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Infant Nutrition
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The cornerstone of infant nutrition is milk. There are two excellent methods of supplying this basic source of nutrition. One is breast feeding, the other bottle feeding with formula. We feel that the optimal milk is mother’s milk and urge you to breast feed. However, there are many good reasons a parent may elect to use formula. Infant formulas fulfill all your baby’s nutritional needs.
If you are a participant in the WIC Program, please use the formula that is mandated by the contract for the WIC Program. However, if you drop out of the WIC Program or are not a participant, this office recommends that you use Similac Advance or Enfamil Lipil either for total feeding and/or supplemental feeding. Please call our office before making any changes to your newborn’s diet. Some other brands may not be appropriate for your baby. Feeding Schedule Feeding is one of the baby’s first pleasurable experiences. The baby’s first love for his parents arises primarily from the feeding relationship. At feeding time the baby receives nourishment both from food and parent’s love. The food helps to achieve healthy growth while the parent’s love, generously given, provides security. Feeding time should be an enjoyable time for you and your baby. It is a time of closeness and love. Whether breast feeding or bottle feeding, hold your baby close. We suggest using a flexible, demand feeding schedule. This means your baby is fed when he is hungry, which is typically every three to four hours. Your baby’s feeding schedule will slowly evolve. At some feedings he may act starved and at others he may seem uninterested - this is only human. If your baby seems hungry sooner than 2-1/2 to 3 hours after the last formula feeding, the use of a pacifier may be all that is needed. Breast fed babies are likely to need more frequent feedings. Don’t hesitate to wake your baby for a feeding to fit your own schedule. If you are one of the fortunate few who has a baby that sleeps at night, do not waken him for a feeding, but allow him to wake as hunger dictates. During the first two or three days after birth, many babies prefer to sleep rather than eat. They may not take more than 1/2 to 1 ounce of formula per feeding if bottle fed. Characteristically, newborns lose up to 10% of their body weight during the first week. This loss of extra tissue fluid is perfectly normal. A baby usually swallows some air while breathing. Give your baby a chance to burp when pausing during the feeding. hold him upright on your shoulder and pat or rub him gently on the back a few times. Alternatively, hold him face down across your lap and gently rub or pat his back. Most babies spit up some milk after feedings. Those “wet burps” are more a mess than serious. Occasionally, a baby may vomit up an entire feeding. This can be ignored unless it continues with subsequent feedings. Breast Feeding Breast feeding is the most natural, least expensive, and most convenient way to feed your baby. In addition to being a food well-suited for your baby’s nutritional needs, it also provides some protection against infection. Breast milk has a thin bluish-white color compared to cow’s milk. This causes some mothers to worry that their milk isn’t “rich enough,” but it has the same number of calories as formula. The breast milk secreted during the first 2 to 3 days of nursing, colostrum, is different in quality and less in quantity than that thereafter. Babies are born with extra fluid which tides them over this period. During the first several weeks of breast feeding, your breasts may initially feel engorged and tender. A hot shower or warm compresses followed by expressing excess milk may help reduce the discomfort. Ice packs (or cold compresses) on the breasts will help to decrease the swelling. Your nipples may become sore and cracked. This can be prevented by proper positioning of the baby. There is frequently leakage of milk between nursing periods which is a nuisance. Nevertheless, all of this unpleasantness is temporary. The milk ducts stretch and adjust to the presence of milk, and even though you are producing twice as much milk, the engorged feeling disappears. Likewise, the nipples toughen, the leakage stops, and the pain is replaced by a pleasant sensation. Technique of Breast Feeding First, find a place where you can relax and assume a position in which you are comfortable. There is no single best position for breast feeding. It is only important that the baby be held in such a way that he can grasp the nipple without straining, and that you are comfortable. Take the breast in your free hand and touch the nipple to the baby’s face next to his mouth. He will nuzzle for the nipple. His gums should press on the areola (the darker skin), not the nipple itself. Thus, the nipple should be well back in the baby’s mouth and he should not be sucking just on the tip. Both breasts should be used at each feeding. At the next feeding, start with the breast where the last feeding was completed. The baby gets most of the milk from one breast in the first five minutes of good strong nursing. In the next five to ten minutes, he gets the hind milk which contains essential fat, so it is important to breast feed ten to fifteen minutes on each side. After breast feeding, dry your breast nipples off. If the nipples are sore, express breast milk and rub it into the nipples. A blow dryer on the low setting will hasten drying. If you are experiencing problems with breast feeding, lactation consultants are available at the hospital where you delivered, and the nurses in both our Raleigh and Garner offices are experienced in giving you advice over the phone or to see you in the office, if necessary. Mom’s Diet A normal, well balanced diet will supply all the needed nourishment for you and your baby. There are no foods that are essential. Likewise, there are no foods which must be avoided. Occasionally, a mother may find that ingestion of a certain food upsets the baby. It makes sense to avoid these foods when recognized. Many drugs are secreted in breast milk; therefore, check with us prior to taking any medications. Alcohol should be avoided. Supplemental Bottle After several weeks, when nursing is well established, a supplemental bottle of formula, such as Enfamil Lipil or Similac Advance, may be given for your convenience. Some mothers prefer to use their own milk rather than formula. Breast milk can be expressed manually or with a pump and then stored in a clean plastic container (antibodies in the breast milk adhere to glass). It can be stored in the refrigerator for 24 hours or frozen for periods or up to six months. When using frozen milk, it must be thawed quickly and fed immediately to prevent curdling of the milk. Bottle Feeding If your baby is to be bottle fed, we recommend using one of the prepared infant formulas with iron such as Similac Advance or Enfamil Lipil. Your baby should continue on this formula for the first year. These formulas come in 3 forms: (1) READY TO FEED formula comes in small disposable bottles and quart cans. It is most convenient but also the most expensive. It needs no preparation prior to giving it to the baby. (2) POWDERED formula is mixed like instant coffee. Follow the instructions on the can: two ounces of warm water to one packed scoop of powdered formula. This form is usually the most economical. (3) CONCENTRATED LIQUID formula comes in 13 ounce cans and is prepared by adding equal quantities of water and concentrated liquid formula. A convenient way to use it is to open a can daily, filling each of six clean bottles with two ounces of concentrated liquid and placing them in the refrigerator. When the baby is ready for a bottle, run two ounces of hot water from the tap into one of the bottles and you have 4 ounces of warm formula ready for use. Be sure to carefully clean the tops of the cans, and unused formula should always be refrigerated. It will keep for approximately three days. Do not re-refrigerate a previously warmed bottle just because it was not completely used by the baby. Bacteria grow rapidly in warm milk and it is not worth the risk. As you have noticed, you do not need to sterilize anything. Bottles and nipples simply need to be washed thoroughly either by hand or a dishwasher. With modern sanitation, the extreme sterilization measures of past years are no longer necessary. Water is tested regularly and is chemically treated. It does not need to be boiled prior to use. If you have well water, we recommend boiling the water for a five-minute period to kill any bacteria. This is only necessary for the first two months of the infant’s life. Bottle Feeding Technique When feeding your baby, keep the bottle tilted so that he does not swallow extra air. Never prop the bottle. Formulas may be fed at room temperature. If warming is desired, place the filled bottle in a pan of warm water for a few minutes. Always test the warm formula by shaking a few drops on your wrist. It should feel neither cool nor warm. The nipple hole should be large enough that when the bottle is held upside down, about one drop per second comes out. To enlarge holes, insert a red hot needle. If the milk drops out rapidly, then the hole is too large and the nipple should be discarded. After a few days, most full term babies will be taking from two to four ounces of formula per feeding. Don’t force formula on the baby; he will take as much as he needs. He will gradually take more and more as he gets older. Vitamins and Fluoride The prepared formulas have vitamins added, and Raleigh and Garner city water is fluoridated; therefore, if your baby is taking one of the commercial formulas mixed with Raleigh or Garner city water, no vitamin or fluoride supplementation is necessary. If you are nursing exclusively, we will prescribe a liquid vitamin preparation. This is normally done at the four week visit. If you are using well water or a community water supply, we will give you a kit to test your water for fluoride, and prescribe fluoride for your baby if it is lacking in your water supply. Water When a baby is either nursing well or drinking well from the bottle, he is receiving an adequate amount of fluid, and extra water is not necessary. Solid Foods We do not feel there is any single ideal time to start solid foods. From a nutritional point of view, infants do not need solid food for the first 6 months. Most babies, however, do as well whether they are started on solids at 3 months or at 6 months. We will talk with you about how and when to introduce solid foods to your baby during your well child checkups. Contrary to popular belief, babies who receive solid foods early do not sleep through the night any sooner than those who are fed milk alone. |