I have found the "(2.5 oz) x (wt in pounds) = 24 hr volume requirement" to
be an extremely useful ESTIMATE for YOUNG babies in my practice. I have used
this guideline for many years and have had excellent results. Basically,
it's a good place to start. By the way, I generally use the birthweight to
make the calculation, not the current (low) weight.
If I have a client with a 4 lb baby premature and not feeding effectively, I
can use it to help the mother know how much milk the baby will need. In this
particular case, the baby would need 2.5 x 4 = 10 oz per 24 hr day, and I
give this AS A MINIUMUM. I usually calculate that this would be
APPROXIMATELY 1 oz every 2 hrs so they have an idea. Often these babies
leave the hospital taking 15 - 20cc every 3 hrs, they have lost a little
weight, but being only 1 or 2 days old, nobody is too worried. Of course,
mother could use this info if she were test weighing at home too. As an
aside, I would counsel the mother to overshoot this amount in her
production, as 300cc per day would be low for her total production. Of
course, these babies have to followed with weight checks.
I do not necessarily think this guideline would work for a 5 month old, 15
lb baby, but then again, most 5 mo olds weighing 15 lbs are likely ok. This
calculation guideline might be a good place to start though, for a 5 month
old weighing 10 lbs, in which case he would need approximately 25 oz per 24
hrs as a place to start.
I would also like to say that I use this GUIDELINE whether the baby is being
fed or topped off with ebm or formula. I do not distinguish between the two,
even though I know that standard formula has a constant calorie count, but
breastmilk does not.
I also recognize that more frequent feeding increases calorie count, and
that this may account for an explanation of "growth spurts" or "frequency
days" or what I call "feeding frenzies" in which baby is taking in more
calories (but not necessarily more volume) during a growing period. Hope
this makes sense.
Laurie Wheeler, IBCLC, MN, RN
New Albany Mississippi, s.e. USA
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