Infant Care
- General Information
- Physical Characteristics
- Feeding
- Odds and Ends
Feeding
Your baby’s primary source of nutrition for the first year
of life will be from breast milk or formula. During the first 4-6
months of life, your baby’s diet should include only breast
milk and/or formula. Regular cow’s milk, juice, and pureed foods
are not recommended this early in you child’s life. Between
4-6 months, your infant will be ready to start pureed baby foods.
BREASTFEEDING:
Breastfeeding is an ideal source of nutrition for an infant. It is
not only easy to digest but also provides an infant with antibodies
to protect against some infections. Initially, breastfeeding can be
challenging as infants and moms learn the process and the milk supply
develops. During the first few days, your baby will get colostrum
which is thick yellow milk. Though the volume of milk may seem small,
colostrum is full of nutrients to satisfy hunger as well as antibodies
to fight infection. During this time, your baby is expected to lose
up to 10% of her body weight. Then, by day 3-5, your milk will "come
in". The breast milk will turn whitish and your breasts will
feel full and hard.
During the first 2 weeks of breastfeeding, your body relies on your
baby to signal the need to produce milk. She should ideally feed at
least every 2-3 hours around the clock, about 8-12 times per day.
Infants will sometimes cluster feed every hour for a few hours at
a time. Each feeding usually lasts from 10-20 minutes per breast.
If the baby starts to fall asleep, try to wake her by undressing her,
rubbing her back, tickling her feet, or changing her diaper. Unless
instructed by your doctor, try to breastfeed exclusively during this
time to produce a good milk supply. After the first two weeks, your
own hormones will help to support your supply and it will be ok offer
bottles some of the time.
If you will be returning to work or would like to use bottles, consider
introducing a bottle by 1-2 months of age. Many babies love breastfeeding
so much that they refuse bottles as they become older. A hospital
grade breast pump used after feedings is a great way to collect and
store extra breast milk. Fresh breast milk can remain at room temperature
for 4 hours, in a refrigerator for up to 48 hours, and in the freezer
for 3 months. Once thawed, breast milk should be used within 24 hours
and never refrozen.
Though breastfeeding can initially be uncomfortable, it should not
be painful. If you develop painful red areas or cracked, bleeding
nipples, speak with your obstetrician. If you are having nipple soreness
with feeding, the infant may not be latching well and you should speak
with your pediatrician or lactation consultant for advice. We generally
do not recommend creams unless instructed by a doctor or lactation
consultant since the baby may ingest the cream during feedings.
While you are breastfeeding, you are eating for two. Be sure to drink
at least 64oz of liquid per day and about 500 calories more than usual
to support your milk supply. Also, be sure to take in 1500mg of calcium
per day. This can be from your prenatal vitamin, or four servings
of dairy per day or from calcium supplements. Since breast milk does
not always provide enough vitamin D, we also recommend supplementing
breastfed babies with a vitamin. If your water supply does not contain
fluoride, your pediatrician will prescribe it starting at 6 months
of age.
Most foods and medicines you ingest enter into your breast milk. Tylenol
and ibuprofen in usual doses are safe for breastfeeding mothers. Discuss
other medications and supplements with your doctor or your child’s
pediatrician. Caffeine should be limited to no more than one cup of
coffee or soda per day because it can not only make your baby irritable
but can also decrease your milk supply. Alcohol should also be avoided.
Swordfish, shark, tilefish and king mackerel contain high levels of
mercury and so should be avoided. Up to 12 oz per week of other fish
and shellfish are fine. In general, watch for trends in your baby’s
behavior. If she is fussy 4-6 hrs after certain foods, then you may
want to limit that food.
There is some evidence that infants can develop allergies to foods
that their mothers eat while breastfeeding. Consider avoiding nuts
and peanut products while breastfeeding. If you have a family history
of food or environmental allergies, asthma, or eczema, be sure to
speak with your pediatrician to determine whether any other foods
should be avoided.
If you have any other questions or concerns, please give us a call
or discuss them with your pediatrician at your next well baby visit.
BOTTLE FEEDING:
If you choose to bottle feed your infant, there are many nutritionally
complete formulas available. We recommend starting with a cow milk
based formula such as Similac Advance, Enfamil Lipil, or Carnation
Good Start Supreme DHA & ARA. If your baby has difficulty with
these formulas, your pediatrician may recommend a change, but most
babies stay on the cow milk based formulas for the first year. All
baby formulas contain iron, which is essential for growth and development.
We generally do not recommend “low iron” formulas.
Most babies start with only 1-2 oz of formula per feeding, but quickly
increase to 4 or more ounces at a time during the first 2 months of
life. If your baby finishes a bottle fully, she may be signaling that
she wants more. Do not hesitate to offer more.
Babies differ greatly in how much they like to eat at a time.
Formulas come in three forms: ready to eat, concentrate, and powder.
Ready to eat is the easiest but most expensive. Powder and concentrate
are fine alternatives. There is no nutritional difference between
these three forms, so choose what works best for your lifestyle. We
recommend using bottled water during the first six months of life
to mix with your powder or concentrated formula instead of tap water.
We do not generally recommend fluorinated bottled water. The amount
of fluoride is not monitored, so your infant may receive either too
much or too little.
Bottles, nipples, and city water do not need to be sterilized or boiled.
Cleaning the bottles and nipples in a sink or dishwasher as you would
any other dishes is adequate. After 6 months of age, city water is
generally fine to use. If your water does not contain fluoride, your
pediatrician will prescribe fluoride for your baby starting at 6 months
of age.
Your baby will initially eat every 3-4 hours around the clock. That
will change as she grows. As long as she is growing well, it is ok
to let her make her own schedule. Most babies who sleep through the
night eat more volume and more frequently during the day, so they
can sleep longer at night. If, however, your baby eats much more at
night than during the day, it is fine to attempt to modify the schedule
to better fit your needs. Be aware, though, that your baby may be
quite stubborn!
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