Feeding Babies During First 6 months of Life

Feedings should be initiated as soon after birth as possible, depending on the infant’s ability to tolerate enteral nutrition. This helps maintain normal metabolism during the transition from fetal to extrauterine life and also promotes bonding between the mother and infant. Most infants can start breast-feeding immediately after birth, almost always within 1–4 hr. Mothers who wish to initiate breast-feeding in the delivery room should be supported in doing so, provided there is no question about the infant’s tolerance of enteral feeding. If so, feedings should be withheld until the infant is carefully evaluated. It if appears that feedings must be withheld for some time, parenteral fluids should be administered.

The successful feeding of infants requires practical interpretation of specific nutritional needs and the wide variability among normal infants in appetite and behavior regarding food. The time required for an infant’s stomach to empty may vary from 1–4 hr or more during a single day. Thus, the infant’s desire for food will vary at different times of the day. Ideally, the feeding schedule established should be based on this reasonable “self-regulation” by the infant. However, this “self-regulation” is not established immediately; considerable variation in the time between feedings and in the amount taken per feeding is to be expected during the 1st few weeks of life. Most infants will have established a suitable and reasonably regular schedule by 1 mo of age.

By the end of the 1st wk of life, most healthy infants will be taking 60–90 mL/feeding and want 6–9 feedings/24 hr. Some will take enough at 1 feeding to be satisfied for as long as 4 hr, but others will want to be fed as often as every 2–3 hr. Breast-fed infants prefer shorter feeding intervals than formula-fed infants. Feeding can be considered to have progressed satisfactorily if the infant is no longer losing weight by the end of the 1st wk of life and is gaining weight by the end of the 2nd wk. Most infants will wake for a middle-of-the-night feeding until 3–6 wk of age; some never desire this feeding, and others continue it beyond 3–6 wk of age. Between 4–8 mo of age, many infants will lose interest in the late evening feeding and, by 9–12 mo of age, most will be satisfied with 3 meals/day plus snacks. All infants do not conform to these general guidelines.

Infants cry for reasons other than hunger; hence, they do not need to be fed every time they cry. Those who wake and cry consistently at short intervals may not be receiving enough milk or may have discomfort from some cause other than hunger (too much clothing; soiled, wet, or uncomfortable diapers; swallowed air [“gas”]; an uncomfortably hot or cold environment). Some infants cry to gain sufficient or additional attention, whereas others become indifferent to lack of attention. Some cry because they simply want to be held. Those who stop crying as soon as they are picked up or held usually do not want or need food. Those who continue to cry when held and when food is offered should be carefully evaluated for other causes of distress. The habit of offering frequent, small feedings or holding and feeding to pacify all crying should be avoided. On the other hand, satisfying the infant’s true hunger as it is expressed is important. This allows physiologic requirements to be met promptly, and it helps prevent the infant’s associating prolonged crying and discomfort with feeding. It also helps prevent eating practices such as gulping an entire feeding or taking small amounts too frequently.

Most infants establish a regular feeding schedule that permits the family to resume normal functioning within a few weeks after birth. If not, individual feedings or the whole day’s schedule can be moved ahead or delayed sufficiently to avoid conflicts with necessary family activities. Some mothers will not understand the goals of infant “self-regulation.” Others will misinterpret the physician’s instructions or may be unable to adjust to the infant’s regimen. These, as well as overanxious and compulsive parents, may do better with more specific feeding instructions.

The postpartum period is a time of great anxiety and insecurity, particularly for the 1st-time mother, who may be temporarily overwhelmed by the responsibilities of motherhood. Thus, it is important for the physician to set aside sufficient time shortly after birth to address the questions and concerns of inexperienced or uncertain mothers. Ideally, these anticipatory guidance sessions should include fathers and other household members. Knowing the personalities and expectations of both parents is invaluable in helping avert physical and psychologic problems centered on feeding. Also, because parental misconceptions and confusion about the dietary and satiety needs of infants are often the basis for abnormal parent-child relations, appropriate counseling can help avoid these problems.