Feeding

Spitting Up

This is very common in newborn babies and is due to a weakness of the muscle at the upper end of the stomach. It improves with age and has usually cleared up by the time a baby starts walking. Most spitting up has nothing to do with what formula your baby is on so formula changes after leaving the newborn nursery are rarely indicated. Please call the office before changing your baby’s formula.

Giving your baby slightly smaller feedings more frequently and avoiding tight diapers will help somewhat. Although burping during feedings is important, a baby should be burped when he or she pauses in feeding and sucking NOT interrupted. Burping is less important than giving smaller feedings. If your baby is still having a significant amount of vomiting despite these measures, call the office and we can discuss possibly thickening the feedings with cereal or other measures.

Most “spitters” start having problems during the first week of life.

If your baby has not had problems in the past but suddenly begins to vomit during the third or fourth week of life, be sure to call the office during regular office hours.

Breastfeeding

Breastfeeding is a very natural and beautiful way of feeding your baby. It is an active process that requires two participants. To successfully breastfeed, a mother must have her own personal motivation and should not be coerced into breastfeeding by a husband, doctor or friends. A woman must not be made to feel guilty for not wanting to breastfeed or for some reason being unable to do so.

There are numerous advantages to breastfeeding. Mother’s milk is readily available, fresh, warm and designed specifically for human infants. Breast milk contains all the fluid and nutrients necessary for your baby’s growth and development in the first 12 months of life. Infants who are breast-fed have a lower risk of developing infections because breast milk contains immunoglobulins, proteins that help prevent infection. There is also evidence that infants who are breast-fed have less chance of developing asthma or food allergies.

Because breast milk is a complete diet for young infants, there is usually no need to begin solids until 4-6 months of age. Breast milk contains a form of iron that is easily digested by babies. No other vitamin supplement is needed.

While some babies are born instinctively knowing exactly how to breast-feed, others are a bit more temperamental. Every infant, mother and delivery experience is different and while breastfeeding is sometimes effortless, it can take a great deal of work! If you discover your baby having difficulty with feedings when you arrive home, feel free to call the office. We can often offer advice over the phone and do have a lactation consultant available for assistance, as does your local hospital. If phone advice isn’t working, we are happy to have you come into the office, where one of our staff can actually work with you and your baby.

In terms of general care, nursing mothers should wear a good bra day and night during the first few weeks of nursing to provide extra support for full breasts. Nipples should be washed occasionally with mild soap and water, although letting leftover milk or colostrum dry on the nipple will sometimes help form a protective film in cases of sensitive nipples. Frequent nursing and drinking plenty of fluids, as well as getting plenty of REST (Ha!) will help to ensure a good milk supply. Unless instructed otherwise, prenatal vitamins should be continued and diet should be continued as it was prior to delivery. Nursing mothers need about 500 calories per day more than usual while breastfeeding (i.e., the same amount of extra calories needed during late pregnancy). There are no specific dietary restrictions but if a certain food seems to upset your baby’s stomach, avoid it. Caffeine is one of the main offenders, so tea, coffee and sodas should be taken in moderation and discontinued if your baby seems to have any discomfort. Also, mothers who drink large amounts of cow’s milk may aggravate gas problems in an infant with a lactose intolerance. Alcoholic beverages in moderation are usually fine; i.e., an occasional glass of wine is fine, but that’s it! Don’t drink any hot liquids while nursing your baby, as spills could cause accidental burns. Lastly, please don’t smoke around your baby while nursing or at any other time!

THE FIRST FEW DAYS after delivery, you may notice a creamy white substance secreted from your breasts. This is colostrum and, while it is secreted in small amounts, it contains high concentrations of glucose, calories and antibodies (to prevent infection). Within 3-5 days after delivery, your breast milk will “come in.” This early breast milk is high in protein but contains less fat at first than it will later on. A mother who pumps her breasts in the first 2-3 weeks after delivery may panic when she finds her milk looks about as satisfying as dishwater! Don’t worry. This is “transitional milk” and will gradually become more milk-like in appearance as the fat content increases in the first few weeks of nursing.

PLEASE DON’T LET A WELL MEANING RELATIVES OR FRIENDS CONVINCE YOU YOUR MILK IS “TOO WEAK” IN THOSE FIRST FEW WEEKS!! If you have concerns, call the office. We can weigh the baby and talk with you about how feedings are going. If your baby is gaining weight well and having 4-6 wet diapers each day, your milk supply is probably just fine.

Many mothers experience BREAST ENGORGEMENT soon after leaving the hospital. This is a sense of fullness in the breasts, caused early on by altered blood flow through the breasts and later on by overproduction of milk relative to what the baby needs. Applying hot packs and massaging the lumpy or tender areas of your breasts just prior to nursing will enhance the letdown reflex so milk is more easily emptied from the breasts. Sometimes using a breast pump to pump a small amount of milk out will soften the breast, making it easier for your baby to latch on. A breast pump may be obtained from the hospital prior to your release after delivery; just ask!

BABIES SHOULD BE FED ON DEMAND ! Initially, she may need to be awakened every 4 hours through the day to remind her to eat. Typically, though, by the fourth or fifth day of life, babies become quite good at “demanding” feedings as often as every 90 minutes around the clock! This can be quite exhausting for a new mother. The good news is that after a “growth spurt” in the second or third week of life, most babies settle down to a little more humane schedule (meaning every 2-4 hours). Remember; if your baby sleeps a longer stretch of time at night, DON’T ARGUE as long as he/she is gaining weight appropriately! Your baby may nurse anywhere from 5-20 minutes per breast, depending upon how vigorous her suck is and how hungry she is at the time. Every baby is different, so don’t worry if your baby is a “grazer” or a very quick feeder. Alternate the first breast offered each feeding.

Many parents ask about SUPPLEMENTAL FEEDINGS for breast babies. This is an individual decision and is often based, in today’s society, more upon work obligations than mother’s preference. If you will be in a situation where you are unable to pump at work and need to substitute a bottle feeding for the times you will be away from your baby, this can be done. One good rule of thumb is to NOT offer your baby a bottle feeding at all during the first month of breastfeeding. The bottle is MUCH easier for the baby to use and babies figure this out quickly, often deserting the breast in favor of this “quick fix.” On the other hand, if you breastfeed your baby exclusively for 3-4 months and then decide to try a bottle, often the baby won’t even attempt a bottle feeding! There is a window of opportunity during the fourth to fifth week of life when a baby can be offered a bottle feeding, just once every 3-4 days, without disrupting breastfeeding. Mothers returning to work should plan a 2 week transition period. During this time, a breastfeeding may be dropped every 4-5 days with a bottle feeding substituted. This gives the mother a chance to gradually adjust to the new feeding schedule, minimizing breast discomfort, and also gradually introduces the new schedule to the baby. Some babies take bottle feedings better from their fathers or other caretakers than from Mom. Depending upon your individual situation, you may opt to use frozen (or refrigerated) breast milk that was pumped at an earlier time or a powdered commercial infant formula. If using pumped breast milk, remember it takes two pumping sessions to get enough milk for a single feeding. (A breast pump isn’t as efficient as a hungry baby!)

Breast milk may be refrigerated for 36 hours or frozen for up to 3 months. When thawing frozen milk, it is best to place the milk container in a bowl of warm water. Do not try to thaw milk in the microwave; this breaks down some of the components of the milk and can potentially be overheated, resulting in burns to your baby’s face or mouth.

Your baby does not need extra water during the first few months of nursing. Water is present in breast milk in adequate amounts for your infant.

Most over the counter medications are acceptable for use when nursing. So are many prescription medications. Always remind the physician prescribing any medication that you are breastfeeding. Birth control pills today have lower concentrations of hormones and may be taken while breastfeeding. You may notice some decrease in the volume of breast milk with these, however. Remember, breastfeeding alone is NOT an effective form of birth control!

Most women breastfeed for 9-12 months. This is a situation that is negotiated between each mother and child individually. Many mothers wean their infants from the breast directly to cup feedings.

Other questions about breastfeeding may come up. Feel free to call the office with any specific questions. We are eager to help make the nursing experience an enjoyable one for you and your baby.

What About Bottle Feeding?

For those of you who are unable or don’t desire to breastfeed, there is an alternative in infant formula. There are various types of good infant formulas available. We can discuss the best type for your particular situation if and when the need arises. Infant formula with iron is recommended for the first 12 months of life for infants who are not breast-fed. Changing to cow’s milk at an early age can cause significant anemia; also, the cow’s milk has more salt, protein, cholesterol, and phosphorus than is recommended for infants.

Most infants will take 1-3 ounces of formula every 3-4 hours in the first few weeks of life. During the “growth spurt” in the second to third week of life, your baby may want to eat every 90 minutes! Let the baby make the rules. Feed him as much as he wants as often as he wants, as long as feedings aren’t closer together than every 90 minutes. If you have a baby who sleeps most of the time, be sure to awaken her every 4 hours during the day to “remind ” her to eat. (During the night, if she’ll sleep, LET HER SLEEP if she is gaining weight appropriately!)

Bottles and nipples should be washed in hot, soapy water. If you have an automatic dishwasher, just run the bottles through a cycle in the top rack. There is no need to boil or sterilize nipples or bottles if your baby is doing well.

If you have city water, there is no need to boil the water prior to mixing your baby’s formula. If you have well water, you may boil it for the first few months or use bottled “nursery water” available at many area groceries for mixing formulas.

Most formulas come in powdered, liquid concentrate and ready-to-use formulations. The powdered form is least expensive and is handy for traveling. It is also most economical for breastfeeding mothers who only use an occasional formula feeding.

Your baby does NOT need extra water during the day until taking more than 32 ounces of formula each day. Water is present in both breast milk and infant formula in adequate amounts and your baby will benefit most by drinking ONLY milk during the first few months of life.

Beginning Solid Foods

For some reason, friends and relatives tend to fixate on when a baby has his first water bottle and first bowl of cereal! Any pediatric allergist will tell you, however, the most important factors in the development of food allergy (other than family history) are breastfeeding and delaying solid foods. Breast-fed babies are afforded some degree of protection from food allergies, and the longer a child is exclusively breast-fed, the better. The sooner solid foods are introduced, the more chance there is of developing allergies over time.

Our goal is to delay solid foods until somewhere between 4-6 months of age. This will vary from baby to baby, however. We can’t realistically expect a baby with a birth weight of 10 pounds to be ready for solids at the same time as a baby whose birth weight was 5 pounds!

If your baby is breastfeeding and sleeping through the night, DON’T start solids! If, however, she has been sleeping 8 hours at night and is now waking for two additional night feedings, she may be ready for solids.

If your baby is bottle feeding and taking more than 32 ounces of formula in a 24-hour period, you may give a solid feeding supplement if she’s still hungry after the 32 ounces.

Rice cereal is a good choice for your baby’s first solid food. It may be mixed with breast milk, formula or apple juice until quite thin, then fed to your baby with a spoon. DO NOT USE AN INFANT FEEDER! These lead to overeating, potential choking or aspiration and defeat the purpose of teaching your baby about eating solid foods.

After several weeks on rice cereal, you can begin to slowly introduce your baby to different solid foods. A good rule of thumb is to introduce solids slowly, using one new food for 5-6 days before trying another. Most pediatricians recommend cereals first, followed by either yellow vegetables or green vegetables, and then fruit. After 6 months, meats may be introduced. Juices should be treated as fruits (but no orange juice until around 12 months of age). Juices should be diluted to half strength with water.

Some foods, including eggs, orange juice, and peanut butter should not be given to children during the first year of life. These foods are considered “high risk” in terms of developing food allergies, especially if received early in life. Honey should not be given to children during the first year of life because raw honey may contain spores causing botulism in young children (which can actually severely harm your child). These foods can be discussed in more detail during office visits.

Please stop the use of the bottle at 12 months of age, as your child must develop past the sucking oral stage, and the fact that rubbing of the teeth with a nipple can cause the teeth to be worn away causing “bottle caries” (or dental decay as the enamel is worn away).