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 Continue reading »

Between 6 and 12 mo of age, after they become accustomed to solid foods and liquids by bottle and/or cup, most infants decrease the volume and frequency of breast-feeding . As the infant demands less milk, the mother’s supply gradually diminishes without causing discomfort from engorgement.

Weaning can be initiated when mutually desired by the mother and infant by substituting formula by bottle or cup for part and, subsequently, all of a breast-feeding. Breast-feeding is eventually replaced with formula-feeding, at which time the infant is weaned completely. Occasionally, an infant takes a cup as readily as a bottle. If so, the intermediate transfer from breast to bottle before transferring from bottle to cup can be avoided. These changes should be made gradually and should be a pleasant experience, not a conflict, for both the mother and the infant.

When cessation of nursing is necessary at an early age, use of a tight breast binder and application of ice bags may help decrease milk production. Restriction of the mother’s fluid intake and small doses of estrogen for 1–2 days also may help decrease milk production.

Important Principles for Weaning:

Begin at appx. 6 months  of age

Avoid foods with high allergenic potential (cow’s milk, eggs, fish, nuts, soybeans). Continue reading »

Very low intake of vitamin C over time may lead to the deficiency disease scurvy.

Age of Onset:

In infants and young children, the usual age of onset of clinical manifestations of scurvy is 6–24 months.

Early Symptoms:

The early symptoms are rather general and include low-grade fever, irritability, tachypnea, digestive disturbances, loss of appetite, and generalized tenderness, particularly in the legs, which is noticeable when the diaper is changed. The pain results in pseudoparalysis, with the hips and knees semi-flexed and the feet rotated outward.

Other Clinical Features:

Edematous swelling along the shafts of the legs may be present; in some cases, there is subperiosteal hemorrhage at the end of the femur .

A “rosary” at the costochondral junctions and depression of the sternum are other typical features.

Changes in the gums are most noticeable after teeth have erupted and are manifested as bluish purple, spongy swellings of the mucous membrane, especially over the upper incisors.

Anemia, which is seen primarily in infants and young children, may be related to impaired ability to use iron or folate.

Other clinical manifestations seen in infants as well as in older children and adolescents include Continue reading »