Feeding

With today’s more natural life styles, more and more mothers are breast feeding. The normal well-nourished mother is almost always capable of producing enough breast milk ideally suited for her baby’s nutritional needs. Consider these advantages of breast feeding:

1. Breast feeding is convenient: it doesn’t require the equipment and preparation that other forms of feeding do.
2. Economy. Breast feeding is less expensive than other methods.
3. It helps mother to get back into shape internally because it releases hormones that cause mild contractions of the uterus.
4. Breast fed babies may be better protected against colds, allergies, diarrhea and various infections.
5. For both mom and baby, the closeness that breast feeding creates provides a tremendous amount of emotional gratification.

The First Feeding

Especially at the beginning, breast feeding can be frequent and takes some patience to establish. Don’t be discourage if the baby is not too interested in the first feeding or two. It takes practice to master the physical techniques of breast feeding and the two of you will learn together.

Breast Feeding Techniques

Here are some suggestions to make breast feeding easier for you and your baby:

• Find a comfortable position. You may find it’s easier to lie on your side facing the baby. Your head and back will need support. Later you may want to sit in a comfortable chair. Hold your baby in your lap with the baby’s head resting in the bend of your elbow.
• Help your baby find the nipple by gently stroking the cheek nearest your breast. Position the baby’s mouth slightly under the nipple so his chin touches the breast below the darkened area around the nipple (the areola). At first, the baby may nuzzle the breast. But gradually, he’ll learn to find the nipple and areola.
• To draw milk out, the baby must suck against the areola. Proper positioning of the baby’s tongue on the areola, not the nipple, will be more comfortable for you and more productive for your baby.
• Burp your baby midway through and at the end of each feeding. To release the suction, slip your finger just inside the baby’s mouth. Then gently hold the baby upright and pat his back.
• Cuddle and talk to your baby during feeding. Breast feeding can be the beginning of a warm and intimate mother/baby relationship. Your well being and the baby’s can be enhanced by the positive feelings associated with breast feeding.

The first milk your baby will receive from you is a yellowish liquid called colostrum. It may last from one to five days. Colostrum is rich in protein and vitamin A, contains disease resistant factors and it acts like a laxative to help clear the baby’s intestinal tract.

Breast Feeding Schedules

Your baby will help you determine how long each feeding should last. Some babies suckle eagerly, others may just nuzzle the breast or reject it completely. Don’t despair! These early attempts are a “getting acquainted” period for you and baby. In time, you’ll both master the technique.

For the first few feedings, to help prevent sore breast, you’ll want to limit the time on each breast to three to five minutes. You can gradually increase the time to a duration most comfortable for each of you. To minimize breast discomfort,try to have the baby feed off both breast at each feeding.

Your baby may need to be fed every 3 to 5 hours during the day. Rest and relax whenever your baby is sleeping fatigue can reduce your milk supply.

Burping

Try to burp your baby in between breast and after the feeding. If, after five minutes, you haven’t been successful, don’t despair; some babies are better burpers than others. Burping gets rid of swallowed air, some babies swallow more air than others. Here are three effective methods:

1. Hold the baby in an upright carrying position, supporting his head on your shoulder. Then gently pat the baby’s back or smooth it upward with your hand.
2. Lay the baby face downward on your lap. Support the baby’s head and smooth or pat the back.
3. Sit the baby up in your lap. Support his head and back with one hand, head and front with the other. Then gently help the baby burp.

Sore Nipples

Mothers with fair skin are the most likely to experience nipple soreness. Before your baby is born, some authorities recommend that you “toughen” your nipples by briskly towel drying them or by rolling them between our thumb and forefinger several times daily.

If you increase the amount of time your baby sucks it will help to prevent sore nipples. To ease nipple soreness you may use mild emollients such as lanolin cream with vitamin E oil between breast feedings. Be sure to remove any ointment from your breast before your baby feeds. Use warm water on a soft cotton ball or towel.

When he feeds, make sure your baby is taking in as much as possible of the areola. You may want to change positions at each feeding.

Engorgement

Occasionally, especially when your milk first comes in, you may experience breast engorgement. This is when the breast become swollen and distended due to an oversupply of milk. As a result, it may be difficult for the newborn to grasp onto the nipple.

1. Pumping off milk manually or with a pump may help.
2. Place warm towels on your breasts or take a hot shower to obtain a good let down.
3. Breast milk can be stored in the refrigerator for 24 hours or frozen for 6 weeks. It should be thawed in the refrigerator and used within 24 hours.

Breast Infections

If you think you have a breast infection, you should contact your obstetrician as soon as possible. Physical symptoms may include:

• A flu-like feeling; aching, nausea, tiredness, no energy.
• Fever.
• A sore breast or a hard red lump on any part of the breast.

If you do have a breast infection, antibiotics will be started immediately, and it is important that you keep feeding from the affected breast. If it’s too painful to have the baby suck, you can try using a breast pump to express the milk.

Breast Fed Stools

Breast fed babies usually have soft, semi-liquid stools that are cottage cheese like and gold, mustard in color. At first, most breast fed infants have a bowel movement every time they feed. But as they get older, some breast fed babies may only have a bowel movement once every 5 to 7 days. A solely breast fed infant will not get constipated and these variations are nothing to worry about unless your baby seems to be very uncomfortable or gassy.

Problem Breast Feeders

The first two weeks will take a lot of practice and patience for both you and your baby. Here are some common problems:

1. Nibblers: Nibblers are infants who will feed on one breast for a short time(just long enough to get their tummies full) and then fall asleep. Consequently they want the breast every 45 minutes. To avoid this, stimulate the baby throughout the feeding. Play with the child’s hands and feet. Try to get the baby to feed from both breast at each feeding and don’t nurse again for at least two hours from the end of the previous feeding. Keep your baby unwrapped and lightly dressed.
2. Refusing The Breast: This can be common problem at first, especially when the breast is engorged. Engorgement can make the nipple difficult for the baby to grasp. To remedy this, put heat on the breasts with a warm wash cloth and express some milk out first. Then the baby can latch on more easily. It’s also important to relax during feedings. If you’re tense and nervous, your baby will sense it and your milk won’t flow as well. If your baby’s screaming and you’re crying, take a “time out period”. while dad rocks the baby, go take a warm bath, relax and then try again.
3. Wants To Eat All The Time: Babies do go through appetite spurts and may often act like they’re starving. Often it’s not so much a reflection of hunger; it’s just strong sucking desire. Use a pacifier if your baby will take one. Or try swinging, which may soothe an infant.

The best way to tell if your infant is getting enough breast milk is by weight gain. At Pediatrix, we’ll follow that closely through the first year.

Supplementation

On a rare occasion, we may recommend that your baby have a formula supplement. This may be to give mom a break. Or, if a mother has been ill, recovering from surgery or is extremely fatigued, her milk supply may not be sufficient. Supplements are usually only temporary. Offer formula only after the baby nurses so that sucking on the breast still stimulates milk production.

Bottle Feeding

If you’ve chosen not to breast feed, or if Pediatrix has suggested a supplementation to nursing, you’ll be using a commercially prepared infant formula. Infant formulas have been designed to fulfill the nutritional needs of your baby by providing all known essential nutrients in proper amounts. Whole milk usually is not recommended until the baby is a year old because:

1. Cow’s milk has too much protein-almost three times the amount in breast milk and infant formula. Consequently it’s hard on the baby’s kidneys.
2. Cow’s milk contains fat and protein that’s harder for your baby to digest than the protein and fat in breast milk or infant formula. This can cause intestinal bleeding in infants less than 12 months old.
3. Cow’s milk contains twice as much sodium (salt) and potassium than is recommended for babies.
4. Cow’s milk lacks Vitamin C and doesn’t contain enough copper or iron.

Formulas have a protein base derived from cow’s milk or derived from soybeans. Soy formula may be recommended when infants are allergic to cow’s milk or have difficulty digesting it. Other brands of formula may be discussed with you during a pre-natal visit, at the hospital or during an office visit to Pediarix.

Formula Preparation

There are three basic formula preparations (Nutritionally they are all the same):

1. Ready To Feed: Requires no mixing and is available in 8 ounce and 32 ounce cans. It’s more expensive than the other preparations.
2. Concentrated Liquid Form: Designed to be mixed with equal parts of water. Available in 13 once cans.
3. Powered Formula: This is the most economical way to prepare formula. One scoop of powder to two ounces of water.

When you mix formula, take care to follow instructions carefully. Too little or to much water can cause serious problems for your baby. The temperature of the formula need not be higher than body temperature. Room temperature is fine.

Bottles and Nipples

Among the choices available are glass, plastic and disposible bottles and nipples in differing shapes, lengths and rates of milk flow. Simply select the one with which you’re most comfortable, or keep using the one your baby’s become accustomed to. Babies may swallow air when they suck, even breast fed babies may need to be burped.

It’s not necessary to sterilize baby bottles. Just rinse with cold water then wash them with hot soapy water and rinse well. If you live in an area where the tap water is safe, there’s no need to boil the water. If it’s safe for you , it’s safe for your infant. Use of softened water is not recommended because of higher salt content.

Always make formula fresh and keep it refrigerated. It’s a near-perfect growth medium for bacteria, so never leave the bottle out after a feeding. Be sure to discard left-over milk. Do not keep an open can of formula-even though it’s refrigerated-for more than 48 hours.

Schedules

Feed your baby whenever he seems hungry. Most infants will want to eat every three to five hours at first. The minimum feeding interval should be about two hours. If your baby sleeps longer than four to five hours during the day, you may wake him up for a feeding. If your baby sleeps through the night enjoy it!

Hold your baby in your lap when you are feeding. Just as important as the milk itself, are the interaction and closeness between you and your child. It will be many months before your baby is ready to hold his own bottle. At Pediatrix, we discourage propping bottles. Also, never leave bottles in the baby’s bed: it’s a bad practice that could cause rotten “bottle baby” teeth.

At first, your infant probably will take two to four ounces at a feeding. If the baby is emptying the bottle, increase the amount of formula next time. Don’t feel that it’s necessary to finish every last drop at each feeding: babies regulate their own appetites in time.

Generally, your child’s getting enough to eat if he seems content after a feeding, has lots of wet diapers and goes a reasonable length of time between meals. Pediatrix will monitor his weight gain and growth closely at well checkups.

Vitamins and Fluoride

No supplemental vitamins are likely to be necessary whether your baby is breast fed or on formula. If additional iron, vitamins or minerals are needed, a Pediatrix staff member will tell you during a well baby visit.

Fluoride supplements are recommended only if the water in your area is not fluoridated, or if you use bottled water. Before one of your Pediatrix visits, we’ll ask you to call your local water department and obtain the percentage of fluoridation in your area. Then we can prescribe appropriately. Fluoride had been found to play an important role in the prevention of dental cavities.

Solid Introduction

Introduction of solid foods is not recommended by The American Academy of Pediatrics until your baby is four to six months old. Introducing solids too early in your child’s life is costly, time-consuming and adds unnecessary calories to his diet.

Baby food should not be put into a bottle or infant feeder because the baby may choke on thick liquids sucked through a nipple. It also makes it difficult for you to determine how much food your baby is taking.

Spoon feeding is a learning process, so don’t be concerned about the first reaction. Make the first experience with a spoon relaxed and pleasant. The baby should be reasonably hungry, but not cranky. Expect at first to get more food on your baby than in your baby.

Pediatrix recommends dry infant rice cereal mixed with formula or breast milk to begin the introduction of solid food. Start out with two to four teaspoons, once a day, at first. Increase the amount and frequency of feeding depending upon how your baby responds. Mix the cereal so that it is thin and runny at first and thicken it as tolerated as your child begins to learn to eat solids.

After several successful feedings with rice cereal, you may try other grains such as oat, barley and wheat cereals.  You may also introduce fruits and vegetables at this time.  You do not have to follow a designated order of introduction of vegetables before fruit or vice versa.  You child may  not like certain foods–that’s ok!   Keep in mind that your child is an individual with likes and dislikes. Expect them to be expressed loudly at times.  Try  the food again at a later time.  Never force foods onto your child as this can create food aversion.  Also, it is important to introduce one new food product every 3 to 5 days so you can watch for adverse reactions. Pediatrix does not encourage mixtures of foods because if an allergic reaction occurs, it’s difficult to pinpoint the cause. Adverse reactions can include:

• A hive-like rash
• Irritability
• Diarrhea
• Cramping
• Vomiting

When you introduce new food to your baby, expect a slight change in the stool color, pattern, consistency and frequency. By eight months of age, your baby will probably be eating three meals and consuming 24 to 32 ounces of formula each day.

With any food or beverage, choking is a possibility. Be sure that the pieces are small and soft and remain close by and alert. Avoid hard foods such as peanuts, uncooked sliced carrots, whole grapes, popcorn, hard candy, sticky foods, fried or fatty foods and foods with added sugar or salt. If there’s a strong family history of allergies, the following foods should be avoided during the first year of life:

• Citrus fruit
• Dairy
• Wheat
• Chocolate
• Egg White
• Strawberries
• Peanut Butter/Nuts

Fruit juices fall into the category of “empty calories.”  They provide a lot of calories without a lot of nutrients.  Therefore, fruit juices should be diluted with water and restricted to four ounces per day.

These feeding guidelines are general in nature. Each child will have individual needs, likes and dislikes. During the first year of life, Pediatrix will follow your baby’s growth very closely. If you have questions or concerns about food and nutrition, just ask.