Infant Feeding

1. See Also
   1. Infant Feeding
   2. Infant Nutritional Sources
   3. Infant Nutrition Components
   4. Bottle Feeding
   5. Breast Feeding
   6. Breast Feeding Technique
   7. Lactation Vitamin Supplementation
   8. Medications in Lactation
   9. Solid Food Introduction in Infants
   10. Constipation in Infants
   11. Neonatal Fluid Management
   12. Preterm Feeding Schedules
2. Monitoring
   1. Adequate newborn weight gain
      1. Anticipate up to 10% weight loss after delivery and regain to birth weight by 2 weeks
      2. Weight gain (1 gram = 0.0352 oz)
         1. Daily: 20-30 grams per day
         2. Weekly: 150-200 grams (5 to 7 ounces) per week
      3. Infant doubles birth weight in 6 months
   2. Adequate hydration
      1. Expect clear urine output 6-8 times daily
3. Protocol: Newborn
   1. Indications to delay start of enteral feeding
      1. Prolonged asphyxia with 5 minute APGAR less than 6
      2. Respiratory distress
      3. Neurologic depression
      4. Abdominal distention
      5. No stool passage by 24 hours
      6. Severe Sepsis suspected
   2. First feeding with sterile water
      1. Tracheoesophageal fistula (risk of aspiration)
   3. Vitamin Supplementation
      1. See Preterm Infant information below regarding supplementation
      2. Vitamin D 200 IU daily
         1. Started at 2 months of age for Breast-fed infants with <500 ml formula/day
         2. Indicated in Breast-fed premature infants (see below)
         3. Consider for darker skinned ethnicity during winter (less sunlight exposure)
   4. Term Infant
      1. Human Breast Milk preferrred
      2. Cow's milk Infant Formula
      3. Soy-based Infant formula
         1. Not recommended (except in vegan families who are Bottle Feeding)
         2. No advantage in milk allergy (30% cross-reactivity with milk proteins)
         3. Attempt to switch to cow's milk Infant Formula
      4. Elemental formula
         1. Indicated in Cow's Milk Allergy
   5. Preterm Infant (especially < 1500 grams)
      1. Premature infant formula
         1. Inpatient (NICU): 24 calories/ounce used until weight >1800 grams
         2. Outpatient:
            1. Use 22 calories/ounce until one year of adjusted age or growth caught-up
            2. Use 20 calories/ounce after catch-up growth achieved up until one year
         3. Supplements
            1. Iron Supplementation 2 mg/kg/day (up to 15 mg/day)
               1. Indicated as addition to formula providing 2 mg/kg/day iron based on gestational age
      2. Human Breast Milk
         1. Feed on demand every 1-3 hours
         2. Supplements
            1. See Lactation Vitamin Supplementation
            2. Milk fortifier or premature infant formula
               1. Use until catch-up weight achieved and weight gain adequate at 20-30 grams/day
               2. Koo (2006) Am J Clin Nutr 84:1357-64
            3. Multivitamins 0.5 to 1 ml per day
               1. Use until weight >11 pounds (5 kg)
            4. Iron Supplementation 2-4 mg/kg/day (up to 15 mg/day)
            5. Vitamin D 200-400 IU per day
               1. Start at 2 months old if exclusively Breast fed
4. Protocol: Birth to 4 months
   1. Avoid honey until over 1 year of age
      1. Risk of neonatal Botulism
   2. Avoid water supplementation
      1. Risk of Hyponatremia
   3. Avoid semi-solid food until age 4-6 months
      1. Infants do not accept semi-solid food
      2. Tongues protrude when spoon in mouth
      3. Unable to transfer food to back of mouth
      4. Risk of Choking
5. Protocol: Age 4 to 6 months
   1. Iron-fortified infant cereal (4-8 Tablespoons per day)
      1. Source of Iron and B Vitamins
      2. Begin with rice
      3. Avoid other grains until older than 6 months
         1. Barley
         2. Oats
         3. Wheat
   2. Unsweetened fruit juices (2-4 ounces per day)
      1. Source of Vitamin C
      2. Plain Vitamin C fortified juice
         1. Dilute juice with water 1:1
      3. Avoid other juices until older than 6 months
         1. Orange
         2. Pineapple
         3. Grapefruit
         4. Tomato
   3. Infant able to transfer semisolid food to swallow
6. Protocol: Older than 6 months
   1. See Solid Food Introduction in Infants
   2. Fluoride Supplementation if indicated
   3. Water intake may begin
      1. Confirm that fluoride concentration not too high
   4. Initiate dental care
      1. Wipe teeth and baby's gums with soft damp cloth