PRINCIPLES OF NUTRITION DURING THE FIRST YEAR OF

LIFE

1. Liquid requirements:
150 ml/kg/day, without exceeding 1000ml/day.
Increases at 200 ml/kg/day:
• in the newborn period
• fever
• during summer
• in case of dehydration (diarrhea, vomiting)

2. Energy requirements:
• quarter I: 110-120 kcal/kg/day
• quarter II: 100-110 kcal/kg/day
• third and fourth quarters: 90 - 100 kcal/kg/day
Add 10% for bottle fed infants, because the specific dynamic action (SDA) of protein in
cow's milk is higher than the ADS protein in human milk.
Add another 10% for infants in foster care.

3. Protein, lipids and carbohydrates requirements:

Breast fed Bottle fed

Proteins 2 - 2.5 g/kg/day 3 - 3.5 g/kg/day
Lipids 4 - 6 g/kg/day 4 - 6 g/kg/day
Carbohydrates 10 - 12 g/kg/day 10 - 12 g/kg/day

4. Food Balance:
Ensuring an optimum ratio
Proteins: Fat: Carbohydrates of 1: 2: 4

5. At least 50% of protein intake should be animal protein, essential amino acids needed
to ensure growth.

6. Human milk is administered in an amount of 150-200 ml/kg/day.

7. Cow's milk is not recommended in infant`s nutrition, but if given, quantity will be 100
ml/ kg/day, maximum 700 ml/day.

8. The infant will receive his age-appropriate nutrition:

• the first 4 months will be breast fed/ bottle fed/ combined fed.
• After 4-6 months will receive new foods.

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BREAST FEEDING
Definition:
Infants` nutrition during the first 4-6 months of life exclusively with human milk.

Composition of human milk and cow's milk:

Human Milk Cow Milk

Dry residue 12.5 - 14 g% 12.5 - 14 g%
Protein 1 g% 3.5 g%
Fat 3.5 g% 3.5 g%
Carbohydrates 6.8 - 7 g% 4.8 - 5 g%
Mineral salts 0.2 g% 0.8 g %
Calorific value 65 - 68 kcal/100 ml 65-70 ml kcal/100\

Age criterion for nutrition:

Month I Day 1: 50 ml 5% glucose serum

Day 2: 7 x 20 ml human milk
Day 3: 7 x 30 ml human milk
Day 4: 7 x 40 ml human milk
Day 5: 7 x 50 ml human milk
Day 7: 7 x 70 ml human milk
Day 8: 7 x 80-90 ml human milk
By the end of the first month: like the eight day .

Month II: 7 x 90 - 100 ml human milk

Month III: 6 x 130 - 140 ml human milk

Month IV: 6 x 140 - 150 ml human milk

Sucking test:
Weigh the infant, with his clothes on, before and after each meal. See how many grams
he gained at each meal and gather all the results in 24 hours. Obtain the quantity of milk
(ml) that the infant received.
If the amount of maternal milk is insufficient the infant must receive combined feeding.

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BOTTLE FEEDING
Definition:
Infants` nutrition in the first 4 months of life with other species`milk:
Infant formula e.g. Humana, Nan, Aptamil, Milumil
NB: Cow's milk and goat milk are not recommended for infant feeding.

Infant milk formulas are prepared before each meal, by dissolving the powder in boiled
and cooled water (a scoop every 30 ml water).

Age criterion for infant nutrition:

Month I Day 1: 50 ml 5% glucose serum
Day 2: 7 x 20 ml infant formula
Day 3: 7 x 30 ml infant formula
Day 4: 7 x 40 ml infant formula
Day 5: 7 x 50 ml infant formula
Day 7: 7 x 70 ml infant formula
Day 8: 7 x 80-90 ml infant formula

By the end of the second week: like the eight day.

The 3rd and the 4th week: 7 x 90 -100 ml infant formula

Month II: 6 x 120 - 130 ml infant formula

Month III: 6 x 130 - 140 ml infant formula

Month IV: 5 x 170 - 180 ml infant formula

COMBINED FEEDING
Definition:
Infants` nutrition during the first 4 months of life with human milk associated with infant
formulas.

Complementary method (Completing combined feeding):

It is used by mothers having only a small quantity of breast milk.
At each meal infant receives human milk and in addition infant formulas.
The infant will be put to the breast first and then will receive in addition infant formula
(preferably a hypoallergenic formula milk - HA).
It is recommended to use the cup / spoon when feeding the infant. If the infant is bottle
fed, after a period of time will quit sucking at the breast.

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Example: infant III month old

6 x 130-140 ml
6 x 50 ml human milk + 80 (90) ml Nan HA1 / Humana HA1 / Aptamil HA1

Alternative Method (Alternative combined feeding):

Used by mothers returning to work.
The infant receives only human milk at some meals and infant formula at other meals
(preferably a hypoallergenic formula milk - HA).
It is recommended to use the cup / spoon when feeding the infant. If the infant is bottle
fed, after a period of time will quit sucking at the breast.

Example: infant III month old

6 x 130-140 ml
4 x 130-140 ml human milk
2 x 130-140 ml Nan HA1 / Humana HA1 / Aptamil HA1

Weaning food

Rules in adding new foods in infants (weaning food):

1. introducing a new food will be made only when the baby is healthy;
2. first new food is individualized depending on the particularities of infant development:
in the eutrophic - starts with soup of vegetables or fruit puree; in the dystrophic - will
initially introduce cereals (gluten-free) and soon the diet will be enriched with protein;
3. introduction of new food will be progressive – we start with 20-30g/day at one meal,
reducing the same amount of milk; the quantity of new food is slowly increased in the
following days, until we replace one entire milk-meal with the new food;
4. should be introduced only one new food a week, at the same meal;
5. in case digestive disorders occur (vomiting and / or diarrhea) – stop giving that food
and resume a few days after digestive tolerance is recovered;
6. the new food will be given with a teaspoon;
7. caloric value of newly introduced food must be greater than that of milk - meal, which
is removed from the diet;
8. number of meals per day depend on age, the sensation of hunger-satiety and weight of
the child;
9. novel foods will be mashed until the first teeth appear, then crushed;
10. the best criterion of introducing weaning food successfully is tracking infant charts of
growth and development.

Weaning food - steps:

After the age of 4 - 4 ½ months:
- cereals (gluten free) – rice, corn
- fruits puree - apples, peaches, pears

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- vegetable soup / mashed vegetables (potatoes, carrots, squash)
After the age of 5 - 6 months:
- meat (beef, poultry)
- cottage cheese
- egg yolk (2-3 times per week)
After 6 months of age:
- cereals with gluten – wheat, barley, oatmeal, rye
After the age of 6 - 7 months:
- liver (alternation with meat and egg yolk)
- yogurt
After 8 months of age:
- white bread
- cream
After the age of 10 (12) months:
- fish

Nutrition in an infant 10 months and one week old:

5 meals x 200 ml or
6 meals x 160 (170) ml

5 x 200ml:
• 1x 200 to 250 ml of milk (breast milk / infant formula) with cereals
• 1x fruits puree with cheese / cereals
• 1x mashed vegetables (e.g. potatoes) mixed with meat / egg yolk
(x 2 – 3 times per week) / liver
• 1x yogurt / cheese with cereals
• 1x 200 to 250 ml of milk (breast milk / infant formula) with cereals

NUTRITION IN CHILDREN WITH LOW BIRTH WEIGHT (Wb <

2500g)
Principles:
1. Liquid requirements:
Week 1: 60 ml / kg / day
Week 2: 130 ml / kg / day
From 3 weeks up to a W of 3000 - 3500g: 200 ml / kg / day

2. Energy requirements:
Week 1: 50 kcal / kg / day
Week 2: 90 - 100 kcal / kg / day
From week 3: 130 kcal / kg / day

3. Protein, lipid, carbohydrate requirements:

Proteins: 2.5 - 4.5 g / kg / day
Lipids: 4.5 – 6.5 g / kg / day
Carbohydrates: 11 - 14 g / kg / day

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4. In the first 10 - 15 days is the period of testing digestive tolerance (gradually increase
the amount of milk given). Will then be breast fed / bottle fed (special milk formula for
children with low Wb) or combined fed with complementary method.

5. If the child's weight is less, than the number of meals increases:

if W is closer to 2500g, will receive 8 meals
if W is closer to 2000g, will receive 10 meals
if W is less than 2000g will be fed by gavage (naso - gastric tube), 10 gavages / day
(infant does not coordinate sucking with swallowing and breathing)

6. Dilution liquid is boiled water.

Special milk formulas for children with low Wb:

• use up to the weight of 2500g, after being recommended to be fed by the transitional
formula or standard formula.
• Examples: PreNan, Nan Premium, Humana 0, Aptamil Prematil, BioPre

In those with W <1800g : fortifiers (FM85, FMS) are added to breast milk.
Human milk fortifiers are designed to increase the caloric, protein and mineral intake.

Nutrition in infants with low birth weight

1. Child 20 days old, with W = 2400g:

Age 20 days → third week → liquid requirements = 200 ml / kg / day

W = 2400g → 8 meals daily

2.4 kg x 200 ml = 480 ml / day

480 ml: 8 meals = 60 ml / meal
8 meals x 60 ml human milk or
8 meals x 60 ml PreNan / Humana 0 / Aptamil Prematil or
completing combined feeding

2. Child 21 days old, with W = 2100g:

Age 21 days → third week → liquid requirements = 200 ml / kg / day

W = 2100g → 10 meals / day

2.1 kg x 200 ml = 420 ml / day

420 ml : 10 meals = 42 ml / meal

10 meals x 42 ml human milk

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10 meals x 42 ml PreNan / Humana 0 / Aptamil Prematil
completing combined feeding

3. Child 18 days old, with W = 1800g:

Age 18 days → third week → liquid requirements = 200 ml / kg / day

W = 1800g →10 gavages / day

1.8 kg x 200 ml = 360 ml / day

360 ml : 10 gavages = 36 ml / gavage

10 gavages x 42 ml human milk + fortifiers

10 gavages x 42 ml PreNan / Nan Premium / Humana 0 / Aptamil Prematil
completing combined feeding