AAP Updates List of Nutrients for Baby’s First 1000 Days

Nutrients Baby First 1000 Days

Low gluten.  Low refined sugar.  Fortified toddler formulas.  Early solids.  Late solids.  When it comes to feeding our children, there has always been lots of interest in what they should be taking, as well as what they should be omitting.  But what’s the real deal?  And is there any science to back up the recommendations?

One group that tries to make sense of what’s out there, nutritionally speaking, is the American Academy of Pediatrics   (AAP).   Since its formation in 1930, the AAP has been dedicated to the premise that children are not simply little adults. They have their own unique developmental and nutritional needs.  In support of that philosophy, the pediatricians of the AAP follow the latest research in infant and child nutrition.

In order to stay current with that research, pediatric providers look to the AAP’s Committee on Nutrition.  This committee, composed of pediatricians and nutritionists, studies the nutritional needs of the pediatric population and develops guidelines based on both research and practical experience.  The group recently turned their attention to prenatal, infant and toddler nutrition.  They published their recommendations in the policy statement “Advocacy for Improving Nutrition in the First 1000 Days to Support Childhood Development and Adult Health.”

While it may not be news that good nutrition is important for infants and children, existing guidelines focused on children two years and older.  This more recent policy statement focused on the period from early pregnancy to age 2—a critical period for brain development.  If you’ve ever looked at a baby’s growth chart, you can appreciate how much head growth happens early on—and with good reason:  a brain is growing in there!

The Essential Nutrients

We’ve known for a long time about the importance of adequate iron for pregnant women and children.  You can’t necessarily see, feel or smell iron deficiency anemia, but severe anemia has been associated with impaired brain development.  In fact, getting iron into pregnant women and children has always been one of the major purposes of the Women, Infants and Children Supplemental Nutrition Program (WIC), which serves low-income households.

Other than iron, what might be important?  The policy statement focuses on certain key nutrients as being particularly crucial to brain development:

  • Protein
  • Zinc
  • Choline
  • Folate
  • Iodine
  • Vitamins A, D, B6, and B12
  • Long-chain polyunsaturated fatty acids

But…How to Get Them In?

It seems like a tall order to get all those nutrients into babies; where does one begin?  Actually, some help in answering this question is on the way.  More definitive guidelines on birth-to-2 feeding are currently being developed by the United States Department of Agriculture (USDA) and the Department of Health and Human Services (HHS).  While the finished guidelines are likely a few years away, the AAP Committee on Nutrition does allude to some general recommendations in their policy statement.

First off, do realize that those 1000 days begin at conception!  It’s just as important for pregnant women to get key nutrients as it is for young babies to get them.  Get into prenatal care early and discuss your and your growing baby’s nutritional needs with your obstetric provider.

Second, give strong consideration to breastfeeding.  The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months, followed by gradual introduction of solid foods.  Ideally, breastfeeding should be continued at least through the first year of life.  Although this is a personal decision, and infant formula makers strive to make their products nutritionally similar to breast milk, it’s impossible to duplicate what nature provides.

Many new breastfeeding mothers find those first few feeds daunting.  Keep in mind that a newborn’s stomach is very small.  While it’s important that feeding be reasonably well established after a few days, infants don’t necessarily need to take a lot during the initial feedings.  Thus, unless directed otherwise by your baby’s provider, it’s often a good idea to avoid supplementing with formula in order to get Mom’s milk established.

Keep in mind that there is a lot of collective knowledge among nursery staff, your pediatric provider, and breastfeeding support groups such as those provided by La Leche League.  Taken together, these individuals have seen and debugged a variety of breastfeeding issues; use them as a resource!

Third, if nutritious food is too costly or otherwise hard to come by, take advantage of support programs.  The best known of these is probably WIC, but don’t forget about the Supplemental Nutrition Assistance Program (formerly “Food Stamps”), and your provider should be familiar with others.  Also, many states have general infant and toddler support services (in Florida, for example, Healthy Start Coalitions provide assistance in a number of ways); they should be able to link families up with nutrition resources.

Finally, work with your pediatric provider in identifying and promoting healthy food choices for growing infants and toddlers.  This, too, can seem daunting, and definitive recommendations are at best a work in progress.  However, young palates are relatively unbiased, and most infants and even toddlers will take a variety of foods over time if they continue to be offered.  One tip:  fruit juice is not at all recommended under the age of 1.  One of the issues with giving fruit juice is that it may dull the appetite for food.  The AAP website for parents, healthychildren.org, gives some general considerations for including healthy choices in the diet.

We all want to give our young ones the best start possible, and providing good nutrition is certainly part of that.  More definitive guidelines on what to provide and how to do it are on the horizon.  As the AAP, the USDA and HHS study the evidence and craft the guidelines, it’s important to continue the dialogue with your obstetric and pediatric providers, who can share what we do know about nutrition’s role in optimizing brain development during those first 1000 days.

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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