Infant Malnutrition (FTT) — Initial Feeding Recommendations — Clinical Pathway: Inpatient

Infant Malnutrition/Failure to Thrive (FTT) Clinical Pathway — Inpatient

Initial Feeding Recommendations

Consider establishing feeding recommendation based on the amount of solids taken. Recommend alignment with Nutrition recommendations, once available. The minimum volumes are an estimate; recommend allowing patient to PO more than minimum volume if continuing to show feeding cues.

Intake Recommendations

Current Nutrition Initial Minimum Intake Recommendations
Start at 50-75% of goal if at risk for refeeding.		 Feeding Frequency
Human milk or formula (minimal or no solid intake)
  • Term Infants:
  • 108 kcal/kg/day
  • Equivalent to 162 mL/kg/day of 20 kcal/oz standard term formula or unfortified human milk

  • Preterm Infants:
  • 110 - 130 kcal/kg/day
  • Equivalent to 150 - 177 mL/kg/day of 22 kcal/oz preterm formula
  • Feeding Frequency:
  • < 3 months, q3, ≥ 8 per day
    • Max 3 hours between feeds
  • ≥ 3 months, q3 during day, ≥ 6 per day

  • Wake the baby to feed if necessary
> 4 tbsp
(2 oz jar of baby food)
solids/day
  • Minimum 24 oz/day of formula or human milk
  • Limit any other fluid intake (water, juice)
  • Order Calorie counts
  • Feeding Frequency:
  • 4 - 6 per day

Source: Nevin-Folino, NL, ed. Pediatric Manual of Clinical Dietetics, 2nd ed. Chicago: American Dietetic Association; 2003.

Calorie Needs by Age

Age
If preterm, use corrected age		 Calories
kcal/kg
< 37 weeks 110 - 130
37 weeks - 6 months 108
7 - 12 months 98

Source: Recommended Dietary Allowances, 10th ed, National Academy of Sciences, National Academy Press 1989; 33-36.

Feeding Recommendations Based on Method

Breastfed
Direct feeding at the breast
and /or
mother has goal of breastfeeding
  • Lactation consult
  • Obtain pre- and post-weights if > 5 days old
  • Initiate supplementation via bottle after nursing to meet goal volume
  • 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
  • Pasteurized donor human milk is available during admission (not following discharge) per parental preference; consent required. Pasteurized Donor Human Milk is available for families.
Bottle Fed
Feeding from a bottle
  • 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