Feeding Recommendations
Recommend alignment with Nutrition recommendations, once available. The minimum volumes are an estimate; recommend allowing infant to PO more than minimum volume if continuing to show feeding cues.
Intake Recommendations
Current Nutrition |
Initial Minimum Intake Recommendations |
Feeding Frequency |
Human Milk or Formula
Minimal or no solid intake |
- Infants > 37 wks
- 108 kcal/kg/day
- Equivalent to 162 mL/kg/day of 20 kcal/oz standard term formula or unfortified human milk
|
- < 3 mos, approx. q3, ≥ 8 per day
- ≥ 3 mos, approx. q3 during day, ≥ 6 per day
- Wake the baby to feed if necessary
|
References: Pediatric Manual of Clinical Dietetics , Recommended Dietary Allowances
Infant Feeding Recommendations Based on Method
Breastfed
Direct feeding at the breast
and /or
mother has goal of breastfeeding |
- Observe feeding
- Lactation referral
- Obtain pre- and post-weights if > 5 days old
- Initiate supplementation, preferably with expressed maternal milk, via bottle after nursing to meet goal volume. If expressed maternal milk is unavailable, consider appropriate infant formula.
- Pump after breastfeeding to increase milk supply
- Assure breast drainage with breast compression and massage while feeding and pumping
- Offer both breasts with each feed
- Increase feeds/add night time feedings
- Wake for feedings
- 0-6 mos: 8 or more feedings per day
|
Bottle Fed
Feeding from a bottle |
- Observe feeding
- Awareness of infant feeding cues prior to feed
- Supportive positioning for oral feeding
- Reduce environmental distractions (e.g., noise and light)
- Offer pacing or breaks if increased WOB and/or oral loss from mouth
- Limit feeds to 30 minutes
- Wake for feedings
- < 3 mos: 8 or more feedings per day
- > 3 mos: 6 or more feedings per day
|
Increase Caloric Density |
-
Fortified Breast Milk/Formula Concentration
- Fortified breastmilk or infant formula concentration can initially begin at 22 kcal/oz.
- If poor growth continues, further fortification/ concentration can continue to 24 kcal/oz.
- Infants who are not adequately growing on fortified breastmilk/infant formula concentration of 24 kcal/ oz. require a more detailed investigation of the etiology. Infants should not be routinely concentrated to > 24 kcal/oz. without consultation from GI or Nutrition for further assistance with the clinical workup.
|
Solids |
- Ensure that offered dietary texture matches current oral motor skills.
- Consider referral to Feeding and Swallowing center
|
Reference: Pediatric Manual of Clinical Dietetics