What is the recommended volume and frequency of paladai (supplementary) feeding for a 13-day-old term baby with a birth weight of 3.2kg and current weight of 3kg, whose mother has less milk?

Paladai Feeding Recommendation for 13-Day-Old Term Infant

This infant requires immediate supplementation with approximately 15-20 mL of expressed breast milk or formula every 2 hours (12 feeds per day), totaling 180-240 mL per day, while urgently addressing the underlying breastfeeding issues. 1, 2

Critical Assessment of Current Situation

This infant has lost 200g (6.25% of birth weight) and has not regained birth weight by day 13, which indicates inadequate feeding and requires immediate intervention. 3

• Normal expectation: Birth weight should be regained by 7-10 days, with pathology carefully excluded if not regained by 12-14 days 3, 1
• Current weight gain: This infant is gaining inadequately and requires urgent nutritional intervention 1, 2

Calculating Supplementation Volume

Target Daily Intake

For a 3 kg term infant at day 13:

• Total daily fluid requirement: 140-170 mL/kg/day = 420-510 mL per day 3
• Target weight gain: 17-20 g/kg/day (approximately 51-60g/day for this 3kg infant) 1, 2
• Caloric requirement for catch-up growth: 120 kcal/kg/day = 360 kcal/day 4

Practical Paladai Feeding Schedule

Every 2-hour feeding (12 feeds/24 hours):

• Volume per feed: 15-20 mL initially, increasing to 30-40 mL as tolerated
• Total daily volume: Start with 180-240 mL/day, advancing toward 420-510 mL/day over 48-72 hours 3, 1

Implementation Strategy

Immediate Actions (First 48 Hours)

1. Supplement after each breastfeeding attempt with paladai:

   • Offer breast first for 10-15 minutes each side
   • Follow immediately with 15-20 mL supplementation 5, 6
   • Increase volume by 5 mL per feed every 12-24 hours as infant tolerates 4

2. Monitor closely:

   • Weight check within 48-72 hours (target gain: 51-60g over 3 days) 1, 4
   • Urine output: should have 6-8 wet diapers per day 7
   • Stool output: at least 3-4 stools per day at this age 7

Addressing Maternal Milk Supply

Critical pitfall: Do not assume permanent low milk supply without proper assessment 5, 6

• Assess lactation adequacy: Evaluate latch, positioning, feeding frequency (should be 8-12 times per 24 hours) 2, 5
• Maternal factors: Check for retained placenta, thyroid dysfunction, polycystic ovary syndrome, insufficient glandular tissue 6, 8
• Increase milk production: Frequent breast emptying (nursing plus pumping after feeds), adequate maternal hydration and nutrition 5, 6

Advancing to Full Feeds

Days 14-21 Target

• Gradually increase paladai volume to 30-40 mL per feed (every 2 hours)
• Total daily intake goal: 420-510 mL by day 21 3
• Continue breastfeeding before each supplement to maintain and increase maternal supply 5, 6

Monitoring Response

• Weight checks: Every 2-4 weeks once adequate gain established 2, 4
• Expected gain: 210 grams per week (30g/day) for first 3 months 2
• Red flags requiring immediate evaluation:
  • Weight gain <17 g/kg/day despite supplementation 1, 4
  • Lethargy, poor feeding, decreased urine output 4
  • Persistent weight loss or no gain after 72 hours of intervention 1, 4

Common Pitfalls to Avoid

• Waiting longer to intervene: Delayed intervention can lead to impaired neurodevelopment 1, 4
• Inadequate supplementation volume: Starting with too little volume (e.g., 5-10 mL) will not meet caloric needs 3, 1
• Abandoning breastfeeding: Continue breast stimulation to preserve and increase maternal supply 5, 6
• Not reassessing feeding technique: Most "low milk supply" is secondary to poor breastfeeding management, not primary lactation failure 5, 6

Electrolyte Considerations

For this term infant on enteral feeding:

• Sodium: 2-3 mmol/kg/day 3
• Potassium: 1-3 mmol/kg/day 3
• These are typically met with breast milk or standard infant formula 3