Assessing Nutritional Intake and Digestive Issues in Preterm Infants

Nutritional intake量

Hello,
My daughter was born at 35 weeks with a birth weight of 1980g.
Her corrected age is now 10 months.
She has started supplementary foods, and her total daily milk intake is approximately 300cc.
She receives solid foods three times a day (for example, up to 2 bowls of porridge).
Is this caloric intake sufficient?
Additionally, since she was four months old, she has frequently experienced constipation leading to anal fissures.
Due to insufficient breast milk, we started formula feeding from the second month and have switched between about seven different brands of formula.
We have also tried probiotics, lactic acid bacteria, and jujube extract, as well as abdominal massage, but none have been effective.
It wasn't until she was close to six months old and started on solid foods that we saw some improvement.
However, her stools are currently very dry, hard, and large, and the issue with anal fissures has recurred (the food is well-pureed).

We have had an abdominal ultrasound at the hospital, which showed no abnormalities.
She has not yet developed any teeth (we are supplementing with calcium), and her growth chart shows that her head circumference is at the 50th percentile, while the rest of her measurements are at the 15th percentile.
Her gross and fine motor skills are normal for her age.

In summary:
1.
Is her nutritional intake adequate?
2.
What can be done about her difficulty with bowel movements?
3.
Why has she not yet developed teeth?
Note: Would supplementing with breast milk along with formula be beneficial? If so, what should the ratio be?
I hope you can provide some clarity on these issues.
Thank you!
ARLENE

arlenekuo, 30~39 year old female. Ask Date: 2012/12/05

Dr. Xiao Kaiwen reply Pediatrics

Born at 35 weeks gestation with a birth weight of only 1980g, this infant meets the definition of "intrauterine growth restriction." At a corrected age of 10 months, the height and weight can reach the 15th percentile, indicating that growth may be catching up to that of normal infants; therefore, it is estimated that caloric intake should be sufficient.

2.
It is recommended to provide more high-fiber foods such as vegetable purees and fruit purees.
You can also try soaking the baby's buttocks in warm water at a fixed time each day (e.g., in the morning) or stimulating the anal area by inserting a rectal thermometer about 2 cm into the anus after feeding.
This can stimulate the contraction of the anal sphincter, and during this time, the rectal reflex is strong, which can help stimulate the baby’s bowel movement.
Additionally, you can gently massage the baby's abdomen in a clockwise direction 2 to 3 hours after feeding to stimulate intestinal peristalsis, or first apply a warm, damp towel to the baby's belly before performing the clockwise abdominal massage to promote bowel movement.
Probiotics may also be considered.
3.
It is normal for infants to begin teething before their first birthday.

Reply Date: 2012/12/05

More Info

Hello Arlene,
Thank you for reaching out with your concerns regarding your baby's nutritional intake and digestive issues. It’s understandable to feel anxious about your child's growth and health, especially considering her premature birth and the challenges you’ve faced with feeding and digestion. Let’s address your questions one by one.

1. Nutritional Intake: Your baby, born at 35 weeks and weighing 1980g, is currently at a corrected age of 10 months. At this age, the average intake for infants can vary, but generally, a total of about 24-32 ounces (approximately 700-950 cc) of milk or formula per day is recommended, along with appropriate solid foods. You mentioned that she is currently consuming about 300 cc of milk and three servings of solid food (like porridge). This amount may be on the lower side for her age, especially considering her prematurity. It’s crucial to ensure that she is getting enough calories and nutrients to support her growth and development. You might want to consider increasing her milk intake gradually, aiming for a total closer to 600-800 cc per day, depending on her appetite and tolerance.

2. Digestive Issues: The constipation and rectal fissures your baby is experiencing can be quite distressing. Since she has been on formula since the second month, it’s important to ensure that the formula is appropriate for her needs. Some formulas are specifically designed for infants with digestive issues, and they may contain added fiber or prebiotics to help with stool consistency. Additionally, incorporating high-fiber foods into her diet, such as pureed fruits (like pears and prunes) and vegetables, can help alleviate constipation. You might also want to consult with a pediatric gastroenterologist if the problem persists, as they can provide specialized guidance.

3. Teething: It’s not uncommon for infants to begin teething around this age, but some may take longer. The absence of teeth at 10 months, especially for a preterm infant, can be normal. However, ensuring she receives adequate calcium and vitamin D is essential for bone and dental health. If you are concerned about her nutritional intake, consider discussing with your pediatrician the possibility of a multivitamin supplement.

4. Breast Milk and Formula Combination: If you are considering reintroducing breast milk along with formula, it can be beneficial. Breast milk provides antibodies and nutrients that can support her immune system and overall health. If you choose to combine both, you might start with a ratio that feels comfortable for you, such as 50% breast milk and 50% formula, and adjust based on her preferences and how well she tolerates it.

5. Monitoring Growth: It’s important to keep track of her growth patterns. Since her head circumference is at the 50th percentile while her weight and height are at the 15th percentile, this could indicate a need for closer monitoring. Regular check-ups with your pediatrician will help ensure she is on the right track.

In summary, it seems that your baby may benefit from an increase in her overall caloric intake, particularly through milk or formula, while also incorporating high-fiber foods to help with her digestive issues. Regular follow-ups with your healthcare provider will be essential in monitoring her growth and addressing any ongoing concerns.
Please feel free to reach out if you have more questions or need further assistance. Your dedication to your baby's health is commendable, and with the right support, she will continue to thrive.

Best wishes,
Doctor Q&A Teams

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