How should infants increase formula intake?

Infant Formula Intake Progression Guidelines

Infants should gradually increase formula intake by approximately 1 ounce (30 ml) per month, starting with 3-4 ounces every 2-3 hours for newborns and progressing to a maximum of 7-8 ounces per feeding by 6 months, while maintaining the appropriate caloric density based on age. 1

Standard Formula Progression by Age

• Newborns (1 month):

  • 3-4 ounces (90-120 ml) per feeding
  • Every 2-3 hours (8-12 feedings/24 hours)
  • Standard caloric density: 24 kcal/oz

• 2-3 months:

  • 4-5 ounces per feeding
  • Every 3-4 hours (6-8 feedings/24 hours)

• 4-6 months:

  • 6-7 ounces per feeding
  • Every 4-5 hours (5-6 feedings/24 hours)

• 6+ months:

  • Maximum 7-8 ounces per feeding
  • Every 4-5 hours (4-5 feedings/24 hours)

Methods for Increasing Formula Caloric Density

For infants requiring higher caloric intake (such as those with chronic lung disease or poor weight gain):

1. Slow transition to calorically dense formulas is recommended to improve tolerance 2

2. For infants under 1 year:

   • Add fat (long/medium-chain triglycerides) or carbohydrate (glucose polymers) modules to increase density beyond 24 kcal/oz
   • Aim for balanced macronutrients: 8-12% protein, 40-50% carbohydrate, 40-50% fat 2

3. Rice cereal addition:

   • 1 teaspoon of rice cereal per ounce of formula increases caloric density by 5 kcal/oz 2
   • Note: This increases a standard 20 kcal/oz formula to 34 kcal/oz when using 1 tablespoon per ounce 2

4. Commercial options:

   • Commercially available antiregurgitant formulas containing processed rice, corn, starch, or guar gum may be used without excess caloric intake 2

Important Considerations and Precautions

• Monitor for tolerance: When increasing formula concentration, watch for:

  • Loose, greasy stools (test for fat if poor growth occurs)
  • Frequent, watery stools (test for reducing substances)
  • If abnormal stools occur, reduce the amount of added fat or carbohydrate 2

• Avoid overfeeding: Follow infant hunger and fullness cues rather than forcing them to finish bottles 1

• Protein considerations:

  • Maintain protein intake appropriate for age (3 g/kg/day in early infancy to 1.2 g/kg/day in early childhood)
  • Do not exceed 4 g/kg/day in young infants due to risk of acidosis 2

• Preterm infants: Be aware of potential association between thickened feedings and necrotizing enterocolitis in preterm infants 2

• Reflux management: For infants with GERD symptoms, thickened feedings (up to 1 tablespoon rice cereal per oz) may help decrease observed regurgitation 2

• Introduction of solids: Wait until approximately 6 months of age before introducing complementary foods 1

Special Circumstances

For infants with poor weight gain despite standard formula intake:

1. Start with 120 kcal/kg/day to achieve "catch-up" weight gain
2. If weight doesn't respond, calculate needed calories using: kcal/kg/day = (RDA for chronological age in kcal/kg × ideal weight for height) ÷ actual weight 2

By following these guidelines for formula progression, infants should achieve appropriate growth and development while minimizing risks of overfeeding or nutritional deficiencies.