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GuidelinesIMCI

Feeding and Growth: Breastfed and Non-Breastfed Infants (Birth up to 2 months)

IMCI - Young Infant (Birth up to 2 months)

BREASTFED INFANTS  

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Ask

  • How is feeding going?
  • How many times do you breastfeed in 24 hours?
  • Does your baby get any other food or drink?
  • If yes, how often?
  • What do you use to feed your baby?

Look, Listen, Feel

  • Plot the weight on the RTHB to determine the weight for age.
  • Look at the shape of the curve. Is the child growing well?
  • If the child is less than 10 days old: Has the child lost more than expected body weight?
  • Has the child regained birth weight at 10 days?
  • Is the child gaining sufficient weight?
  • Look for ulcers or white patches in the mouth (thrush)

If the baby:

  • Has any difficulty feeding, or
  • Is breastfeeding less than 8 times in 24 hours, or
  • Is taking any other foods or drinks, or
  • Is low weight for age, or
  • Is not gaining weight
    AND
  • Has no indications to refer urgently to hospital:

Then assess breastfeeding:

  • Has the baby breastfed in the previous hour?
  • If baby has not fed in the last hour, ask mother to put baby to the breast. Observe the breastfeed for 4 minutes. (If baby was fed during the last hour, ask mother if she can wait and tell you when the infant is willing to feed again).
  • Is baby able to attach?
    • not at all OR poor attachment OR good attachment
  • Is the baby suckling well (that is, slow deep sucks, sometimes pausing)?
    • not at all OR not suckling well OR suckling well
  • Clear a blocked nose if it interferes with breastfeeding

Note:

- Young infants may lose up to 10% of their birth weight in the first few days after birth, but should regain their birth weight by ten days of age
- Thereafter minimum weight gain should be: Preterm: 10g/kg/day or Term: 20g/kg/day

10% of birth weight = birth weight divided by 10

Classify Feeding  in Breastfed Infants 

Not able to feed
  • Not able to feed
    OR
  • No attachment at all
    OR
  • Not suckling at all
Feeding problem
  • Not well attached to breast
    OR
  • Not suckling effectively
    OR
  • Less than 8 breastfeeds in 24 hours
    OR
  • Infant is taking foods or drinks other than breast- milk
    OR
  • Thrush
  • Advise the mother to breastfeed as often and for as long as the infant wants, day and night
  • If not well attached or not suckling effectively, teach correct positioning and attachment 
  • If breastfeeding less than 8 times in 24 hours, advise to increase frequency of feeding
  • If mother has a breastfeeding problem see advice for common breastfeeding problems 
  • If receiving other foods or drinks, counsel mother on exclusive breastfeeding, and the importance of stopping other foods or drinks 
  • If thrush, treat and teach the mother to treat for thrush at home 
  • Follow-up in 2 days 
Poor growth
  • More than 10% weight loss in the first week of life
    OR
  • Weight less than birth weight at or after 2 week visit
    OR
  • Low weight for age, or
  • Weight gain is unsatisfactory
    OR
  • Weight loss following discharge of LBW infant
  • Advise the mother to breastfeed as often and for as long as the infant wants, day and night
  • If less than 2 weeks old follow-up in 2 days 
  • If more than 2 weeks old follow-up in 7 days 
Feeding and growing well
  • Not low weight for age and no other signs of inadequate feeding
  • Less than 10% weight loss in the first week of life

 

NON- BREASTFED INFANTS 

image

Click here to open the above PDF

Ask

  • How is feeding going?
  • What milk are you giving?
  • How many times during the day and night?
  • How much is given at each feed?
  • How are you preparing the milk?
  • Let caregiver demonstrate or explain how a feed is prepared, and how it is given to the baby
  • Are you giving any breast milk at all?
  • What foods and fluids in addition to replacement milk is being given?
  • How is the milk being given? Cup or bottle?
  • How are you cleaning the utensils?

Look, Listen, Feel

  • Plot the weight on the RTHB to determine the weight for age
  • Look at the shape of the curve. Is the child growing well?
  • If the child is less than 10 days old: Has the child lost more than expected body weight?
  • Has the child regained birth weight at 10 days?
  • Is the child gaining sufficient weight?
  • Look for ulcers or white patches in the mouth (thrush)

Note:

- Young infants may lose up to 10% of their birth weight in the first week afterbirth, then from day 7-10 regain birth weight loss
- Thereafter minimum weight gain should be: Preterm: 10g/kg/day OR Term: 20g/kg/day

10% of birth weight = birth weight divided by 10

Classify Feeding & Growth in Non- Breastfed Infants

Not able to feed
  • Not able to feed
    OR
  • Not sucking at all
Feeding problem
  • Milk incorrectly or unhygienically prepared
    OR
  • Giving inappropriate replacement milk or other foods/fluids
    OR
  • Giving insufficient replacement feeds
    OR
  • Using a feeding bottle
    OR
  • Thrush
Poor growth
  • More than 10% weight loss in the first week of life
    OR
  • Weight less than birth weight at or after 10 days of age
    OR
  • Weight gain is unsatisfactory
    OR
  • Weight loss following discharge of LBW infant
Feeding and growing well
  • Not low weight for age and no other signs of inadequate feeding
  • Less than 10% weight loss in the first week of life
  • Counsel the caregiver on home care for the young infant emphasizing the need for good hygiene 
  • Praise the caregiver

 

Integrated Management of Childhood Illness 2022; Young Infant (Birth up to 2 months); Assess, Classify and Identify Treatment: Feeding and Growth (Breastfed), Feeding and Growth (Non-breastfed)

Last checked for updates: June 2023

Drugs mentioned

NeoHealth® ID 18091 · updated 8/21/2023