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1

Physiologic considerations of 
INFANTS

1 Month baby = 1 oz stomach (size of fist)

WEIGHT GAIN
lose 6% in 1st/2nd week of life
DOUBLE birth weight by 5-6 months
5 pounds per year on average

LENGTH
50% increase in 1st year
100% increase in 1st 4 years
300% increase by 13 years

2

RDA
DIETARY intake for Children

38-42weeks gestation >2500gm

Birth - 6 months
110 kcal/kg/day

6 - 12 months
80 kcal/kg/day
not a sig difference between GENDER

PRETERM / <2500gm
<130 kcal/kg/day

3

RDA
for Birth - 6 months

110 kcal/kg/day

Breastfeeding is recommended for this age range

4-6 months of age:
digestive system ready to take complex food/cereal/babyfood
better neck/head control
some teeth

4

RDA

6 - 12 months

80 kcal/kg/day

not a sig diff between boys/girls <10 y/o
LESS THAN  birth -6 months = 110

Master chewing & finger foods

Try CUPS / utensils

5

RDA
for PRETERM
 or <2500gm

<130 kcal/kg/day

needs MORE than full term children 110->80

6

Breastfeeding info

PREFERRED source of nutrition for FIRST 6 MONTHS
only CONTRAINDICATED if:
HIV / Chemo Medication / TB

Frequency is MORE OFTEN
1-2 hours, more than usual

Bowel Movement = after each feeding

7

Content of Formulas

WANT TO BE IDENTICAL TO HUMAN MILK

40-50% Carbohydrates
lactose is main source

30-40% Fats

5-10% Protein

Water

Micronutrients

8

Lactose Deficiency

Lactose Intolerance:
Diarrhea / Ab pain / Bloating
infants < 36 weeks gestation

SECONDARY lactase deficiency:
TEMPORARY decrease in lactase cause by
gastroenteritis / malnutrition

Congenital lactase deficiency:
INBORN error of metabolism = Rare

9

FAT

Content of Formula

Varies between products, but mainly:
TRIGLYCERIDES

no restriction < 2 y/o
needed for proper neurologic development

Minimum requied in formula = 30% of calories as fat
MAX = 54% 

10

Protein
Content of Formula

Whey Protein
more soluble & remains in solution throughout stomach
20% cows milk vs 50-60% human milk

Casein Products
CURDS --> form micelles

Whey:Casein Ration = 60:40
for HUMAN milk, 20:80 for cows milk

 

11

Protein Requirements

Birth - 6 months:
2.2 gm/kg/day

 

6 months - 1 year:
1.6 gm/kg/day

12

WATER
Content of Formula
+ RDA for WATER

NO supplemental water is Necessary
even once starting baby food

Fluid Maintenance:
100 ml/kg/day for 1st 10kg
PLUS + 50 ml/kg/day for each additional-kg between 10-20kg

 

13

Vitamins & Minerals
needed for Infant SUPPLEMENTATION

VITAMIN D
All infants : 400 IU/day 
starting within 1st few days of life

IRON
Full-term breastfed: 1 mg/kg/day after 4 months of age
varies by preterm/formula

FLUORIDE
Based on the amount of fluoride present in water source
fluoridated toothpaste

14

Vitamin D Supplementation

ALL INFANTS
400 IU/day

starting within the first few days of life

UNLESS receiving at least 
>1 liter of fortified formula/day

15

IRON SUPPLEMENTATION

for infants

FULL Term + Breastfed
1 mg/kg/day after 4 months of age

Pre-term Breastfed
2 mg/kg/day after 1 month

Partial Breastfed
if 50% HUMAN milk fed --> use ABOVE dosing

Formula Fed:
Iron-fortified formulas supply sufficient iron for first 12 months of life

16

Fluoride SUPPLEMENTATION

Based on the amount of fluoride present in WATER SOURCE
NOT recommended @ <6 months

Fluoridated TOOTHPASTE should be used

<3y/o --> use grain of rice amount

>3 years of age --> pea size apoint

start with first tooth eruption

17

Milk Comparisons

FDA LIMIT for 
Renal Solute Load
 = 277 

Cow's Milk: 
20% Whey : 80% Casein
308 Renal Solulte load

DO NOT RECOMMEND COW'S MILK IN 
FIRST YEAR OF LIFE

18

Soy-Based Formulas

Corn Starch / Tapioca Starch / Sucrose
for the CARB -- instead of LACTOSE

recommended if lactase deficient or allergy
NOT recommended for pre-term infants

HIGH concentration of 
PROTEIN / MANGANESE


 

19

Therapeutic Formulas

Casein-Hydrolysate-Based Formulas

Pregestimil // Nutramigen // Alimentum

= BROKEN-down proteins --> AA's
so that it is easier to digest

Indicated for patients w/
GI Distrubances
----
less palatable

20

Therapeutic Formulas

WHEY-Hydroysate Based

Carnation Good-Start

MORE Palatable vs Casein
maybe more acceptable if need for
GI INTOLERANCE

21

Therapeutic Formulas
OTHER CONSIDERATIONS

Premature Infant Formulas
decreased renal solule load --> whey predominant
want to mimic breast milk ratio = 60W:40C

Pre-Thickened Formulas
indicated for GERD

Concentrated Formulas
24 vs 27kcal/oz = HIGHER calorie

Human Milk Fortifiers
Adds Calories, without adding volume

22

What is COLIC?

20% of infants experience this

Insoluble Crying
 = worse in evening

Gassy / Hernia / Sensitivity to milk protein ???

usually subsides by 3 months of age
needs a LOT of patience

23

Considerations for CONSTIPATION

DO NOT USE
Low-Iron Formulas

Honey - botulism risk

Plain Water? - NO NUTRITIONAL USE

JUST GIVE THEM MORE FORMULA
NO DRUG THERAPY
see a doctor if been going for too long

24

Formula Warming

Bring to
ROOM TEMPERATURE

AVOID use of microwave
can have HOT SPOTS --> burn mouth

Sterilization of nipples/bottle

25

Full Term Baby & 1 month old

Stomach Capacity

"SIZE of THEIR FIST"
Full Term
20 - 90mL = 1-3oz

1 month
90 - 150mL = 3-5oz

26

Problems with Feeding:

GERD

do NOT add CEREAL to formula
may WORSEN the GERD

Recommend:
formulas that THICKEN in the stomach

27

Monitoring if
​Problems with Feeding:

Weight
use a weight curve
Height

Head Circumference

HYDRATION STATUS
 # Wet Diapers (weight)
TEARS
soft fontanelle

28

How MUCH to feed the baby?

◦Birth – 2 weeks: 
2-3 ounces/feed

◦3 weeks – 2 months
4-5 ounces/feed

◦2 months onward: 
~ 6 ounces/feed

◦Birth to 6 months ~ 110 kcal/kg/day
◦6 months – 12 months ~ 80 kcal/kg/day

29

How OFTEN to feed the baby?

Healthy, term infants = Q4 HOURS
preterm = q 2-3 hours

FEED ON DEMAND!
until they are satisfied

Nightime feedings may stop after 1-2 months

during illnesses --> frequency will VARY
constipation --> MORE frequent
vomiting --> LESS frequent
DIARRHEA --> fluid/electrolyte replacement

30

HOW TO PREPARE FORMULA?

LIQUID CONCENTRATE