A nurse is reinforcing teaching about formula feeding with the guardian of a term newborn who was born 2 hr ago.
Which of the following instructions should the nurse include?

Choice A rationale

The American Academy of Pediatrics recommends that term newborns should be fed on demand or at least every 3 to 4 hours, which provides sufficient caloric intake for growth and prevents hypoglycemia. Formula is digested more slowly than breast milk, so offering a bottle every 3 to 3 1/2 hours is generally appropriate to meet the infant's nutritional needs and satisfy hunger cues. Regular feeding supports adequate weight gain, which is a critical developmental milestone in the neonatal period.

Choice B rationale

For the first few weeks, the nurse should instruct the guardian to wake a sleepy newborn if more than 4 hours have passed since the last feeding to prevent excessive weight loss and hypoglycemia, as their small glycogen stores are rapidly depleted. However, after the initial period and once the infant is feeding well and gaining weight appropriately (usually about 2 weeks old), night waking is typically not necessary.

Choice C rationale

Diluting ready-to-feed formula by adding filtered water is contraindicated because it reduces the caloric and nutrient density below required levels for the newborn's growth. The proper ratio of formula powder or concentrate to water is crucial for providing essential electrolytes, protein, and carbohydrates. Dilution can lead to water intoxication or hyponatremia and cause serious neurological complications due to electrolyte imbalance.

Choice D rationale

Prepared infant formula should be used or discarded within 24 hours if stored in the refrigerator, not 72 hours. Bacteria can rapidly proliferate in prepared formula, even under refrigeration, increasing the risk of gastrointestinal infection for the newborn. Formula ready-to-feed containers, once opened, should also be used within 24 to 48 hours or discarded to maintain optimal safety.