Feeding Your Baby
Breast milk is good for your baby. It is superior to any alternative form of infant formula and is uniquely designed to meet the nutritional needs of your infant. It contains antibodies which will help protect your baby against illness. Breastfeeding is easy, inexpensive, and convenient; there are no bottles to wash and no formula to prepare. Breast milk is easy to digest, and less allergenic, thus there are fewer problems with constipation and diarrhea. Breastfeeding provides a special bonding for baby and mother. It also helps mom get back into shape by contracting the uterus.While breastfeeding may be the natural thing to do, it helps to know a little about how to do it. Here are a few steps to help you get started.
- Wash hands with soap and water.
- Hold your baby close to your breast and turn your baby so you are tummy to tummy.
- Hold the breast in your hand and gently stroke the babies lips with the nipple until the baby opens wide. Your baby has a "rooting reflex" which will make him turn his mouth toward your touch.
- Pull the baby onto your breast, helping him to take in as much of the brown area of the nipple as possible.
- Nurse the baby on both breasts, about 10 minutes per side, burping in between.
- To remove the baby from the breast, place your finger in the corner of his mouth to break the suction.
- Proper positioning of the baby on the breast and using different positions to hold your baby while nursing is very important to reduce nipple soreness.
How do I know my baby is getting enough milk?
- Your baby should have at least 6-8 wet diapers per day and frequent bowel movements. Call us if your newborn is stooling less then 4 times a day in the first two weeks of life.
- Initially, your baby should nurse 8-14 times over 24 hours (every 1 1/2 to 3 hrs). In the first 2 weeks of life, you should wake your baby for feedings if she sleeps beyond 5 hours.
- Your breast should feel full before feeding and softer after your baby has nursed.
- In general, your baby should seem satisfied and content after feeding. If you are concerned, you should call us. We may want to have the baby weighed.
Collecting and Storing Breast Milk
Situations arise where you may need to be separated from your baby; school, work or an evening out. When this occurs, you may wish to pump and store your milk ahead of time. There are a number of different breast pumps available and you will need to find the one that fits your needs.
Breast milk may be stored in the refrigerator for 48 hours. To freeze breast milk, first cool it in the refrigerator, and then put it into the freezer. Frozen breast milk should be used within 3 months if it is stored in the freezer compartment of a refrigerator. Milk stored in a deep freezer is good for 6 months. Remember to label the breast milk with the date that you pumped it. Thaw milk in the refrigerator or in warm water just before feeding. Thawed milk must be used within 24 hours. Note: freezing breast milk destroys some of its antibodies.
You may introduce a bottle of breast milk or formula at 2-3 weeks of age (2-3 times/week). This is enough to get your baby used to a bottle, but not so much that it will compromise your breast milk supply.
When a Nursing Mother is Ill and Needs to Take Medications
When a mother becomes ill, she should not interrupt breastfeeding for fear that she may make her baby sick. Breast milk passes immunity to the baby in many circumstances. Frequent hand washing will also decrease the risk of contagiousness.
If you are nursing while ill, it is generally best to avoid most medications. If you wish to take medicine, the following medicines may be taken safely (at the recommended dose) without risk to your baby:
For fever: Acetaminophen, Ibuprofen
For colds: nasal sprays (eg. Afrin, Neosynephrin); Benadryl (Other antihistamines may be given, but there may be a slight decrease in mother's milk supply)
For pain: Acetaminophen, Ibuprofen, Codeine, Naprosyn
For infection: Antibiotics do not usually produce adverse effects in breast-fed infants.
You may take: Penicillins (eg. Amoxicillin), Cefzil, Suprax, Keflex, Augmentin
For weight reduction
After your child reaches one month of age, you may take products with Aspartame(Nutrasweet) or saccharin. Mothers who carry the gene for phenylketonuria should consult us before taking Aspartame.
If you are taking a medicine which is not listed here, please call and speak with one of our providers or phone nurse.
If you decide to bottle feed your baby, rest assured in knowing that formulas will provide your baby with all the nutrients she needs to grow and be healthy. An advantage in bottle feeding is that it's easy for dad and others to feed the baby when mom needs a break.
There are basically two kinds of formula which you may choose to use: cows milk protein or soy protein. Formulas are labeled "with Iron" or "low Iron". Formula "with Iron" is recommended so your baby won't become anemic. Most babies will do fine on cows milk-based formula and it is recommended unless you have a family history of milk allergy or your baby is having problems with cows milk formula. In that case, you may want to try a cow's milk-based formula that does not contain lactose, or a soy-based formula.
There is no need to boil water for formula or sterilize bottles and nipples if you live in a city with sanitized water. To avoid bacterial infection you should thoroughly wash the bottles and nipples in hot soapy water using a bottle brush. Most bottles may be placed in the dishwasher. Always rinse your infant's bottle after it is empty to avoid bacterial growth; it is very hard to remove dried milk after it hardens.
When preparing formula, you should always start with clean hands. Here are some general guidelines for mixing formula:
Ready to Feed: No Mixing required. Pour directly into bottle.
Concentrated Liquid: This must be mixed in a 1 : 1 ratio with water. If you make a 4 ounce bottle, add two ounces of concentrated liquid to two ounces of tap water.
Powdered: Add one scoop of formula to every two ounces of water. Measure the water first and then add the formula and shake.
Breast milk or formula is recommended for your baby's entire first year. Whole milk should not be given to infants under 12 months unless it is recommended by us.
Tip: Always hold your baby during feedings. Never prop the bottle and don't give your baby a bottle in bed.
If your baby doesn't finish his bottle, you may offer it up to one hour later. If refrigerated, you may keep it up to four hours. Bottles for nighttime feedings that are prepared in advance should not be left at room temperature. They should always be refrigerated.
Infant formulas and breast milk contain all the necessary vitamins so there is no need to give supplemental vitamins unless we have recommended vitamin D supplementation. Extra fluoride is not needed in any baby less than 6 months of age, regardless of whether they are formula-fed or breastfed. After 6 months of age, certain babies and children may require fluoride supplementation, but only if their primary water source has no or low fluoride content (well water, some bottled water). If you have concerns about the fluoride content in your water supply, discuss this with your pediatrician at the 6 month well baby visit.
There is enough water in formula and breast milk to meet your babies needs, so no extra water is really needed. It may be offered during hot weather or when baby is ill. Once your baby starts eating solid foods, he may require more water.
When is your infant ready?
It is recommended that solids be started between 4 and 6 months of age. They are not necessary before this time because breast milk or formula provide all the nutrition and calories a baby needs. Feeding solids too soon may cause infant allergies and may increase their risk for later obesity. Solids do not help babies to sleep through the night.
Some signs which will help you recognize if your child is ready for solids are:
- Baby can sit with some support and turn head away when full.
- Baby is able to swallow food from a spoon.
- Baby is drinking more than 36 ounces of formula per day.
How to Begin Solids
- Start with plain iron fortified infant cereal, such as rice.
- Mix 1-2 tablespoons of cereal with breast milk or formula until it develops a mustard-like consistency. Feed with a small spoon. Continue with cereal for 2 - 3 weeks, 1-2 times per day.
- Next add plain vegetables, then fruit. Try one new food at a time, waiting 3 - 5 days between new foods. Squash, sweet potatoes and carrots are high in Vitamin A and are liked by most babies. Avoid wheat products, corn and berries until 9 months of age.
- Around 9 months, slowly introduce finger breads, cereals, and strained meats. You may try other protein foods such as beans, yogurt and cottage cheese.
- Avoid egg whites, fresh cow's milk, shellfish, peanut butter, citrus, chocolate and honey until one year of age.
A cup should be introduced around 6 months of age. This is a good time to start juice, limiting the amount to 4 to 8 ounces per day. Don't put juice in your baby's bottle, help him learn to drink it from a cup.
Tip: If using jarred baby foods, mix single foods like chicken, with peas or peaches. These products are better for baby and cost less than combination or mixed dinners.
Healthy Eating for Your Child
Many parents have concerns about what, how much and how to get their child, to eat. Parents are responsible for selecting and buying food, making well-balanced meals, setting the timing of meals and snacks, presenting food in a form that the child can handle and setting standards of behavior at the table. The parent is not responsible for how much a child eats, whether he eats, or how his body turns out.
By Daniel Feiten MD