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Pediatricians taking care of sick and well children from birth to age 21
Feeding
Providing your baby the very best possible nutrition in infancy and early childhood will benefit him in sound growth and development, good health, and freedom from undesirable consequences of inappropriate nutrition. Clinical data and review by nutrition and pediatric professionals resulted in the current recommendations by the Committee on Nutrition of the American Academy of Pediatrics.
The basic approach to feeding is the same whether you have selected breast or bottle feeding. The time set aside for feeding really satisfies two of your child’s greatest needs. During feeding she/he receives love as well as nutrition. This early intimate contact that the infant senses from his mother establishes the maternal-child bonds that will continue to grow throughout the years. Therefore it is important that you try to be relaxed, confident and enthused during these periods.
Please choose a link below to read more about the following feeding techniques. Although breast milk is the best source of nutrition for your baby, many mothers cannot breastfeed or choose formula instead.
A) Breastfeeding (see below)
B) Formula Feeding (see below)
All babies whether breastfed or formula fed should receive supplemental Vitamin D in the form of an over the counter multivitamin drop. Please ask the doctor for more information.
No whole milk in any form should be given before 1 year of age.
Whole milk is a poor alternative to breast milk or formula. Why?
– The low iron content invites iron deficiency and anemia (low blood cell count).
– This can be compounded by the loss of blood from injury to the intestinal lining due to milk protein effects/allergies. Allergic reactions are prone to occur.
– Butterfat of cow milk is poorly absorbed depriving the infant of a necessary energy source.
– The mineral content greatly exceeds the infant’s requirements and physiologic limits. These high levels plus the protein excess causes an excessive solute load to the kidney.
Feeding Considerations:
The feeding schedule in the hospital is generally geared for staffing convenience to provide optimal care for both you and your baby. We certainly encourage you to alter the feeding plan at home to best conform to the needs of you, your baby, and your family.
Generally, your infant will be ready for feeding every 2-4 hours. If, during the day, your baby goes longer than 4 1/2 hours, awaken him and feed him. You may nurse at more frequent intervals, sometimes as often as every 1 1/2 hours. Many newborn babies feed 9-10 times in a 24 hour period.
After the first week or so, if your baby demonstrates a willingness to sleep through the night, consider yourself fortunate, and allow her to sleep until morning. Most babies will be able to sleep through the night by three months of age.
Your baby will need breast milk or formula until 12 months of age. We postpone introduction of solid foods until about 4-6 months of age, since breast milk or formula will provide adequate nutrition for growth in the initial months. Given earlier, baby food contributes no special nutrients or energy not already provided by breast milk or formula, and risk potential allergic reactions. The gastrointestinal system is not adapted to handle the solid foods until later. We will discuss solid foods as their introduction becomes advisable. The usual sequence is cereal, vegetables, fruits and meats. Some foods are more prone to cause allergic reactions than others (peanuts, nuts, seafood, eggs, milk and wheat). We encourage you to talk with the doctor regarding introduction of these foods.
Be relaxed and flexible in your approach to feeding. When your baby is ready for a particular food is largely a matter of trial and error. There is no single super food, nor forbidden fruit. Therefore, do not be frustrated if your baby appears unable to take a particular item.
Spitting up:
Spitting up occurs because your baby has overeaten or swallowed excess air while eating. They sometimes spit up while burping. You should be able to tell the difference between vomiting and spitting up. Most babies do not even seem to notice spitting up. With vomiting, the baby might feel distress and discomfort. Vomiting produces much more volume than a spit up. Generally, a baby who spits up, but continues to gain weight and is not fussy is fine. To reduce spit ups, burp the baby frequently during feeds, avoid feeding him lying down, and do not jostle him immediately after a feed. Instead of placing her in a car sear or feeding seat, you may elevate the head of the mattress by placing a pillow, blanket or towel under the mattress (not under the baby’s head.)
Sterilization:
Sterilizing bottles and nipples is not mandatory if your water source is properly treated. Wash nipples, bottles, pacifiers, and all utensils with hot soapy water and a brush. Dishwashing liquids are more effective than soap. Protect bottles by placing them upside-down on a rack or clean towel.
Breastfeeding
Breast Milk:
Breast milk is the best source of nutrition for your baby. It has a balanced distribution of protein fat and carbohydrate for the caloric needs for your baby, and levels of minerals appropriate for growth. In addition, protective immune substances are secreted by the breast. These immune substances help your baby combat infections from bacteria and viruses, and protect against allergies.
We encourage all mothers to breastfeed and would like to assist you if you have concerns or problems with your feeding attempts. Mother’s diet should be a normal diet with a few exceptions. Be sure to drink plenty of fluids. Of course, tobacco and alcohol are unquestionably discouraged.
The breast usually fills with milk by the third or fourth day after delivery. However the early fluid secreted by the breast immediately after delivery is rich in antibodies and acts as a laxative for your baby. Nursing time should be about 5 minutes per breast the first day and increased by a few minutes each day. Nursing longer periods initially can cause your nipples to become sensitive or uncomfortable. Eventually, ten minutes at each breast is usually long enough since your baby will take most of your milk in the first few minutes. Baby should not nurse longer than 20- 25 minutes at any one time.
It is normal for your baby to lose up to 10% of his birth weight in the first several days of life. Most babies will regain their birth weight by 2 -3 weeks.
Common Breastfeeding Problems:
Occasionally breast milk may not be sufficient volume for your baby to gain adequate weight. This can be suspected if your baby seems very hungry after a feeding, very fussy before time for the next feeding, and if your baby does not gain weight appropriately. When this occurs, we encourage you to continue to breastfeed, and to supplement with an appropriate volume of formula after the breastfeeding to provide sufficient calories for growth. We find this approach to work very well.
The breasts and nipples should be washed each day with plain water. To feed, guide the nipple into the baby’s mouth. Be sure to hold the breast away from the baby’s nose so as not to hinder his breathing. Both mother and baby should be comfortable whether sitting in a chair or lying in bed.
After your milk flow is well established, your baby may nurse either from both breasts each feeding, or from only one. Try to be consistent.
Having a C-section should not deter you from nursing.
Pumping/Expressing Breast Milk:
For your comfort and relief or convenience, breast milk can be pumped, stored and used at a later time. If desired or needed, you can always supplement with formula. Breast pumps are very helpful in many situations, especially in cases where the mother will go back to work after maternity leave. You can rent or buy a pump. There are different models, both manual and electric. You should base the pump you purchase or rent on your needs and the time that will be spent away from your baby. If you have questions about pumping ask the nurse or doctor for suggestions.
We can also provide you with the names of lactation consultants. In most cases, experts recommend that if the baby is able to breastfeed, to wait at least one month to start pumping. This will depend on the circumstance. As with breastfeeding, pumping can be difficult in the beginning for some people. With time it becomes easier.
Breast Milk Storage and Preparation:
Wash your hands prior to expressing or handling your milk. Be sure to store the milk only in sterile containers designated for breast milk storage. Label the container with the date collected so that you can use the oldest first.
Use sealed and chilled milk within 24 hours if possible. Disregard all milk that has been refrigerated for more than 72 hours.
If you do not plan to use milk with a few days, you can freeze it. Frozen milk is good for at least 1 month in a freezer attached to a refrigerator. It is best to store milk in the back of the freezer. If kept in a zero degree deep freezer, it is good for 3-6 months.
Thaw the milk by placing it in the refrigerator over night or letting warm tap water run on the container or bag for a few minutes. Never microwave breast milk (or formula) because uneven heating can cause burns. Thawed breast milk should be used in 24 hours.
Do not combine fresh breast milk and frozen milk. Place any unused defrosted or fresh milk in the refrigerator; however, if your child has drunk from that milk it should be discarded at the end of the day.
Formula Feeding
Formula:
Upon leaving the hospital, your baby will take 1-2 ounces of formula approximately every 2- 4 hours. Every week or so thereafter, you will probably observe that the baby will desire more. There is a range of normal formula intake and the best indicator of the proper amount is your baby’s appetite. If she desires more, feed her more.
Remember, your baby may be full before the bottle is empty. Never force him to drink more than he wishes. Overfeeding can cause babies to vomit. When your baby is finished eating, disregard any remaining formula in the bottle. Do not set it back for your baby to finish later, since it can spoil or become contaminated.
Each feeding should be interrupted every 1-2 ounces for an attempt to burp the infant. Do not worry if she does not burp successfully each time. It is common for babies to spit up occasionally as they are burped.
There are various types of formula available for the healthy newborn. Iron-fortified formula is best. Some of our recommendations include:
– Similac Advance with Iron
– Enfamil Gentlease (WIC approved)
Formulas come in three varieties:
1) Ready to Feed – Premade bottles or cans. Do not add water.
2) Concentrate – Add equal parts water and formula.
3) Powder (*most common*) – One level scoop (included in can) per 2 ounces of water.
Why Iron-Fortified Formula?
Every year we learn more about feeding babies- more about the effects of various nutrients such as protein, fat, vitamins, and minerals on growth and development. Iron is a mineral supplied by food and used to make good red blood which in turn supplies oxygen to all parts of the body. A rapidly growing baby has a great need for iron, not only for day-to-day maintenance, but also to constantly replenish iron stores that are being used to support growth.
Our reasons for prescribing an iron-fortified formula are supported by the Committee on Nutrition of the American Academy of Pediatrics. This group of experts in infant feeding recommends that every bottle fed infant be given an iron-fortified formula, first from the bottle and then from a cup.
The amount of iron in your baby’s formula will NOT cause gastrointestinal distress such as vomiting, diarrhea, cramps, gas, colic or constipation. Do not change or discontinue the iron-fortified formula unless we have advised you to do so.