It is a recognized fact that human milk is the best food for infants and will meet the nutritional requirements early in life up to three months when it is supplied in sufficient quantity.
Energy
The calorie requirement of the infant is high in terms of his body weight. The calorie requirement of infants (0-6 months) is 118 kcal/kg body weights. Older infants (6-12 months) require 108 kcal/kg bodyweight.
However, an individual variation may be possible since the activity of infants varies widely. During rapid growth the food storage is greater than during slow growth, so as to supply calories when the need arises.
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Protein
The recommended allowances for protein are based on the intakes and composition of human milk from which the protein is assumed to be fully utilised. Gradually foods are introduced in which the protein quality is less than that of human milk. Thus when a regular mixed diet is given the allowance should be increased i.e., 2.9 gm per kilogram body weight from six months to one year.
Fat
The intake of fat is important to maintain calorie adequacy. About 3 percent of the total calorie intake should be supplied as linoleic acid in order to maintain the integrity of the skin and normal growth. Human milk supplies about 6 to 9 percent of its calories as linoleate. Many child specialists now recommend formulae in which vegetable fat has been substituted for butter fat as it increases the intake of linoleic acid.
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Water
The normal daily turnover of water by the infant is as much as 15 percent of his body weight. The water loss from the skin is large because of the greater surface area in relation to body weight. Infants require about 1150 ml water per 100 calories. This requirement is met by breast milk and by formulae containing 5 to 10 per cent sugar and enough water to give a concentration of 20 calories per 25 gm of formula.
Minerals
The circulating hemoglobin of the well-nourished infant is sufficient during the first three months, after which foods providing iron must be added in order to meet the needs of the expanding blood volume. The sodium requirement is about 1 mg per kilogram. Many trace elements are required but the diet will be adequate in these if the major nutrients are given in sufficient amounts. The use of fluorinated water for the dilution of infant formula has been recommended in some countries.
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Vitamins
Vitamins A and D will be obtained from the milk intake. The dangers of toxicity of Vitamins A and D must be kept in mind. The vitamin D content of the formula and of any other foods should be taken into consideration before prescribing supplements. Commercial formulae, evaporated milk and most fresh milk contain sufficient Vitamin D and a supplement is not required. It may be necessary to prescribe a supplement of 200-400 I.U. Vitamin D for the breast-fed baby as mother’s milk is low in fats and Vitamin D.