Infant Feeding (Part 2)

Posted on February 23rd, 2013 by Denise | No Comments

Infant Feeding (Part 2)

By

Denise Koonce OTR

Last week I began by giving the background to the questions which are beneficial in assessing and creating a treatment plan for infants with a feeding disorder.  This week we will continue with “putting the pieces together” by answering “what is the infant’s feeding schedule?” and “what kcal/per oz of formula is being mixed?”

What is the infant’s feeding schedule?  The areas which make up a feeding schedule include:  what times of the day/night they are eating, what is the intake volume and how long it takes for them to finish a feeding.    It is important to know the infants feeding schedule to have a starting point for goal planning.  Ask the parents to keep a record for at least a week with all of these entries so you can determine averages, patterns, best feeding times and worst feeding times.  For reference, the average intake for a healthy, full term, newborn baby (0–3 months), within a few days after birth and moving forward, should be about 3-6 oz within 20-30 minutes every 3 hours.  Some infants, such as pre-term infants or infants born with complications, may not have the endurance to purely feed orally and may receive additional nutrition enterally.  Two of the most common delivery methods are via a nasogastric feeding tube or a Mickey button.  Infants who receive mechanical assistant may leave the hospital feeding 1 ½ oz by mouth and 1 ½ oz enterally each feed.  So, here again it is important to find out how long it takes for the infant to ingest the oral feeding and at what rate, the amount over time, the enteral feed is delivered.  The oral feed may take 30 minutes and the enteral feed may take up to an hour.  Determine if the enteral feed is delivered via mechanical pump or gavage.  The gavage method uses gravity as the natural force to deliver the formula through the tube and into the stomach.  The caregiver can control the rate by raising or lowering the large syringe holding the formula which is connected to the feeding tube.  If the formula is allowed to flow too quickly the infant may respond by spitting up and/or retching if a fundoplication is in place.  It is best to control the flow so the infant receives the full amount in about 30 minutes.  This time period will help prevent the uncomfortable retching or spit up because it is the average time it takes for our stomach tissue to stretch during a feed.  Some children due to safety are unable to eat by mouth and receive all of their nutrition enterally.  There are numerous combinations of enteral feed deliver from continuous to bolus depending on the patients needs.          

What kcal/per oz of formula is being mixed?  Kcal/per oz is important because this tells you how many calories are in every ounce of liquid.  Situations where kcal/per oz is especially important is with infants who are failing to thrive.  These infants may not tolerate a average oral feeding time or cannot tolerate the liquid volumes of 20kcal/oz but need the same caloric intake value that 20kcal/oz provides.   In other words, an average kcal/per oz is 20kcal/1 oz of liquid or 20kcal/30ml of liquid.  Therefore the average infant 0 -3 months of age will ingest 60 -80kcal every feeding.  Some infants are unable to ingest this amount of liquid within 20-30 minutes and struggle with the appropriate amount of weight gain.  Therefore in order to increase caloric value without increasing liquid volume the formula should have a higher caloric value.  This can be accomplished by using a formula formulated to deliver 22 or 24 kcal/per oz or by using a 20 kcal/per oz formula and use a recipe to add more formula per oz of liquid.   The reason for doing this is generally weight gain.  This must be done with the permission and oversight of the physician and a nutritionist, if one is involved.  There are several situations when a patient may be medically fragile that this method is helpful because they do not need to work as hard.  It provides them with the necessary caloric value for growth without having to ingest a large liquid volume.     

Please continue to join us next week as we finish up the questions helpful in assessing an infant with a feeding disorder.  Please share with us any experiences or questions you may have regarding the text that was discussed in this blog.  Until next time keep “putting those pieces together.”

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