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 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.
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). 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), 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. 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), maternal dietary factors, and daily intake.
Calorie Requirements at Different Ages*
Age | Requirement | |
|---|---|---|
kcal/lb/day | kcal/kg/day | |
< 6 months | 50–55 | 110–120 |
1 year | 45 | 95–100 |
15 years | 20 | 44 |
* 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. | ||
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, particularly weight (changes in the child’s percentile rank on standard growth charts 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.
