The first months of caring for a baby can be particularly challenging and filled with uncertainty -- whether it's your first child or your third. As you and your baby settle into a routine, your pediatrician can make the transition a lot smoother. Here, the questions I and my partners in practice, my sons Jim and Bob, hear most often from parents.
1. How can I tell if my baby is getting enough breast milk, since I can't count the number of ounces?
The most reliable sign is adequate weight gain. If your baby's gaining four to seven ounces a week, he's probably getting enough milk. Since it can be difficult to tell just by looking whether an infant is gaining weight, especially in the first month or two, you might want to pop into your pediatrician's office for a weigh-in between checkups if you're concerned.
Another important way to gauge your baby's intake is to note the contents of his diaper. If he's eating enough, he'll have four to six wet ones a day. His urine should be pale or clear; if it's a dark, apple-juice shade, he may not be getting enough milk.
The number and nature of his bowel movements will tell you not only whether he's downing enough breast milk but also whether he's taking in adequate amounts of the high-fat milk he needs to grow. By 2 weeks of age, babies who are getting enough "grow milk" will produce at least three diaperfuls of yellow, seedy stools a day. Other signs of breastfeeding success: You'll feel the tingling of the milk-ejection reflex, see your infant sucking vigorously, and hear him swallowing; and he'll drift off contentedly to sleep after nursing.
2. I'm not sure that I'm bonding with my baby. Isn't this something that's supposed to happen automatically?
Love at first sight isn't a guarantee. For some parents and infants, bonding can be a slow and gradual process. Keep in mind that you're adjusting to the most intense physical and emotional changes in your whole life. Give it time, and those feelings of attachment will develop. Meanwhile, there are steps you can take to help your natural instincts kick in:
Breastfeeding. If you can, nurse as often as possible. Holding your baby close while you give her nourishment can create an intimate connection that few other activities match. Breastfeeding also releases the hormone oxytocin, which has a relaxing effect on the mother -- and that's always good for the baby. Moms who aren't able to breastfeed, as well as dads, can simulate this experience by wearing a short-sleeved shirt to promote skin-to-skin contact and by caressing, making eye contact with, and talking to their infant during feedings.
Baby wearing. Toting your infant in a carrier is a terrific way to get close, and it's one of the best strategies for calming her down when she's fussy.
Bedtime closeness. Take advantage of quiet time at night to get to know each other. Create a soothing routine just before bed that promotes physical intimacy, such as a bath or a few minutes of snuggle time.
Balance. It's natural for new parents to want to give and give to their baby, leaving no energy for themselves. Make a point of sharing babycare responsibilities, ask friends and family members for help, and remember to treat yourself to time alone -- to read, go out with friends, or do whatever else makes you feel relaxed and contented.
3. Our 5-month-old wakes up four to six times a night. Sometimes he's not even hungry -- he just wants us to comfort him. How can we get him to sleep through the night?
While many babies this age are able to sleep for five-hour stretches, or even all night, others are prone to waking periodically. To help your little one stay in dreamland:
- Play recordings of lullabies or other soothing sounds (such as waterfalls or crashing waves) or place a ticking clock or metronome in the nursery. (Infants are often comforted by this because they've just spent months listening to the regular beat of their mom's heart while in the womb.) That way, your baby can soothe himself back to sleep more easily when he awakens during the night. If he has a tendency to rise with the dawn's early light, put blackout curtains in his bedroom.
- Nurse or bottle-feed right before bed so that he's less likely to wake up for a feeding. If he does wake up during the night because he's hungry or because he needs his diaper changed, keep stimulation to a minimum by not turning on the light or playing with him.
- If you plan to try the cry-it-out approach or another strategy to get your child to sleep through the night, wait until the connection between you and your baby is stronger and you're proficient at reading his cries. While all babies eventually need to learn to fall asleep on their own, forcing your child to soothe himself to sleep before he's ready can undermine his trust in you as a source of comfort and may keep you from figuring out which style works best for you and your family. Worst of all, it may hinder the discovery of other possible causes of your baby's discomfort, such as an ear infection, stuffy nose, gastroesophageal reflux, or other medical condition.
4. Our 3-month-old's bowel movements vary from day to day. Sometimes she has several in one day and none the next. Should we be concerned?
A baby's bowel movements typically differ from one day to the next. At this age, most infants will have several in one day but will occasionally go a whole day without having one at all. Constipation is rare in babies who haven't started solids yet, but if your child seems to be straining or cries when she has a bowel movement, breastfeed more frequently or, if formula-feeding, give her two tablespoons of prune juice daily.
5. Is it true that I could spoil my baby by picking him up every time he cries?
As a father of eight and a pediatrician who's been in practice for more than 30 years, I can tell you unequivocally that babies cry not to control but to communicate their needs. In fact, studies show that infants cry less, calm down more quickly, and become more independent when they're responded to promptly.
That said, not every cry should be viewed as a signal for you to scoop up your child. Recently, a mother brought her 8-month-old son into the office for a checkup. As we were discussing his progress, I noticed that she picked him up within a millisecond of his every peep. As I watched them, it became clear to me that the son's anxiety triggered the mother's, which in turn made him become even more fussy.
I suggested that she try an old trick my wife and I used with our infants: As soon as the baby begins to cry, show him how relaxed you are (even if you're anxious) and instead of swooping him up, offer gentle words of reassurance. This conveys an important message -- that there's no problem and that someone's there for him. Sure enough, as soon as this mother gave her baby the "You can handle this" expression, he stopped fussing.
In time, you'll learn which cries require immediate attention and which are less urgent. Until then, create a supportive environment that lessens your baby's need to cry, and let him know that you'll be there for him when he's upset.
6. I'm going back to work in a couple of weeks and I'd like to continue breastfeeding. What's the best way to do this?
First, invest in or rent a good pump. The more convenient it is to express and store your milk, the easier it will be for you to take on the challenges of breastfeeding and working. Consider such factors as where you'll be pumping (if at your desk, an electric model might be your best bet; if in the rest room, a lightweight, portable manual pump may be a better choice), your baby's age and how long you'll be pumping, and whether you plan to have another child.
To keep up your milk supply, breastfeed as much as you can when you're at home. In the mornings, set your alarm early so that you can have a little extra time to nurse and cuddle your baby before you leave for work. Ask your caregiver not to feed your child within an hour of when you expect to be home in the evenings so that when you arrive you can breastfeed right away. On weekends, try not to spend too much time away from your baby, and nurse her as often as she wants.
At work, don't skip pumping sessions. Even if you have only a few minutes, it's better to pump for a short time than to put it off till later. It's the frequency, not the length of pumping sessions, that stimulates your body to produce milk.
7. I can't get my husband more involved in caring for our 6-month-old son, and I want his help. What can we do?
When I first became a dad, I took a backseat too. Martha was such a good mother that I thought I wasn't really needed. But I soon came to realize that this is a lose-lose situation. Dads provide a unique way of caregiving that's different from moms', and babies thrive on both. And staying on the sidelines prevents fathers from learning how to comfort, care for, and develop a relationship with their babies.
Give your husband time and room to learn how to be a caregiver. If he's in charge, don't rush over as soon as you hear your baby cry; trust him to work it out himself. If possible, leave him alone to sit during times when you know your baby's likely to be in a good mood -- say, right after a feeding or a nap.
Dads can also carve out roles that are uniquely theirs, such as taking the baby for a walk in a carrier either in the evenings, when an infant is likely to get cranky, or right before bedtime. When my son Matthew was an infant, I used a comforting technique I called the "neck nestle." I held him to my chest with his head tucked under my chin as I sang him to sleep.
8. How do I know when to start feeding my baby solids, and which foods should I start with?
Most infants don't need solid food before 6 months because they receive all the nutrients they need from breast milk or formula. However, your pediatrician may recommend you start sooner if your baby shows signs that she's ready, such as mimicking your mouth movements while watching you eat or grabbing your food. If she doesn't seem interested at 6 or 7 months, don't try to force-feed her. The most important goal is to encourage the development of a healthy attitude toward food.
Whenever you start your child on solids, begin with foods that are the least allergenic and the closest to breast milk and formula in taste and consistency, such as mashed bananas or rice cereal. Use your finger to put a little banana on your baby's lips, then let her suck your finger. Once she's introduced to the new taste, gradually increase the amount and watch her facial expressions. If the food goes in, accompanied by a smile, she's ready and willing. If it comes back out with a grimace or if she turns her head away, try again in a couple of weeks.
For breastfeeding babies, it's best to offer solids at the end of the day, when your milk supply is usually lowest. (Formula-fed babies can eat at any time.) And remember that feeding isn't just about giving nutrition. It's a perfect opportunity to interact and connect with your baby.
Contributing editor William Sears, M.D., is the coauthor of The Baby Book and The Discipline Book.