Infant Feeding in Special Circumstances

Abstract

1. Rebecca Cherry, MD* 2. Dan W. Thomas, MD† 1. *Clinical Fellow, Pediatric Gastroenterology and Nutrition, Children's Hospital Los Angeles, Calif 2. †Division Chief, Pediatric Gastroenterology and Nutrition, Children's Hospital Los Angeles, Calif After completing this article, readers should be able to: 1. Determine the caloric requirements of neurologically impaired infants. 2. Describe nutritional problems in infants who have malignancies. 3. Plan the approach to feeding an infant who has multiple food allergies. 4. Appreciate the importance of occupational therapy support for feeding difficulties. 5. Discuss the indications for use of different types of feeding tubes. Healthy infants are able to sustain themselves easily with the calories and nutrients provided from human milk or from standard infant formulas. Some infants, however, have increased caloric requirements due to chronic medical conditions such as cardiac disease, prematurity, or malignancy. Conversely, other children, such as neurologically impaired infants, may have decreased caloric requirements. Still other infants can have an intolerance to the components of standard formulas or an inability to take nourishment because of feeding dysfunction. Such differences may necessitate alternative approaches to feeding. During the first few postnatal months, a healthy term infant typically has an energy requirement of approximately 100 kcal/kg per day to achieve both normal development and a weight gain of at least 20 g/d after the age of 2 weeks. This energy requirement decreases about 10% to 20% during the second 6 postnatal months, with an expected weight gain of approximately 12 g/d. The energy requirement of a low-birthweight infant ranges from 90 to 120 kcal/kg per day, depending partly on ambient temperature, activity level, and mode of feeding. Low-birthweight infants who weigh less than 1,000 g at birth, those who are sick, and those in the first 2 to 3 weeks after birth may have different requirements. In addition to a higher energy requirement than term infants, preterm infants differ in specific nutrient requirements and in the optimal intake of fats, carbohydrates, and proteins. Such infants require a specialized “preterm” (if taking <500 mL/d) or …