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Infancy is a period of rapid growth second only to the fetal period, with a pressing need to optimize nutrition to ensure adequate growth and organ development. This article covers defining nutritional requirements in infancy, appropriate measurement of growth, and provides an overview of common nutrient categories. This activity describes the nutritional needs of preterm infants, as well as selected pathological conditions in infancy, and highlights the role of the interprofessional team in evaluating and improving care for such infants. Objectives: Outline the caloric need for the term and preterm infants. Review micro and macronutrient requirements for the term and preterm infants. Describe the growth indicators in assessing growth or growth failure and the importance of breastfeeding and donor milk in the nutrition of newborns. Explain the importance of collaboration and communication among the interprofessional team to ensure the appropriate nutrition is supplied to term and preterm infants. Access free multiple choice questions on this topic.

Infancy is a period of rapid growth second only to the fetal period. There is a pressing need to optimize nutrition to ensure adequate growth and organ development. With much emphasis placed on the developmental origins of health and disease, pioneered by the Barker hypothesis [1], maintaining optimal nutrition is one of the vital aspects of infancy. Under-nutrition during the fetal period due to placental, maternal, or fetal conditions can lead to intrauterine growth restriction (IUGR) with impaired organogenesis and decreased birth weight. While fetal nutrition is not usually compromised until an extreme degree of maternal malnutrition occurs, postnatal growth restriction in neonatal and post-neonatal period is predominantly an acquired condition due to inadequate nutrient intake. Continued undernutrition during infancy is hence prone to growth failure or failure to thrive (FTT) and metabolic disturbances that can persist into adult life. Low birth weight and rapid compensatory weight gain are independently linked to multiple morbidities in addition to altered growth, including increased risk of childhood and adult obesity, insulin resistance, increased leptin levels, and thus type 2 diabetes mellitus, as well as higher mortality in the future.[1][2][3] Besides, epigenetic modifications resulting from dietary and environmental influences in infancy have the potential to change long term health outcomes into adulthood, as seen in infants and children with over-nutrition developing metabolic syndrome as adults.[4][5] Preterm infants are particularly at high risk of postnatal growth failure due to the inherent challenges faced due to prematurity. Improved care of preterm infants, including current advances in neonatal and infant nutrition, has been shown to improve growth and development in this high-risk population.[6] This topic covers defining nutritional requirements in infancy, appropriate measurement of growth, and provides an overview of common nutrient categories. The nutritional needs of preterm infants and common clinical pearls of preterm infant nutrition are discussed briefly.

Ensuring neonates and infants receive appropriate nutrition in the hospital and outpatient setting necessitates a team-based approach. The pediatrician, gastroenterologist, NP, PA, or nurse would first gain an understanding of the child's overall health, feeding regimen and schedule, and any concerns the parent might have through the interview and history-taking. The nurse would meticulously measure the infant's growth parameters as accurate measurements are vital, and the team would compare them with previous measurements to determine if the infant is receiving adequate feedings. If the child is being breastfed and there are parental concerns with breastfeeding techniques, the team could refer to a lactation consultant who would be able to offer guidance to the parent by evaluating their current method and providing education and support. If the quantity of feeds is an issue, the health providers will work with the parent to make a plan that sets feeding and weight goals for the infant. For infants receiving commercial formula, the team may also recommend fortification with iron and supplementation with vitamin D and either order and administer these in the inpatient setting or provide prescriptions for these nutrients for the parents to fill at the pharmacy.[43]