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EDUCATIONAL INSIGHTS: Pediatric Practice Pearls – “On Infant Growth and Feeding Advice”

Posted: Aug 13, 2019
Comments: 0
Author: UCA Admin

Content provided by Thomas W. Tryon, MD, MBA, FAAP; UCA Pediatric Section Chair

One of the more common questions I encounter from parents in our Pediatric Urgent Care is whether or not their infant is growing and feeding normally. We also see the frequent infant who is “vomiting everything they are eating” according to the parents, but in fact they are often being overfed by their parents who are unsure of how much to feed their infant. Certainly, hypertrophic pyloric stenosis does occur in infants (blockage of the passage out of the stomach due to thickening of the muscle at the junction between the stomach and intestines), but spitty babies are much more common. Interestingly, the National Institutes of Health recently released a news article, “Guidelines for introducing solid foods to infants may lead to unhealthy weight”. (https://www.nih.gov/news-events/news-releases/guidelines-introducing-solid-foods-infants-may-lead-unhealthy-weight) According to the NIH, “Common recommendations from hospitals and infant formula manufacturers for introducing solid foods to infants could raise the risk of overfeeding or underfeeding, suggests a computer modeling study funded by the National Institutes of Health. Parents often seek guidance from medical professionals on how and when to first give solid foods to their infant. Many national and international organizations recommend waiting until an infant is 6 months old before introducing solid foods. However, recommendations vary significantly for infants between 6 months and 1 year.

Little research evidence is available on how much solid food is appropriate during this time and what types of solid food are best.” In general, I would support this being a discussion between the family and their primary care provider who is best equipped to be monitoring appropriate growth and development. However, since this question is frequently asked of us in urgent care, here are a few general guidelines:


  1. For growth and weight gain in infants, remember the “2-2-2-1-1-1-1/2-1/2-1/2-1/2-1/2-1/2” guideline for the first 12 months of life. That is, an infant should gain 2 pounds and grow 2 inches each month for the first three months of age; then 1 pound and 1 inch each month for the next three months of age and then ½ pound each month and ½ inch each month for the last six months of the first year. While inexact, it is a good general range.
  2. While recommending breastfeeding on demand, for bottle fed infants (including babies being fed pumped breastmilk) a good rule of thumb is to recommend giving their age in months plus up to 2 ounces at each feeding. Therefore, a newborn should be getting ½ to 2 ounces at a feeding while a 4 month old can handle 4-6 ounces at a feeding. Feeding more than this will be putting more food in a stomach not large enough to handle the volume and will increase the risk for regurgitating food and “vomiting everything they are eating”.

I am indebted to my wonderful Pediatrics attending Dr. Joanne Kennedy who shared these pearls with me many years ago while training as a resident. I trust you find them useful it your practice, as we daily work to improve the lives of patients in our urgent care practice.


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