Nutrition Assessment: Nutritional Intake

 Fluid Requirements
 Energy Requirements
 Vitamin and Mineral Supplement Recommendations
 Introduction of Non-milk Feedings Recommendations
 Obtaining Dietary Intake Information

Fluid Intake

• Adequate fluid intake is essential. LBW infants are at increased risk for dehydration.
• Some VLBW infants with BPD, chronic lung disease or cardiac complications may be fluid restricted.
• Fluid needs are increased by fever, diarrhea, and vomiting.
• As for full term infants, caregivers should be asked if urine color is pale and infant is producing at least 6-8 wet diapers per day. Because of increased risk of dehydration however, consider assessing actual fluid intake.

Minimal fluid intake should be at least 100-120 ml for each kg the infant weighs (1.8 to 2.2 ounces per pound). Recommended total fluid intakes for most infants are about 150 ml per kg.

Energy Intake

• Should be at least 100-120 kcal/day. Some low birth weight infants will require more.
• The best indicator of energy need is growth pattern on current energy intake.

Breastfed Infants:

For a quick assessment:

• Breastmilk is usually calculated at 20 kcal/oz.
• Breastmilk fortifiers are not recommended once the infant reaches a weight of 2500 grams.
• If the infant is nippling at the breast adequacy is determined by pre- and post-feeding weight checks, growth pattern and observation of breastfeeding.
• Signs that the infant is breast feeding effectively include rhythmic sustained suckling, audible swallow, softening of the maternal breast, maternal signs of milk ejection.
• Please see section on breastfeeding for more information.

Formula Fed Infants:

Weight	Expected Total Daily Formula Intake
	24 kcal/oz	20 kcal/oz
4.5 lbs.	10	12
6 lbs.	14	16
8 lbs.	18	22
10 lbs.	23	27
12 lbs.	28	32

Other Sources of Energy:

Food	Approximate Energy Value
Dry Infant Cereal	14 per Tbsp.
Commercial Infant Fruits	8 per Tbsp.
Commercial Infant Vegetables	5 per Tbsp.
Commercial mixed dinners	9 per Tbsp.
Commercial Infant Desserts	11 per Tbsp.
Glucose polymers (ex: Polycose)	4 kcal/g or about 8 kcal/level tsp.

The following Web sites provide information for calculating energy and nutrient values of foods and diets:

• USDA Nutrient Data Lab Food Composition Data (Searchable database of foods/Agriculture Handbook No. 8) Use the search term "infant" to get information about infant formulas. Use the search term "babyfood" to get information about commercial infant foods.

• Nutrition Analysis Tool (NAT) Click on "NAT" and type "babyfood" in the "Add a new food" box. This will bring up over 200 infant foods to chose for nutrition information.

Supplementation

• If infant is taking less than 24 ounces of standard formula or equivalent amounts of breastmilk per day, an infant multivitamin and mineral supplement should be given.
• Preterm infants should have iron supplement by 2 months in a dose of 2 to 4 mg/kg/d.
• Supplement breastfed infants with Vitamin D.
• Some infants require other supplements. For more information see section on vitamin/mineral supplements.

Introduction of Non-milk Feedings

• The American Academy of Pediatrics says 6 months is appropriate for breastfed infants.
• If developmentally ready, non-milk feedings should be added to diet between 4 and 6 months, corrected age. (See developmental aspects of feeding)

Obtaining Dietary Intake Information

Caregiver reports of dietary intake may vary in accuracy. The advantages and disadvantages of common methods of obtaining dietary intake information follow. Methods should be selected based on appropriateness for the family as well as the reason for obtaining the information.

It is important to remember that feeding preterm infants can be an emotional issue for families. Families may feel responsible for inadequate dietary intake and growth. Please see section on what families tell us. Families may find dietary assessment stressful. Every attempt should be made to undertake this procedure with a family-centered, non-judgmental approach.

Accuracy of dietary information may be enhanced by:

• Taking time to thoughtfully ask questions about dietary intake with the family and/or referring to a registered dietitian who has extensive background and training in dietary assessment.
• Asking caregivers to remember the activities of the days for which information is to be collected so that food intake can be associated with other events.
• Providing careful instructions to families before asking them to keep dietary records. Ask them to:
• count only formula that was actually ingested, not all that was prepared.
• provide information for night feedings as well as day feedings.
• gather information from all caregivers for the infant.
• accurately measure scoops of powder or liquid ounces used to make formula. (Studies repeatedly find that many caregivers do not mix formula according to label directions.)
• Please see section on breastfeeding for assessment of breastmilk intake.
• Making reminder and clarification phone calls to families while they are keeping records.
• Verifying information by asking questions such as, "How many cans of formula do you buy when you go to the store and how long do those cans last?" or, for families enrolled in the WIC program, "Do you find that you have formula left over or need to buy more formula than WIC provides?" Another way to verify information is to review records with parents, paying particular attention to variations, such as days on which there are several hours without feeding.

Methods of Gathering Dietary Intake Information for Infants

Method	Description	Advantages	Disadvantages
Intake Questionnaire	Caregivers are asked a series of questions such as, "How much formula does your infant usually ingest in 24 hours?"	Can be completed at time of initial visit.	May be difficult for some caregivers to accurately answer questions about "typical intakes." Infant may be in period of rapid change and instability.
24 hour recall	Caregivers are asked to remember what infant has ingested in last 24 hours.	Can be completed at time of initial visit.	Last 24 hours may not accurately reflect typical intake. Relies on caregiver memory. Caregiver with infant at assessment visit may not have been with infant for all of last 24 hours.
3 day records	Caregivers are asked to keep records of everything the infant has to eat and drink for 3 days.	Likely to be more accurate than methods that rely on memory alone.	Record keeping is difficult for some busy families and for those with limited literacy. Families must be trained to do this well.
7 day records	Caregivers are asked to keep records of everything the infant has to eat and drink for 7 days	Most informative if family is able to keep good records for this long.	Same as 3 day, but 7 days is even more difficult for some families and may not be worth the extra effort.

 

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More information contact: Joan Zerzan
Page reviewed: 3/16/2007