Health Supervision Visit, 6 Months

Assess

• Anthropometric measurements
• Physical examination
• Adequacy of human milk or formula intake
  • High-protein intakes from formula and complementary foods may be a risk factor for excessive infant weight gain; recommendations have been proposed (though not yet made) to limit total protein to 15% of energy intake.
• Iron intake
  • If iron intake is inadequate, especially for breastfeeding infants, then supplements of iron should be continued (1 mg/kg/d).
  • Research indicates that the complementary foods of more than 50% of infants in the United States do not meet iron requirements; this applies to more than 95% of breastfed infants.
• Screen for food insecurity using the validated 2-question Hunger Vital Sign tool
  • 1 in 7 children live in a household experiencing food insecurity
  • Rates of food insecurity are higher in households with children younger than 6 years; single parent households; and immigrant, Black or Latinx families
    • Provide resources for families experiencing food insecurity. (Table 3)

Discuss

• Begin complementary foods from all groups, emphasizing sources of iron.
  • Encourage baby-led weaning and offer soft, bone-free versions of whatever the family is eating at meals.
  • Encourage sitting at the table with the family for meals and use of all 5 senses to explore food.
  • Encourage a wide variety of healthy iron-rich foods, including starches, meats, fruits, and vegetables.
  • At this stage, infants are simply exploring new tastes and textures, which encourages them not to be picky eaters later in life.
• Continue vitamin D at 400 IU/day.
• If bottle-feeding, advise not to put baby in bed with a bottle (for a nap or the night).
• Avoid honey.
• If infants are weaned from breast before 12 months, iron-fortified formula should be used.
  • There is little evidence that partially or extensively hydrolyzed formula prevents atopic disease, even in high-risk infants.
• Avoid soy milk, cow milk, and goat milk before 12 months of age, unless medically indicated.
• Limit whole milk to <16 oz per day.
• Avoid juice.
• Continue breastfeeding.

Calculations

Estimated energy requirements (kcal/d) for infants 6 months to 2.99 years (weight in kg; height in cm):

• Males: −716.45 − (1.00 × age) + (17.82 × height) + (15.06 × weight) + 20
• Females: −69.15 + (80.0 × age) + (2.65 × height) + (54.15 × weight) + 20/15
  • Energy cost of growth for girls: 6 to 11.99 months: 20 kcal/d; 12 to 35.99 months: 15 kcal/d.