If the delivery was uncomplicated and the neonate is alert and healthy, the neonate can be brought to the mother for feeding immediately. Successful breastfeeding Breastfeeding (See also Nutrition in Infants.) Breast milk is the nutrition of choice. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for a minimum of 6 months and introduction... read more is enhanced by putting the neonate to the breast as soon as possible after delivery. Spitting mucus after feeding is common (because gastroesophageal smooth muscle is lax) but should subside within 48 hours. If spitting mucus or emesis persists past 48 hours or if vomit is bilious, complete evaluation of the upper gastrointestinal (GI) and respiratory tracts is needed to detect congenital GI anomalies Overview of Congenital Gastrointestinal Anomalies Most congenital gastrointestinal (GI) anomalies result in some type of intestinal obstruction, frequently manifesting with feeding difficulties, distention, and emesis at birth or within 1 or... read more .
Daily fluid and calorie requirements vary with age and are proportionately greater in neonates and infants than in older children and adults ( see Table: Calorie Requirements at Different Ages* Calorie Requirements at Different Ages* 
). Relative requirements for protein and energy (g or kcal/kg body weight) decline progressively from the end of infancy through adolescence ( see Table: Recommended Dietary Reference Intakes* for Some Macronutrients, Food and Nutrition Board, Institute of Medicine of the National Academies Recommended Dietary Reference Intakes* for Some Macronutrients, Food and Nutrition Board, Institute of Medicine of the National Academies ), but absolute requirements increase. For example, protein requirements decrease from 1.2 g/kg/day at 1 year to 0.9 g/kg/day at 18 years, and mean relative energy requirements decrease from 100 kcal/kg at 1 year to 40 kcal/kg in late adolescence.
Newborns should be fed on demand, typically about 8 to 12 times a day. Average intake per feed in the first few days may be only 15 to 30 mL. After 48 hours, signs that feeding is adequate include the infant seeming satisfied after each feed, having 6 to 8 wet diapers a day and regular bowel movements, sleeping well, being alert when awake, and gaining weight.
Nutritional recommendations are generally not evidence-based. Requirements for vitamins depend on the source of nutrition (eg, breast milk versus standard infant formula Formula Feeding The only acceptable alternative to breastfeeding during the first year is formula; water can cause hyponatremia, and whole cow’s milk is not nutritionally complete. Advantages of formula feeding... read more ), maternal dietary factors, and daily intake.
Feeding problems
Minor variations in day-to-day food intake are common and, although often of concern to parents, usually require only reassurance and guidance unless there are signs of disease or changes in growth parameters Growth Parameters in Neonates Growth parameters and gestational age help identify the risk of neonatal pathology. Growth is influenced by genetic and nutritional factors as well as intrauterine conditions. Growth parameters... read more , particularly weight (changes in the child’s percentile rank on standard growth charts Physical Growth of Infants and Children Physical growth includes attainment of full height and appropriate weight and an increase in size of all organs (except lymphatic tissue, which decreases in size). Growth from birth to adolescence... read more are more significant than absolute changes).
Loss of > 5 to 7% of birth weight in the first week indicates undernutrition. Birth weight should be regained by 2 weeks in breastfed infants (earlier in formula-fed infants), and a subsequent gain of about 20 to 30 g/day (1 ounce/day) is expected for the first few months. Infants should double their birth weight by about 5 months.
