’s reach to prevent
choking
◦ Balloons, coins, pen tops, small balls, other items of
similar size
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Juice
◦ Fruits juices should be served in a cup, not in a bottle
◦ And not before the infant is six months of age
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Prolonged sucking on a bottle of milk or juice
also bathes the upper teeth in a carbohydraterich fluid
◦ That favors the growth of bacteria that produce acid that
dissolves tooth material
◦ Babies regularly put to bed with a bottle have teeth
decayed all the way to the gum line
 A condition known as nursing bottle syndrome

Food Allergies
◦ New foods should be introduced one at a time so
that allergies or other sensitivities can be detected
 For example, when fortified baby cereals are
introduced, try rice cereal first for several days
 It causes allergy least often
 Try wheat-containing cereals last
 It is a common offender
 Introduce egg whites, soy products, cow’s milk, and
citrus fruits still later

Nine times out of ten, the allergy won’t be
evident immediately but will manifest itself in
vague symptoms occurring up to five days
after the offending food is eaten
◦ Wait a month or two to try the food again
 Many sensitivities disappear with maturity

If a food causes an allergic reaction
◦ Irritability due to skin rash, digestive upset, or
respiratory discomfort
◦ Discontinue its use before going on to the next
food

If your family history indicates allergies, apply
extra caution in introducing new foods
◦ Parents or caregivers who detect allergies early in
an infant’s life can spare the whole family much
grief

Foods at One Year
◦ For the infant weaned to whole milk after one year
of age, whole milk can supply most of the needed
nutrients
 2 to 3.5 cups a day meet those needs
 A variety of other foods should be supplied in amounts
sufficient to round out total energy needs
 Meat and meat alternatives, enriched or whole-grain
breads, fruits, and vegetables