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FEEDING
All babies lose approximately 10% of their birthweight in the first few days of life, and usually take approximately two weeks to gain back to their birth weight, whether they are bottle-fed or breast-fed.
A. Breast Feeding - Breast-feeding is encouraged and recommended. It can be an enjoyable, rewarding, and successful experience, if you are well prepared, motivated, relaxed, rested, well nourished and supported by your family. Current medical opinion is that breast milk causes less milk allergies and results in decreased incidence of illness, especially gastrointestinal problems, in babies from birth to six months of age. However, in today’s working world, it is sometimes not possible to breast-feed your child, and bottle-feeding of a recommended formula is a very acceptable and common alternative.
1. Breast Care
It is helpful to begin preparation for breast feeding during pregnancy by washing with a firm washcloth to toughen your nipples. To minimize drying and cracking, use pure lanolin or A or D ointment on the nipples after feeding. They need not be wiped off before the next feeding. Clean your nipples with plain water, as soap tends to dry the skin. Many mothers find that their nipples get tender after the first few days of breast-feeding. Airing the nipples will help to desensitize them and using a blow dryer may help to do this.
2. Beginning Breast-feeding
For the first few days after delivery, you will notice an initial discharge from your breast. This discharge, called colostrum, is very rich and nutritious for your baby. Both colostrum and breast milk will provide some protection against infection.
During the first few days of breast-feeding, we suggest that you limit the length of feedings to prevent undue nipple soreness. Start with five minutes on each side, and increase the time gradually, adding two to three minutes each day.
Alternate the breast you start on first. Use a safety pin or a ribbon on your bra as a reminder which breast was last suckled.
To suck properly, your baby should take some of the areola (the dark area surrounding the nipple) into her/his mouth. Care should be taken not to pull the nipple from your baby’s mouth without first breaking the suction. Do this by placing your finger at the corner of the mouth.
You may not notice any significant changes in your breast until about the third or fourth day when your milk comes in. As your milk continues to come in, you may experience fullness. The degree of discomfort accompanying a feeling of fullness varies. Wear a good maternity bra to support the weight of your milk-filled breasts.
To relieve discomfort, soften your breasts with massage, using warm packs and hot showers. Encouraging your infant to nurse will also relieve the fullness. If redness or tenderness of the breast occurs, however, contact your obstetrician. This may be a sign of infection.
Should a sore or cracked nipple occur, keep it dry and exposed to air between feedings. Start feeding on the least sore side. Switch once the milk has let down. Very cautious sun bathing or use of a heat lamp may be of some help. We do not suggest the use of a breast shield, unless you consult with us first.
3. Feedings
The position in which you nurse your infant may vary. Your comfort and the comfort of your baby is most important. Try various positions: Sitting up or lying side by side. The more stimulation and emptying your infant gives the breast, the more milk will be produced to meet the demands for nourishment and growth.
The amount of time your baby spends feeding will vary depending on her/his needs. An average may be 10 to 15 minutes. Eighty-five percent of the baby’s nutritional requirements are met in the first three and one-half minutes. The rest of the suckling time satisfies the baby’s need to suck while supplying a small trickle of milk and providing stimulation to the breast for continued milk production. Use both breasts once at each feeding, and remember to alternate the side on which you start.
4. Schedules
Feeding schedules will vary as your baby’s needs change. Babies tend to set their own schedules. We recommend feeding when your baby appears hungry, rather than following a rigid schedule. While in the nursery we have left standing orders for the nurses to bring the mother the baby every four hours or at the baby’s or mother’s request for nursing. No water supplements will be given without the mother’s okay. There are some general guidelines to follow, however. As a routine, an infant should not need to be fed more frequently than every two hours. If your baby sleeps more than four hours during the day at one time, you may want to awaken her to be fed.
At night if your infant sleeps beyond four hours, be sure to maintain adequate feedings during the day. Sleeping more at night and eating more during the day helps to establish a day/night routine for your child. In order to ensure adequate rest for yourself, try to nap when your baby sleeps, day and night.
5. Supplements, Replacements, and Expressing
Supplementing your infant’s diet with water generally is not nutritionally necessary or advisable. We feel the practice of using water or glucose water supplements in the first days of life may interfere with lactation and the maternal-infant bond. We discourage it. A baby sucks differently from a nipple than from the breast, and this may confuse him/her in the first two weeks of life.
Babies naturally require less fluids in the first few days, corresponding with the mother’s normal production of colostrum and milk. After lactation is well established, at two weeks of age approximately, an occasional replacement of water, breast milk, or prepared formula is acceptable, and even advisable, especially if you contemplate returning to work or being away from home. Also, the bottle will allow your baby to become familiar with an artificial nipple whenever you are unavailable to nurse.A bottle often will be better accepted when given by the father, and is also a way of allowing the father to participate in the feedings.
You can freeze your breast milk by hand-expressing any residual milk following a feeding into a plastic bottle liner to be kept frozen until needed. Breast milk can be kept in the freezer for two to six months. Do not leave it sitting out of the refrigerator once defrosted. Do not defrost the breast milk in a microwave as this will break down the natural antibodies which are secreted in the breast milk. Fresh breast milk may be stored in the refrigerator for no more than 24 hours.
6. Diet
Good nourishment is important for you and your baby. Your selections from the basic food groups assure a well-balanced diet. Snacks between meals should be nutritious. Strict dieting for weight control should be avoided as it may lead to a lack of milk production, fatigue, and a malnourished mother. Nursing mothers naturally feel the need for extra liquid since body water is used up in milk production. Inadequate fluid intake may result in a darker colored concentrated urine and constipation.
Although most mothers do drink milk, any juice or liquid will suffice. We suggest drinking at least one glass of liquid with each feeding. Also, you should continue to take prenatal vitamins while breast-feeding. Mothers need an extra 500 calories per day while breast-feeding.
Certain foods might be irritating and gas-producing to your infant. One of the most common offenders is any sort of caffeinated product (coffee, tea, cola, and carbonated beverages).
If there is a strong family history of allergy, we may recommend the elimination of other foods from your diet.
Occasionally a baby may also become gassy or colicky as a result of mother’s intake of cow’s milk and milk products. Generally, processed milk (yogurt, ice cream, cheeses, etc.) consumed by the mother are tolerated much better by these babies. If you feel this may be happening, you may replace your milk intake with other liquids without problem as long as the rest of your diet is nutritional.
Medications or drugs of any kind (including those sold over the counter) should not be used without consulting us first.
B. Bottle feeding -
Many different types of commercial formulas are available, which provide all the nutrients necessary for adequate growth and development. Prepared formulas can be purchased with or without iron in Ready-To-Use, concentrated and powdered forms. Cow’s milk is not an adequate substitute for a formula. Formula should be continued through twelve months of age. Always check the formula temperature by placing a few drops on the inside of your wrist.
*Note- Microwaves can easily overheat a bottle of formula which can then burn the baby’s mouth.
In the first few weeks, it may be easier to use Ready-To-Use formulas, but after that time we recommend the use of powdered or concentrate formulas with iron. They are less expensive and contain everything necessary to satisfy an infant’s complete nutritional needs. Follow directions on the formula can for preparation. (Note: Plastic liners are not accurate for mixing formula, so use glass or plastic bottles for mixing.)
Several different feeding bottles are available and the choice is strictly up to you. No one nipple style holds an advantage over another. For cleaning purposes, a thorough cleaning either in the dishwasher or with hot soapy water using a nipple and bottle brush will suffice.
Sterilization of bottles and water is not necessary unless you have well water. Sterilize well water by boiling for five minutes. Then allow to cool. Sterilize the bottles and nipples also by boiling for 5 minutes. All new equipment should be washed thoroughly and sterilized before use. The heated cycle of a dishwasher is adequate sterlization/cleansing of this equipment.
Bottles for the day may be made up each morning and stored individually in the refrigerator. A can of formula may also be poured into a sterilized glass container, covered and refrigerated to make up bottles as needed during the day. If excess formula is unused after 48 hours, discard and open a new can. ( This does not apply to powder formula cans.)
It is best to feed your baby in a semi-upright position, holding the bottle at such an angle that the nipple is filled with milk. This prevents air from getting into the stomach, although air is still swallowed as the baby alternates swallowing with breathing.
Bottle-propping is not recommended because of the danger of choking, and the increased risk of middle ear infections, as well as the lack of stimulation and warmth that is necessary for your baby’s development. If you are using plastic or glass bottles, watch the rate at which bubbles rise in the bottle. There should be a moderate flow. If the nipple size is too large, your baby will tell you by gulping milk which runs out of his mouth. If the hole is too small, he will tire before he has satisfied his hunger.
Babies eat for calories and their intake will depend on physical growth as well as activity. Your baby will establish a schedule within the first few weeks. In general, during the first month your baby will drink two to three ounces every three to four hours. This will increase to three to four ounces during the second month, and more in succeeding months. Average amounts of formula consumed per day after the first one to two months probably range around 28 to 32 ounces per day, with an occasional maximum of 35 ounces. If your infant consistently takes 35 or more ounces of formula per day, please let us know. A good rule of thumb to use to gage the amount of formula each feeding is by giving one ounce for every two and one-quarter pounds the baby weighs.
During the first four weeks of life, it is best not to let your baby sleep longer than four hours at a time during the day. Waking your baby for feeding or play during the day and allowing prolonged sleep at night helps to establish day and night patterns of activity.
C. Burping - Even if fed properly, babies usually swallow some air; therefore burping is important, especially so with newborns. Hold the baby upright over your shoulder or sitting up with the chin gently supported by your hand and pat his back gently until he/she burps. He/she should be burped one or two times during the feeding and not just at the end. It is often helpful to lie the baby on his right side for a little while to facilitate burping. If after doing this your baby will still not burp, just continue the feeding. Some babies just don’t burp as often.
D. Solid Foods - Many regimens for solid foods are possible. The initial timing depends upon your individual baby and your home schedule. Nutrition will be addressed during each well child visit. We usually recommend beginning solid foods between four and six months of age by beginning with rice cereal. If you have any questions, please ask.
E. Vitamins, Iron, and Fluoride - All recommended commercial formulas contain adequate amounts of iron and vitamins, so bottle fed babies do not require additional supplements. We encourage nursing mothers to continue taking their prenatal vitamins.
Fluoride drops (or vitamins with fluoride) are advised for babies in areas without fluorinated water supplies and babies given well water. Your local health department or our office can advise you on water quality in your area.
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