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Feeding Your Baby

Few things in life are as wonderful and satisfying as nourishing a new baby. But it can also be tricky. And if you're like most new parents, you're probably getting advice from every corner.

"As soon as you have a baby, everyone acts as though they were asked to serve on the committee on how to feed her," says Loraine Stern, M.D., coeditor of the American Academy of Pediatrics's (AAP) Guide to Your Child's Nutrition. "They'll tell you what you're doing wrong, so your job is to nod and smile and to keep doing what's working well for you and your baby."

To get you started on the right track, we've asked the experts for answers to common questions:

 

How can I tell whether my baby is eating enough?

The best way is to make sure he's growing normally by having him measured and weighed regularly at your pediatrician's office, says Dr. Stern. (This will happen at every well-baby visit anyway.) But remember that it's normal for a newborn to lose about 10 percent of his birth weight in the first few days after delivery. If you're breastfeeding, the doctor may recommend that you bring your baby in for a checkup within two days of leaving the hospital after delivery, to see if he's nursing correctly and consuming enough. A breastfed infant grows more slowly than a formula-fed one; fortunately, the latest growth charts provide measurements for both.

At home, you can do a diaper check. A well-fed baby should produce six to ten wet diapers a day, at least four stools if he's breastfeeding, and two to three bowel movements if he's getting formula. Within the first few days of birth, your baby's stools will progress from a dark-brown or black to a mustard color; they'll be more liquid in consistency if he's nursing than if he's formula-fed.

At the end of a feeding, your baby should also seem contented, not frustrated and anxious. If you're at all concerned that he's not eating enough, call your pediatrician.

 

I feel as if I'm nursing my newborn all day long. Is this normal?

Most likely, yes. "It can be hard for a first-time mom to understand how big a commitment breastfeeding is," says Judy Hopkinson, Ph.D., lactation physiologist at the USDA/ARS Children's Nutrition Research Center at Baylor College of Medicine, in Houston. "I tell moms to regard the first four to six weeks of their baby's life as a time to nurse, period. Eventually, you'll settle into a more comfortable routine in which you're not feeding quite as frequently."

 

I've been breastfeeding my 5-month-old since birth. Now my sister claims that he'll sleep longer and more soundly during the night if I give him a bottle of formula at bedtime. Is this true?

Formula takes longer to digest than mother's milk, which makes a baby feel fuller longer; therefore, he may be less likely to wake up hungry. "But giving your baby more breast milk during the day to meet his growing needs can also help him sleep better at night," says William Dietz, M.D., director of the division of nutrition and physical activity at the Centers for Disease Control and Prevention, in Atlanta. "If you can breastfeed exclusively, it's of tremendous benefit." Research has shown that breastfeeding strengthens a baby's immune system, facilitates brain development, reduces the risk of ear infections and sudden infant death syndrome, and helps prevent obesity. It might even cut your baby's risk of developing heart disease when he's an adult.

If you have a larger-than-average baby and he's still waking up hungry during the night, however, it may be a sign that he needs additional nourishment, says Dr. Dietz. If your little one's at least 4 months old, ask the pediatrician if you can introduce one or two servings of rice cereal between bottle- or breastfeedings.

Schedules, nipple confusion, & more

My friend feeds her newborn on a schedule, but I prefer to feed my baby whenever she's hungry. Should I be more organized about this?

If your baby's satisfied and growing and you're happy too, there's no reason to change. In the first few weeks of your baby's life, it makes more sense to feed her "on demand" until you understand her needs. Some babies need to be fed every one to two hours, while others can go longer in between; nursing babies eat more frequently than formula-fed ones.

After a month or two, some moms do prefer to schedule feedings. As long as the baby's content and is eating 8 to 12 times a day, that's okay, says Dr. Stern. Keep in mind that a baby's feeding needs can change, so you may have to readjust her schedule over time. If you listen to your child's signals, you'll do just fine.

 

I'd like to occasionally give my breastfed baby a bottle, but I'm worried about nipple confusion. What can I do to prevent it?

Most infants move from breast to bottle without much trouble, says Hopkinson. But bottle-feeding is easier for most infants -- the liquid comes out with less effort -- so your baby may start to prefer it over breastfeeding (even if there's expressed milk in the bottle). Since a young baby is most prone to nipple confusion, try to wait until she's been nursing successfully for a month or more before giving her a bottle.

Even when nipple confusion does occur, it can be overcome fairly easily. When a baby drinks from a bottle, she doesn't need to open her mouth very wide, but when she nurses, she must open it enough to take in a large circumference of areola so that the nipple and milk can reach the upper palate of her mouth. If she tries to nurse the way she'd drink from a bottle, she won't be able to latch on properly to draw in milk. So when you're nursing, be sure that your baby's mouth is open wide and taking in a good amount of your breast. If she starts to refuse it, brush your nipple against her cheek to stimulate her suckling reflex, and shift positions until she has a good latch-on.

 

I'm thinking about using a breast pump. What do I need to know?

When you use a pump, someone else -- your partner in the middle of the night or a babysitter if you go back to work -- can give your baby breast milk from a bottle. Breast milk also freezes well, so you can pump when you have time and defrost it when needed.

If you're thinking of pumping, try to breastfeed exclusively for as long as you can in order to build up a decent supply of milk before you begin, suggests Anne Merewood, director of lactation services at the Breastfeeding Center at Boston Medical Center.

Which pump you choose depends on how you'll use it: If you're going to be returning to work full-time, you may want to buy (or rent) a double set-up electric pump, with adjustable speed and suction levels; pumping both breasts stimulates them to produce more milk. But if you just need a break at home or have more flexibility at work, a hand pump may be fine. Good brands include Medela and Hollister, says Merewood, who also likes the Avent Isis hand pump. If one doesn't work, try another. "Too many moms blame themselves instead of the pump," she says.

 

What's the best formula for my baby? Is it okay to switch brands?

All formulas on the market, including generics, must meet strict Food and Drug Administration (FDA) guidelines for content and quality. So switching from one brand to another shouldn't cause a problem, says Dr. Stern, although it may take a little while for your baby to get used to the new taste.

What you shouldn't do is switch from one kind of formula to another unless you have a good reason to do so. For most babies, a cow's-milk-based, iron-fortified formula is best.

The exceptions: If your baby is lactose-intolerant, try a soy-based formula; if you have a family history of allergies, you can lessen the risk of your baby's developing them by using a hypoallergenic (or elemental) formula. Since these variations may have drawbacks -- and because they are almost certainly more expensive -- schedule a time to talk to your pediatrician first so he can help you choose one that's appropriate for your baby.

Avoid low-iron formulas -- they were developed years ago when people believed iron caused constipation in babies. Since then, research has disproven this myth and experts agree that babies need iron to avoid anemia.

Allergies, gas and more

Should I buy the new formulas that contain DHA/ARA?

In 2001 the FDA approved the use of DHA (docosahexaenoic acid) and ARA (arachindonic acid) in formulas. This combination of fatty acids is found in breast milk and is important for brain and vision development. Although the enriched formulas more closely mimic breast milk, most experts still aren't convinced that they provide extra benefits, and they cost about 20 percent more than standard formulas.

"There is no clear-cut advantage for most babies," says Nancy Krebs, M.D., chair of the AAP's committee on nutrition. Research so far is most convincing for preterm infants: All babies receive DHA/ARA while they're in the womb, so preemies may be able to make up for some of the nutrients they missed out on by receiving the enriched formulas. More studies are currently under way, but until the results are available, talk to your pediatrician and weigh any potential benefits against the cost. "There's no right and wrong," says Dr. Krebs, "and this will not make or break your child's development."

 

I gave my baby formula for the first time, but when she spit up, it looked like cottage cheese. Could she be allergic to it?

Probably not -- welcome to Spitup 101. Just as bowel movements look different in breastfed and bottle-fed babies, so too does spitup, says Dr. Stern. The protein in formula forms a hard, thick curd in the stomach and takes longer to pass through, so the spitup is less fluid than a nursing baby's. That's also why a formula-fed baby's stools are firmer and less frequent.

 

What's the best way to prevent gas in my baby when I feed him?

Gas usually happens when your baby tries to consume too much too soon and ends up gulping a lot of air along with the milk. If you're bottle-feeding, hold the bottle flatter or use a tilted one. If you're nursing and your breasts are very engorged, try pumping them slightly before you start feeding.

There's no solid evidence that if a mom eats such potentially gas-producing foods as broccoli, cauliflower, and onions it will affect her nursing baby. But some infants do develop cramping when their mothers drink milk -- they have trouble digesting the cow's-milk protein that can pass through the breasts. If that's the case, talk to your pediatrician, who may suggest that you either cut out or limit your milk intake while you're breastfeeding and get calcium from other dairy sources, such as yogurt or cheese.

If your baby seems especially uncomfortable after nursing and you've recently had a particular food or beverage, you may want to scratch it from your diet and see whether that helps.

It's also important to burp your baby frequently to let gas escape from his tummy. Use whichever position he seems to like best -- draping him over your shoulder, resting him tummy down on your knee, or sitting him up on your knee and rubbing his back. "You don't have to use much force on your baby to release gas bubbles," says Hopkinson. "Gently rubbing or patting his back should be enough."

 

When can I start to give my baby a little bit of fruit juice?

Wait until she's about 6 months old, according to the AAP, and stick to 100 percent fruit juice rather than fruit drinks. Even then, you should limit intake to no more than four ounces per day. (If you want to quench your baby's thirst on hot days, you can dilute the juice with water to increase the volume for her to drink.) Large amounts of juice can cause diarrhea or excessive weight gain and may fill her up so she has less room for breast milk or formula.

Once you've mastered the practical stuff, feeding your baby can be a wonderful bonding time, relaxing and rejuvenating for both of you. So hold her close and enjoy the calm -- it won't be long before she's wearing sauce all over her face and pitching peas at the dog.

Laura Flynn McCarthy's last article for PARENTING was "The Truth About Bonding," in the December/January 2002 issue.

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