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  • image Human milk is the preferred source of nutrition for almost all neonates and infants, including those born prematurely.

  • image An infant formula is a nutritionally complete substitute if human milk is not available.

  • image All infant formulas sold in the United States are required to meet FDA standards.

  • image Cow milk–based formulas are used by most US non-breastfeeding infants.

  • image Formulas for premature infants are designed to supply nutrients needed to promote growth and body composition changes that mimic those of a normal fetus at the same gestational age.

  • image Some infants will require formulas with altered macronutrients, such as extensively hydrolyzed protein (semi-elemental) formulas, due to cow milk and soy protein sensitivities or other conditions.

  • image Two nutrients of significant importance in infant nutrition are iron and vitamin D.

  • image Enteral products are available for children who need supplemental nutrition beyond a regular toddler diet in most of the infant formula categories discussed and used for similar indications.

  • image Expressed human milk and infant formulas must be handled and stored properly.

  • image Oral rehydration therapy (ORT) is a mainstay of treatment for mild-to-moderate dehydration; severe dehydration requires intravenous rehydration.


Patient Care Process* for Oral Nutrition and Rehydration of Infants and Children



  • Patient characteristics (eg, age, diagnosis)

  • Patient history (eg, medical, surgical, dietary)

    • Feeding history: human milk or formula (type, volume, caloric density)

  • Objective data

    • Body weight

    • Length/stature, body mass index, head circumference

    • Labs, if appropriate, to assess alterations in organ function (eg, serum electrolytes; glucose; BUN/SCr; albumin, liver function tests)

    • Intake and output (diarrhea, vomiting)


  • Nutrition status (growth parameters)

  • Evaluate data for any factors that would dictate formula selection

  • Determine degree of dehydration and appropriateness of oral rehydration therapy (ORT)


  • Choose an appropriate oral/enteral formula based on characteristics of the infant, child, or adolescent (see Chapter 160)

  • Recommend an alternative formula given intolerance to the current feeding regimen

  • Develop a plan to meet the iron and vitamin D needs of an infant based on current guidelines

  • Make referrals to other providers, when appropriate (eg, physician, dietitian, lactation specialist)

  • Develop a plan for ORT


  • Provide oral/enteral support using estimated goals (see Chapter 158)

  • Provide nutrient supplements to prevent or correct deficiencies

  • Provide patient/caregiver education regarding all elements of the nutrition care plan or ORT

  • Provide ORT per established guidelines

Follow-up: Monitor and Evaluate

  • Appropriate growth

  • Gastrointestinal symptoms, tolerance to formula

  • Laboratory parameters, as indicated

  • Signs and symptoms of dehydration/rehydration

*Collaborate with patient, caregivers, and other healthcare professionals.


Preclass Engaged Learning Activity

Visit the American Family Physician website and review the article titled “Infant Formula”. The website is useful to enhance student understanding of the available infant formulas and their place in therapy.


Infancy is a period of rapid growth followed by continued growth ...

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