Infant Feeding

The newborn’s diet must supply calories and nutrients, including carbohydrates, proteins, fats, vitamins, and minerals needed to support the rapid growth and development that occurs in early life.

During the first few months of life, nutritional needs can be met by either breast milk or commercially prepared cow's milk–based formula.

Alright, let's look at the composition of breast milk, which differs with each of the three phases of milk production, also known as lactogenesis.

Phase I of lactogenesis starts during pregnancy and continues through the first few days of postpartum. During this phase, the breasts produce an early version of breast milk called colostrum which is a thick, yellowish fluid, high in protein, vitamins, minerals, and immunoglobulins like IgA, which protect the infant’s gastrointestinal tract from infections and aids in establishing normal flora in the infant’s digestive tract.

Colostrum is low in fat and carbohydrates. It also has a laxative effect, which promotes the passage of the infant’s first bowel movement called meconium.

Next, Phase II of lactogenesis starts two to three days postpartum. The milk produced during this phase is called transitional milk.

Compared to colostrum it contains less immunoglobulins and proteins, but has more vitamins, fats, and lactose. The last phase of lactogenesis is Phase III, when mature milk is produced.

Mature milk is the ideal food for infants, though it’s low in vitamin D, so a daily supplement of 400 international units, or IUs, is recommended until the baby starts eating solid foods.

Mature milk is also low in iron, but since the iron found in breast milk is easily absorbed, supplementation is not needed.

Now, the nutritional content of mature breast milk will vary during the course of the feeding session. So, foremilk, which is the first milk that flows from the breast, is rich in protein and carbohydrates, and low in fat and calories.

It is also quite watery, so it quenches the infant’s thirst. On the flip side is hindmilk, which is the milk near the end of feeding, is rich in fat and higher in calories.

Alright, now let’s switch gears and discuss infant formulas. Standard infant formulas are based on cow’s milk that’s been modified by decreasing the protein content, replacing the butterfat with vegetable oil, and adding carbohydrates and essential nutrients such as vitamins and minerals, especially iron.

There are also other formulas for infants with special needs. For example, there are hydrolyzed formulas, where the protein has been broken down into smaller sized proteins than those found in standard cow's milk-based formula.

This type of formula is used when milk protein allergy is suspected, because the hydrolyzed proteins are less likely to stimulate antibody production.

Next, are elemental formulas which are easier to absorb because they contain protein derived from free amino acids and fat in the form of medium-chain triglycerides.

These formulas are used for infants with abnormal gastrointestinal tracts and fat malabsorption problems, like severe liver disease, or gastroschisis, a birth defect where there’s an opening in the abdominal wall that allows the infant’s intestines to extend outside of the body.

There are also formulas that are higher in calories that can be used to meet the needs of preterm infants, and low-phenylalanine formulas for infants with phenylketonuria, or PKU, who lack the enzyme needed to digest phenylalanine, an amino acid found in infant formulas.

Finally, there are soy-based formulas which are used to feed infants with galactosemia, a hereditary disorder that impairs the body’s ability to digest galactose, a type of sugar found in human milk; lactose intolerance; or when a vegetarian diet is preferred.

Okay, let’s move on to the education you’ll provide about infant feeding. For breastfeeding, instruct your patient on techniques that can help promote successful breastfeeding.

Demonstrate the different feeding positions, including the cradle hold, cross-cradle hold, football hold, and side lying hold.

Demonstrate how to help the baby latch onto the breast and to ensure that the baby is latched on well. Next, let your patient know that most breastfed babies will need to nurse every 2 to 3 hours, or about 8 to 12 times each day, and will typically nurse for about 15 to 30 minutes on each breast, and teach them that a good time to burp their baby is when they switch from one breast to the other.

Also teach your patient that babies should never be put on a strict feeding schedule and explain how a good milk supply can be maintained by feeding their baby regularly.

Now, if your patient bottle-feeds their baby, help them choose the type of formula that is best for their baby. Teach them how to safely prepare and store the formula, including safety precautions such as cleaning and sanitizing nipples and bottles, keeping prepared formula in the refrigerator, and discarding any formula left in the bottle after feeding.

If they are reconstituting formula from a powdered or liquid concentrate, emphasize the importance of following the preparation instructions on the formula container exactly, to avoid feeding their baby formula that is either too concentrated or diluted.

If they want to warm a bottle of formula before feeding, instruct them to place the bottle in a bowl of warm tap water, and to never use a microwave since this can cause uneven heating, which may cause burns to their baby’s mouth.

Then, let them know that their baby will typically need to eat about every 3 to 4 hours, and will usually eat 15 to 30 mL of formula each time during the first week of life, and around 90 to 150 mL by the second week of life.

Then, instruct them to hold their baby close to them in a semi-upright position during feeding, to gently place the nipple against their baby’s lips to stimulate the sucking reflex, and then insert it when the mouth opens.

Remind them to angle the bottle slightly so the nipple fills with formula instead of air. Alright, as a quick recap… The newborn’s diet supplies calories and nutrients needed to support the rapid growth and development that occurs in early life.

During the first few months of life, newborn nutritional needs can be met by either breast milk or commercially prepared cow's milk–based formula.

Nursing considerations are focused on providing teaching for safe and effective breast