Nutrition of newborns
Optimal nutrition during the neonatal period supports newborn growth and development, as well as providing bonding with the parents. Current recommendations are for exclusive breastfeeding for the first 6 months of life, followed by a combination of solid foods and human milk until 12 months of age. Parents may also choose to feed their newborn commercially prepared formula. It is important for parents to know about the nutritional needs of newborns, the benefits of breastmilk, and bottle feeding.
By Naomi Ysimura
Fluids and calories
For their first 2 days, newborns need 60 to 80 mL of fluid per kilogram (kg) of body weight per day. For the next 4 days, they need 100 to 150 mL/kg/day. For the remainder of their first month, they need 120 to 180 mL/kg/day. They lose fluid through urination and respiration. It is essential to monitor their intake and output carefully, as they have little tolerance for fluctuations in fluid balance. Caloric intake, measured in kilocalories (kcal), provides energy for growth, physical activity, and metabolic function. For the first 3 months of life, infants require 110 kcal/kg/day. Each ounce of breast milk and of formula contains about 20 kcal.
Human milk offers many health benefits for newborns, including enhanced immunity, maturation of the gastrointestinal tract, and reduced risks of diabetes mellitus and childhood obesity.
Feeding-readiness cues include: rooting, sucking motions, and hand-to-hand or hand-to-mouth movements. It is important to initiate breastfeeding when the newborn demonstrates these cues rather than waiting until he is sleeping or crying. The optimal time for initiating breastfeeding is immediately after an uncomplicated birth. Putting the newborn and the mother in direct skin-to-skin contact (tummy-tummy) facilitates the first breastfeeding experience for the mother-infant pair. Common positions for breastfeeding are the cradle, the modified cradle or across-the-lap, the football or clutch hold, and the side lying position. It’s important for the mother to use a position she finds comfortable and easily achieves latch, that is, a seal between the newborn’s mouth over the nipple, areola, and breast that creates enough suction to remove breast milk.
Breastfeeding patterns vary among newborns, but in general, they should breastfeed eight to 12 times in each 24 hour period. Although newborns are often sleepy during the first few days, parents should attempt feedings every 3 to 4 hours. After this initial period, when a newborn is feeding regularly and gaining weight, it is appropriate for them to shift to on-demand feedings. The duration of feedings also varies. Also, some newborns feed from one breast per feeding, while others switch easily during a feeding. It is also imporant to determine when the newborn is finished feeding. The breast(s) will feel softer, the newborn will suck slowly or release the breast, and he will appear content or will fall asleep. These cues help parents determine the appropriate duration of feedings.
Parents should use commercially prepared formula, either the powder, concentrate, or ready-to-feed type, for all feedings. Although manufacturers of infant formula provide detailed instructions for using these products, it is important to make sure parents understand how to use them. They should hold their newborn in a semi-reclining position for all feedings. Propping of bottles during feedings can result in choking, tooth decay, and loss of interaction opportunities. It’s necessary to hold the bottle so that the nipple is filled with fluid, not air. Cues that the newborn is satisfied after feeding include turning his head away, stopping sucking, or falling asleep. During and after each feeding, parents should facilitate burping because newborns swallow air during bottle feeding. They need to understand that they must discard any formula that remains in...
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