BREASTFEEDING

“Breast is Best”. The American Academy of Pediatrics and the National Association of Pediatric Nurse Practitioners recommends breast milk as the ideal food for the growing infant. We congratulate you on your decision to breast-feed your baby.

When you feed your baby it is important that you be relaxed, rested and have had an adequate fluid intake. Babies are very sensitive to fatigue and tension and may not feed well under these conditions. Drink a full glass of juice, milk or water immediately before or after nursing to insure a good intake.

Wash your hands, sit down in a comfortable chair and put the entire areola (the brownish area around the nipple) as well as the nipple into the baby’s mouth. If your breasts are too full, you may have to express a little milk before she can grasp the breast. To take the baby off the breast, try not just to pull the nipple out. The suction may cause soreness and cracking of the nipple, so it is best to insert your finger into the corner of the baby’s mouth in order to release the suction.

The Nursing Mother’s Diet

You should eat a well-balanced diet.  Don’t overdo any one kind of food, especially chocolate, spices and onions.  As a general rule, you can eat anything and everything but in moderation.  An excess of eggs, milk, fish, peanuts and citrus fruits may predispose your baby to allergies (especially if allergies or asthma run in the family). Do not try to lose weight with a strict diet while you are nursing. Be sure to check with our office before taking any kind of medication, as many medicines do come through the breast milk and may be harmful to the baby. Please inform us if you choose a vegetarian or other restrictive diet.

How Often to Nurse

Your baby will let you know how often she needs to nurse.  Times vary from 2-4 hours between daytime feedings.  Many breast-fed babies nurse 8-10 times in 24 hours during the first 6 weeks of life.  Breast milk is digested more quickly than formula so the baby’s stomach empties quicker.  As your baby gets older the time between feedings will generally increase, but during periods of rapid growth, she may nurse more frequently.

How Long to Feed

Begin with 3-5 minutes per side at each feeding.  During the first few days, the baby will be getting colostrum (thick yellow milk) from your breast.  Colostrum is rich in maternal antibodies, which are good for the baby’s immune system.  On about the third or fourth day, your regular milk will come in and your breasts will feel full, engorged and somewhat uncomfortable.  This will be relieved by the baby’s feeding.  Work the nursing time up to 10-15 minutes per breast.  Try to alternate which breast you start your feedings with.  The baby should usually empty a breast in about 10 minutes.  Any additional time is mostly pleasurable sucking and nuzzling.

Vitamins

The American Academy of Pediatrics now recommends giving babies who are breast-fed (or taking less than 32 ounces of formula per day) a supplemental daily dose of Vitamin D. Standardized dose preparations are available “over-the counter”.

After Each Feeding

After nursing let the nipples dry before replacing pads and bra or applying any ointments.  A wet bra can become a very good place for organisms to grow and cause an infection.

Formula Supplements

Some nursing mothers decide to give supplemental bottles of formula so they can leave the baby with a sitter or to give the father an opportunity to feed the baby. Try not to start supplementing until the baby is about 3-4 weeks old or until you have established a good supply of breast milk.

PROBLEMS DURING BREASTFEEDING

Cracked Nipples
Occasionally, soreness and cracking may occur.  Be sure to keep your breasts clean and dry.  Some of the things you might want to try between feedings are: moist heat, ice, lanolin cream (Lansinoh) and A&D ointment.  At feeding time any applied creams or ointments may be gently wiped off if there is any excess.  If necessary, breast shields may also be used. Also, expressing breast milk onto the nipples and letting them air-dry may provide relief.

Engorgement
When the baby misses a feeding for some reason your breasts may feel full and uncomfortable and may leak.  This may be relieved by pumping your breasts gently to express some of the unused milk.  There are also manual and electric breasts pumps on the market.

Infection
If you see a red area on your breast or a painful lump in your breast, you should consult your obstetrician. This may simply be a milk duct, which has become plugged, or it may be an infection called mastitis.  Frequent nursing will usually relieve a clogged duct, but an infection might need medication. Moist heat, adequate rest and pumping your breast may help to fight mastitis in addition to other treatment that your obstetrician may prescribe.

Contraception

Contrary to popular belief, you can still become pregnant while breastfeeding!

Is My Breastfeeding Baby Getting Enough?

Some markers to look for:

• 8-12 feedings lasting 10-12 minutes of rhythmic sucking and frequent swallowing

• Diapers –
  Day 2-5: 2-3 wet diapers and at least one stool
  Day 5-6: 6-8 wet diapers and at least one stool turning to yellow and seedy in consistency.

• Satiated or satisfied baby

• Weight loss in the first 3-5 days does not exceed 8-10% of birth weight

• Once the milk “comes in”, at least one breast should be significantly softer at the end of the feeding than at the beginning

• Back to birth weight by the end of the 2nd week, then gaining 4-8 oz./week

If your baby is not meeting these markers you should give our office a call.

FORMULA

Many different types of formulas have been marketed over the years.  We now prefer that you feed your baby one of the standard cow milk formula brands. We strongly recommend that your baby remain on formula for the first twelve months of life. Unless otherwise advised, formula with iron is best.  These formulas come in a variety of preparations so you must be sure to follow any mixing directions carefully.  Be aware that powdered and concentrated formulas are much less expensive than the ready-to-feed cans. Remember – we strongly discourage the use of whole milk or evaporated milk prior to twelve months of age.

We do not believe that sterilization of the formula is required, but you may wish to boil the water used to mix formula during the first month only.  In addition, all bottles and nipples should be washed thoroughly in hot water at all ages.

All standard brands and forms of infant formula are vitamin-fortified. It is recommended, however, that you give your baby additional Vitamin D until he is taking over 32 oz. of formula daily. Fluoride is important for growth, healthy teeth and strong bones. It has been added to the water supply in most Boston-area communities.  Therefore, we do recommend that you use tap water when preparing your baby’s formula.  Let water run for 2 minutes in the morning before using, and do not boil water longer than ten minutes to avoid high lead concentrations. There are now several filters available that remove lead from tap water if this is a potential problem in your home.

Advancing to Solids

ADVANCING TO SOLID FOODS

There are many correct ways to feed a baby and there is no absolute feeding schedule.  Do not be in a rush to make a gourmet of your baby!  Starting solid foods too early has been shown sometimes to cause anemia and may predispose your child to allergies, diabetes and obesity later in life.

The general feeding guidelines presented here are designed to give your child the least feeding difficulty.  If you have any problems or questions regarding your child’s diet, please bring them up at your routine office visits or call the office during our regular office hours.

Newborn to 4 Months

During the first 4-6 months feedings should be limited to breast milk or formula only.  The baby’s intake should gradually increase to 32-35 ounces in a 24-hour period if you are using formula.  Breast-fed infants will be nursing 5-6 times per day.  These feedings may be supplemented occasionally with small amounts of plain water.  It is highly recommended that solid foods and juices not be introduced in this period. Remember- if your baby is growing well on your breast milk or formula, he does not need anything else.  If your baby seems not to be satisfied by breast milk or 32 ounces of formula per day, please consult us before starting other foods.

4-6 Months

You may begin solid foods if you baby does not appear to be satisfied with 32 ounces of formula per day or is requiring breastfeeding more than every 3 hours on a regular basis.

Cereals are usually introduced first.  Precooked rice or barley cereal is usually well tolerated.  Note that rice cereal is usually more constipating while barley is more of a laxative.  The type of cereal you use should be matched to your baby’s bowel habits.  Begin with one teaspoon once or twice per day and gradually increase the amount if your baby seems to enjoy it. The cereal may be prepared with a small amount of formula or breast milk.  Do not add the cereal to the baby’s bottle!  For the next few weeks, gradually introduce fruits and vegetables.  It is wise to introduce only one new food at a time and use it for 3-4 days before adding another new food.  In this way one may discover your baby’s possible allergies, intolerances or dislikes. These might be indicated by irritability, food refusal, colic, rashes or changes in her bowel movements.

Please note that an excess of yellow/orange vegetables (carrots, squash, sweet potatoes, etc.) can cause a temporary yellow discoloration of the baby’s skin. This is called carotenemia and is not harmful in any way. You can reverse this discoloration by reducing the amount of these foods that your baby is eating.

Be sure to read the labels on all baby foods, as some do contain additives that are undesirable (for example- citrus fruit concentrate in some brands of bananas).

Juices may be useful during this period for constipation, but otherwise are NOT recommended!

6-12 Months

When a good variety of fruits and vegetables have been introduced, you may want to begin with meats.  Single meats are preferred to mixed dinners because they have higher meat content.   A better idea is to mix meats, vegetables, fruits and cereals, as you like on your own.

Plain yogurt and cottage cheese are nutritionally excellent foods that most babies like.  Avocados are another good choice at this age. Be sure to mash or blend these foods thoroughly.

Juices may be started during this period, but are not essential to good nutrition and should be strictly limitedto 4 oz. per day. Excessive juice consumption is probably the most common cause of malnutrition and obesityin children and should be avoided!  If you do choose to offer a small amount of juice, however, apple, cherry, and grape are a few good choices.  Remember that you should count these as “new foods”.

Our previous advice was to avoid many “allergy provoking” foods (nuts, tomato, fish, etc.) during the first 12 months of life. Recent studies have determined that avoiding these foods does NOT reduce the risk of your child developing food allergies! Therefore, we no longer recommend such restrictions. You should, however, continue to avoid raw HONEY until after your child’s first birthday.

12 Months and Up

As your baby learns to chew, junior foods may be used. It is often easier and less expensive to mash and chop foods from the regular family menu.  Be sure to prepare foods adequately to prevent choking and aspiration. Toddlers need to be supervised closely at all mealtimes. Grapes and junior hot-dogs should always be sliced. Peanuts, hard candy, gum, raisins and popcorn should be avoided entirely, as these are the foods most commonly choked on.

Whole milk is now introduced and may replace formula and breast milk. Offering a mixture of whole milk and formula/breast milk for the first week is recommended in order to reduce problems with taste avoidance and intestinal upset.