If the delivery was uncomplicated and the neonate is alert and healthy, the neonate can be brought to the parent for feeding immediately. Successful breastfeeding (chestfeeding) 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 emesis is bilious, complete evaluation of the upper gastrointestinal (GI) and respiratory tracts is needed to detect congenital GI anomalies.
Daily fluid and calorie requirements vary with age and are proportionately greater in neonates and infants than in older children and adults (see table ). Relative requirements for protein and energy (g or kcal/kg body weight) decline progressively from the end of infancy through adolescence (see table ), but absolute requirements increase.
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. Signs that feeding for older newborns and infants is adequate include the infant seeming satisfied after each feed, having 6 to 8 wet diapers a day and regular bowel movements, being alert when awake, and not losing excessive weight (followed by consistent weight gain).
Requirements for vitamins depend on the source of nutrition (eg, breast milk versus standard infant formula), maternal dietary factors, and daily intake.
Calorie Requirements at Different Ages*
Age | Requirements (kcal/kg/day) |
|---|---|
< 6 months (and full term) | 100–120 |
1 year | 80-85 |
15 years | 35-50 |
* When protein and calories are provided by breast milk that is completely digested and absorbed, the requirements between 3 months and 9 months of age may be lower. Butte NF. Energy requirements of infants. Public Health Nutr. 2005;8(7A):953-967 and doi:10.1079/phn2005790 and Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128 Suppl 5(Suppl 5):S213-S256. doi:10.1542/peds.2009-2107C. | |
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 parameter percentiles, particularly weight (changes in the child’s percentile rank on standard growth charts are more significant than absolute changes).
Loss of > 10% of birth weight in the first week usually indicates undernutrition. Birth weight should be regained by about 2 weeks in breastfed infants (earlier in formula-fed infants), and a subsequent gain of approximately 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.
