newborn and infant feeding advice information

It is a personal decision whether to breast or formula-feed your baby. Our practice will support our parents in whatever feeding decision they make, regardless of whether it is breast or bottle feeding. We do strongly encourage, along with the American Academy of Pediatrics, breast feeding your baby even if it is only for a short period of time. However, there are formulas available today that provide an excellent alternative for parents that choose not to breast feed or to supplement breast feeding. Our ultimate goal is simply that your baby be provided the nourishment they need to grow healthy and strong.

Breast Feeding

Breast-feeding can be an enjoyable and rewarding experience for both infant and mother. It can, also, be frustrating and difficult in the beginning. We suggest that every mother prepare themselves prior to delivery by reading about the topic and/or discussing it with a lactation specialist. A consultation with a lactation specialist is available in the hospital once the baby has been delivered. These lactation specialists can be an excellent source for information and help even after leaving the hospital. The primary goal of lactation specialists is to make breastfeeding enjoyable and every mother successful at nursing for as long as possible.

Usually a mother's actual milk supply will become adequate to nourish an infant within two to five days of delivery. Prior to this the mother will produce colostrum. Colostrum is comprised of important elements that will help protect a newborn from infections, as well as provide the nourishment that a newborn will need.

Breast feeding your newborn as soon as possible after delivery will help encourage the production of a mother's milk supply. The mother should nurse as often as possible until their milk supply has come in. A baby should suckle for 15-20 minutes on one side, then they should suckle for another 15-20 minutes on the opposite side. Remember to burp in between sides to help the baby stay comfortable and to help them stay awake during the complete breastfeeding session. The mother should alternate the starting breast each time they nurse their baby.

Infants should nurse every 2 hours initially in the first few weeks, then every 2-4 hours thereafter. They should go no longer than 4 hours at night without being fed. This schedule should encourage adequate milk production, as well as provide the baby the nourishment that they need.

The following are indications that your infant is getting the nourishment that they need:

1. The infant is gaining weight
2. The infant is having six to ten wet diapers a day
3. The baby is active and alert
4. The baby is having bowel movements every day

The American Academy of Pediatrics (AAP) and the Canadian Pediatric Society have strongly recommended that breast-feeding should be the preferred feedings for all infants � term and premature.

Recommendations for the duration of exclusive breast-feeding remain controversial. The World Health Organization (WHO) recommends human milk as the exclusive nutrient source during the first 6 months after birth. Regardless of when complementary foods are introduced (at 4 to 6 months), breast-feeding should be continued at least through the first 12 mos.

Human milk has a unique composition. The protein quality (proportion of whey [70%] and casein [30%]) of human milk differs from that in bovine milk (82% casein, 18% whey). The concentration of calcium and phosphorus in human milk is significantly lower than in bovine milk and infant formula.

In human breast milk, the minerals are bound to digestible proteins and have a higher absorption rate than those in infant formula.

The concentrations of iron, zinc and copper decline as lactation continues, but appear adequate to meet the infant's nutritional needs until complementary feedings begin. The concentration of iron will not meet most infants' nutritional needs beyond 6 months of breast-feeding.

At that time, iron-containing foods are indicated to prevent subsequent iron deficiency anemia. Cereals are a great source of iron. The content of Vitamin K in human milk is low. To meet initial Vitamin K needs, infants are given a single intra muscular dose of Vitamin K at birth.

Vitamin D deficiency has been reported in breast-fed infants who have dark skin pigmentation and/or inadequate exposure to sunlight and may lead to a development of Rickets. All breast-fed infants should receive supplementation of Vitamin D.

Specified factors in breast milk may affect the host defense of the infant. In both developing and industrialized countries, there is a reduction in the incidence of gastrointestinal issues, respiratory disease, and otitis media that is directly attributed to breast feeding.

THE AMERICAN ACADEMY OF PEDIATRICS RECOMMENDS:

To prevent rickets and vitamin D deficiency in healthy infants and children and acknowledging that adequate sunlight exposure is difficult to determine, we reaffirm the adequate intake of 400 IU per day of vitamin D by the National Academy of Sciences and recommend a supplement of 400 IU per day for the following:

  1. All breast fed infants unless they are weaned to at least 500 mL (17 oz) per day of vitamin D-fortified formula or milk.
  2. All non-breastfed infants who are ingesting less than 500 mL (17 oz) per day of vitamin D-fortified formula or milk.
  3. Children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL (17 oz) per day of vitamin D-fortified milk, or do not take a daily multivitamin supplement containing at least 400 IU of vitamin D.

For mothers returning to work there are many commercially available breast pumps that you can use. Although many types are available, electric pumps are the quickest and easiest to use. If it is the mother's goal to continue breast feeding after returning to work, then it is imperative that they continue nursing as often and frequently as they would at home to keep their milk supply up.

Formula Feeding (Bottle Feeding)

Infant formulas are a safe alternative to breast milk. An infant will require formula for at least a full year. There are three types of infant formula: lactose, soy and elemental. Most formulas are derived from cow's milk that has been extensively modified so that a baby can digest and utilize the nutrients. While most infants thrive on formulas derived from cow's milk, some infants may exhibit intolerance to formula. Soy based formulas are available for infants that are allergic to or cannot tolerate the protein in cow's milk. Consequently, a number of alternative formulas of special composition have been manufactured for infants with gastrointestinal or metabolic disturbances.

Formulas should provide all the nutrition that your infant will need for healthy growth.

Infant formulas are used in the following ways:

1. As a substitute for human milk in infants whose mother chose not to breast-feed.
2. As a substitute for human milk in infants for whom breast-feeding is medically contraindicated.
3. As a supplement for breast-fed infants who do not gain weight adequately.

Formulas are iron-fortified to prevent iron deficiency anemia. The American Academy of Pediatrics sees no role for the use of low-iron formulas in infant feeding and recommends that all formulas fed to infants be fortified with iron.

Infant formulas are available in 3 forms: ready-to-feed, concentrated liquid and powder. Using either powder or liquid concentrated formulas ensure that your infant will receive adequate fluoride, which has been added to the tap water. Unless you have well water, water sterilization is not necessary. If you do not feel comfortable using tap water or you have well water, you can buy fluorinated baby water to add to powdered or concentrated formula.

You will not need to sterilize the bottles or nipples if they are washed thoroughly with soap and hot water. A dishwasher is good enough for thoroughly cleaning bottles, too.

Recommended bottle feedings by age are listed below to be used as a guideline:

AGE NO. OF FEEDINGS VOLUME (OUNCES)
Birth - 1 wk 6 - 10 1-3
1 wk - 1 mo 7-8 2-4
1 mo - 3 mo 6-7 4-6
3 mo - 6 mo 4-5 6-7
6 mo - 9 mo 3-4 7-8
10 mo - 12 mo 3 7-8

The American Academy of Pediatrics recommends soy formulas for the following:

  • Term infants whose nutritional needs are not met from breast milk.
  • Term infants with galactosemia or hereditary lactase deficiency
  • Term infants with documented transient lactase deficiency


Soy protein-based formula is NOT recommended for the following:

  • Preterm infants with birth weights less than 1800 g
  • Prevention of colic or allergy.
  • Infants with cow's milk protein-induced enterocolitis or enteropathy.
Feeding Frequency

Whether bottle or breast fed, feed your baby when they seem hungry. Normally every two � four hours in the beginning. Stop feeding them when they seem full and vigorous interest in drinking has stopped. Trying to impose a rigid schedule on newborns or infants is difficult and can be frustrating for both you and the infant. Initially, feed your baby "on demand", which means letting him take what he needs when he needs it. After several months a pattern will emerge that makes sense to both you and your child. These patterns can gradually be converted into a schedule that works for your whole family.

Formula intake per day varies from infant to infant. The size of your baby may or may not correlate with how much he/she will eat. Some very large babies obtain enough nourishment and grow well with 16 - 20 ounces per day. On the other hand, some smaller babies may take in 32 - 36 ounces per day. Every infant's metabolism is different. If the baby is happy and continues to gain weight and grow, then everything is fine.

Flouride

Fluoride is recommended to help reduce the occurrence of dental caries in children. Fluoride sources include infant formula, tap water, fluorinated store bought water, and toothpaste. If you will be mixing your infant formula with bottled water, then you need to make sure that it is fluorinated. Your water should contain 0.6 ppm of fluoride or greater. �City Water� (Fulton, Cherokee, DeKalb, Forsyth, and Gwinnett counties) has enough fluoride in its tap water. Fluorinated toothpaste should not be used until your child is considerably older. A specially formulated "infant" toothpaste is available that is safe for babies to use.

The American Academy of Pediatrics recommends fluoride supplementation for children 6 months old to 16 years old whose intake of fluoride is inadequate.

Situations where it is possible that your child is not getting enough fluoride:

  • Source of water is well water or spring water
  • Using bottled water to mix formula (unless you are using fluorinated bottled water)
  • Using a water filter that removes flouride

Note: Fluoride supplementation requires a prescription. If you have any of the conditions listed above discuss fluoride supplementation with our office.

Solid Foods

The majority of your child's nourishment during their first year comes from either breast milk or formula. Solid foods are intended to supplement formula, not take the place of it. You may introduce solid food when your baby weighs 12 pounds and is between 4 and 6 months old. These instructions should be used as a guide only. ALL CHILDREN ARE DIFFERENT. It is not necessary to start foods at 4 months and some infants can wait until later. As always, you should consult with our office about adding solid foods to your child's diet.

When your child is ready, introduce single ingredient foods one at a time and continue for 3 days before introducing the next food. This will help isolate food sensitivity and prevent food allergies. If your child develops a rash, has unusual amounts of gas, vomits or has other adverse symptoms when eating the new food that is being introduced, discontinue immediately. Note the symptoms, time, and amount, so that you can discuss with our nurses, pediatrician, or nurse practictioner. If reaction is severe contact our office immediately. Keeping a log of the foods that you have introduced might, also, help you keep track, too.

Introduce rice cereal first, then other infant cereals, then stage 1 vegetables, then stage 1 fruits, and finally stage 1 meats. Start with rice cereal diluted to a soupy consistency with formula or breast milk. Feed your infant 2-3 tablespoons twice daily. You will gradually increase feedings to three times daily and gradually change the consistency when your infant is ready.

SOLID FOOD FEEDING GUIDELINE
4 -5 months 1 - 2 teaspoons twice daily (cereals only)
4 -5 months Cereals and/or 1/2-1 jar daily stage 1-2
6 months 3 jars daily stage 1 & 2, yogurt can be added to diet
7 months 3 jars daily, stage 2 & 3
8 months 3 - 4 jars daily, stage 2 & 3
9 � 12 months Start junior foods and table foods if they can chew and swallow adequately
Food Avoidances

Avoid using added salt, sugar, sugar substitutes, or excessive spices.

Acidic foods, acidic juices, shell fish, strawberries, and eggs should be avoided until a child is at least 1 year old.

Honey and shell fish should be avoided completely until a child is at least 2 years of age.

Nuts and popcorn should be avoided until age 6 when they can be chewed properly, to avoid choking hazards.

Wash ALL fresh fruits and vegetables exceptionally well.

Nothing round (hotdogs, grapes, etc.) should be given to children under 3 years of age. These items need to be cut into halves or fourths to avoid choking hazards.

Vitamins and Minerals

Breast milk and infant formula contain the vitamins and minerals that your child will need, although sometimes iron may need to be supplemented. Our pediatrician will check your child for iron-deficiency anemia between 9 months and 2 year physicals.

Your child may need an iron supplement after 6 months if you are exclusively breast feeding. Iron fortified cereals can be started after 6 months if we feel that this is necessary.

Additional vitamin supplements may be considered if your child was born prematurely or has other underlying conditions. We will discuss these with you if they feel that vitamins are necessary. If you have any questions or other concerns, please discuss them with our practitioner.

After 12 months, most children will not need vitamins if they have an assorted diet of foods from all food groups. If you decide to give your child vitamins, please, consider the following:

Pick vitamin brands that provide nutrient levels of less than 100% of the recommended daily allowances (RDA, RDI, or DV)

DO NOT give too much of any vitamin. TOO MUCH IS DANGEROUS

DO NOT supplement trace elements such as chromium, copper, fluoride, iodine, manganese, molybdenum, selenium, and zinc without the recommendation of your practitioner.

If your child is eating a vegetarian, vegan, or other restrictive diet, please, talk to your pediatrician about vitamin supplements.

Whole Cow's Milk

Most children can tolerate whole cow's milk at 1 year of age. Make sure that the milk that you provide is pasteurized whole milk with vitamin D.

The American Academy of Pediatrics recommends use of whole milk for children between one and two years of age. Whole milk provides important fatty acids that your child needs for his/her developing nervous system. The fatty acids are used to produce myelin, which helps to increase the speed of signal transmission along the nerves.

You should aim for your child to drink between 12-18 ounces of milk per day, but not more than 24 ounces.

The American Academy of Pediatrics recommends the following:

0-12 months: Formula or Breast milk

12-24 months: Whole Milk

2-5 years: 2% Milk

> 5 years: 1% Milk or Skim Milk

There is no right or wrong way to transition your child to whole cow's milk. Some children will tolerate switching directly to whole milk. Other children will require a more subtle change. You can try every day to replace one bottle or cup of formula with milk. An alternative method is to start mixing formula or breast milk with cow's milk and gradually increase the cow's milk until your child is drinking only whole milk.

Goat's milk is not a good alternative to cow's milk, because it does not have sufficient folic acid.

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