How many kilocalories per kilogram of body weight does a breastfed term infant require each day?

Loss of > 5 to 7% of birth weight in the first week indicates undernutrition. Birth weight should be regained by 2 weeks in breastfed infants (earlier in formula-fed infants), and a subsequent gain of about 20 to 30 g/day (1 ounce/day) is expected for the first few months. Infants should double their birth weight by about 5 months.

Written by dr. Dyah Febriyanti, IBCLC

Calories in Breastmilk

Breast milk contains 87% water, 3.8% fat, 1.0% protein, and 7% lactose1. Fat and lactose are the main sources of calories in breast milk, about 50-65% and 35-40%. Lactose is the main form of ‘sugar’ in breast milk. Breast milk contains about 7g/dL lactose.2 The fat in breast milk remains stable, about 3,4-4,5%, starting from 21 days after delivery. The breast milk calories from fats, lactose, and a little from protein, are about 65-70 ccal/dL3. Average caloric content in breast milk is 67 ccal /dL 4.

The composition of breast milk is dynamic. It depends on babies’ requirements and growth. Compared to the preterm milk, full term breast milk contains less fat and water. Fats in breast milk also depend on a mother’s body mass index, pregnancy weight gain, parity, menstruation, and breastfeeding frequency.3 Otherwise, fats and lactose in breast milk production have an effect on the mother’s weight. Breastfeeding mothers tend to lose the pregnancy weight easier.5

A breastfeeding mother with overproduction tends to have the breast milk containing less fats, protein and higher lactose. The calories in a normal supply mother who only breastfeeds are higher than those of a mixed-feeding mother6. The mother’s diet has no effect on the amount of fats and lactose in the breast milk, but has an effect on the type of fats in breastmilk4. In other words, the caloric content in breastmilk is not dependent on the mother’s diet, unless she is malnourished. Starvation and dehydration will decrease the breastmilk volume.

In the first month, the caloric content in the preterm milk and full term milk is shown below7:

Infant Calorie Requirements

Somebody’s energy needs are pictured by the amount of ‘calorie’ needed by a unit of the body weight. Kilocalorie is a measurement used for energy produced by food. Technically, a kilocalorie is the amount of energy required to increase the temperature of 1 kilogram water as much as 10C 8. The common indicator showing if an infant gets enough calories per day is weight gain, length, and head circumference. Calorie requirements of 0-1 year old infant is about 100–120 ccal/kg/day. 9

Estimated calorie requirements (based on age) are shown below:4

• 0-3 months = (89 x weight [kg] – 100) + 175
• 4-6 months = (89 x weight [kg] – 100) + 56
• 7-12 months = (89 x weight [kg] – 100) + 22
• 13-35 months = (89 x weight [kg] – 100) + 20

When a baby starts being given the complementary feeding, the main calorie source is breast milk, and then it is reduced gradually. About 24 months, the main calorie source is food. Recommended calorie intakes for a breastfed baby are4:

Estimated calories requirements of infants: 8

Taken from: United States Department of Agriculture, 2009

SOURCES

1. Martin, Ling dan Blackburn. Review of Infant Feeding: Key Features of Breast Milk and Infant Formula. Nutrients 2016, 8, 279
2. World Health Organization. 2009. Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals.
3. Ballard, Olivi., dan Morrow,Ardythe L. Human Milk Composition: Nutrients and Bioactive Factors. Pediatr Clin North Am. 2013 60(1)
4. International Lactation Consultant Association. 2013. Core Curriculum for Lactation Consultant 3rd Edition. Jones & Bartlett Learning. p340
5. Baker, J.L et al. 2008. Breastfeeding Reduces Postpartum Weight Retention. Am Soc Clin Nutr 2008 vol. 88 (6) 1543-1551
6. Prentice, Philippa dkk. 2016. Breast milk nutrient content and infancy growth. Acta Pædiatrica 2016 105, pp. 641–647
7. Riordan & Wambach. 2016. Breastfeeding and Human Lactation, enhanced 5th Jones & Bartlett Learning. p 419-468
8. United States Department of Agriculture. 2009. Infant Nutrition and Feeding: A Guide for Use in the WIC and CSF Program. Hlm 12-14
9. Al-Salem. 2014. An Illustrated Guide to Pediatric Surgery. Springer International Publishing Switzerland. hlm 5-7

Table of Contents

For patients < 2 years of age, the following recommendations are made:

• Plot weight for height values instead of BMI. Children with weight-for-height values above the 95th percentile are considered overweight. There is no cutoff for obesity.

• Assess parental weight status because this can identify future obesity risk and predicts obesity in young adulthood.

• Diets aimed at reducing weight are not recommended for this age group.

• Dietary reference intakes for macronutrients (from the Institute of Medicine) can be found HERE
• Energy requirements for newborns - 2 months of age: 100-120 kcal/kg/day (from Rudolph's Pediatrics, 21st ed.)
  • Protein: 1.8-2 g/100kcal/day
  • Fat: 3-5 g/100kcal/ day
  • Carbohydrate: 10-12 g/100kcal/ day
• Energy requirements for infants 3 months of age: 95 kcal/kg/day (from Harriet Lane)
• Energy requirements for infants/toddlers 4 months - 35 months of age: 82 kcal/kg/day

• For example, a 4 month old baby that weighs 8 kg:
  • Should get 82 kcal/kg/day = 656 kcal/day * 1/6 (number of feedings per day) * 30 cc/20 kcal = ~164 cc/feed
    [or 5 ounces (30 ounces per day) every 4 hours if using a formula with 20 kcal/30 cc ]

• Practitioners should discuss long-term risks associated with the development of obesity and establish obesity prevention strategies.

• Patients 0-12 months - encourage breastfeeding exclusively until 6 months of age and continued to 12 months or beyond, after introduction of solid foods. Offer new foods repeatedly and avoid sugar sweetened beverages and snack foods.

• No televisions in the room where the infant sleeps.

• All caregivers should follow the prevention steps, not just parents (grandparents too!)

• Patients 12-24 months - avoidance of sugar sweetened beverages, excessive juice intake, excessive milk intake (no more than 16-24 ounces per day and switching to skim or 1% milk, as early as 12 months of age), establish an eating routine - 3 meals per day eaten at the table with other family members and no television, make sure healthy foods and snacks are available at all times, especially fruit and vegetables, offer water between snacks, increase opportunity for active play