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Friday, May 26th, 2017

Infant Feeding

Whether to breast-feed or feed your infant formula is a very personal and important decision.  We are here to help you with feeding your baby no matter what your choice is.  Occasionally women choose bottle-feeding because they are returning to work and think they cannot breast-feed.  Or, they have had an unhappy experience with breast-feeding before and so decide not to try the next time.  We can help you have a different experience this time, and we can give you tips on how to breast-feed and work.  There are very few instances when a woman cannot breast-feed.  So, if you are wondering, ask your nurse, physician or lactation consultant at your delivery hospital for help in making your decision.  It is easier to stop breast-feeding than to start several days after birth.  If you have decided that breast-feeding is not for you, please know that your decision will be supported and we will help you learn to feed your baby.

BOTTLE-FEEDING

If you have chosen to bottle-feed your baby, your baby should receive an iron-fortified formula for the first year of life.  The American Academy of Pediatrics recommends an iron-fortified formula to prevent anemia and to promote optimal brain maturation as the absorption of iron is less efficient from formula than from breast milk.  Studies have shown that babies receiving an iron-fortified formula have no more gassiness, fussiness or constipation than infants receiving low iron formula.  Soy formula is iron fortified too.  We recommend beginning feeding your baby with Similac or Advance or Isomil (if there is a strong family history of cow’s milk protein allergy).  If your baby has any difficulties with this initial formula choice, we will help you choose an effective alternative. 

Although it is usually more economical to purchase formula by the case, do not do so until you are satisfied that your baby is tolerating a particular formula.  Ready-to-feed formula can be convenient during the first few weeks at home and on trips, but it is more expensive.  The liquid concentrate or powdered formula that you mix with water is more economical, is easy to use and your baby will benefit from the fluoride in the drinking water.  It is essential to follow the directions carefully for mixing the concentrate or powder.  An overly concentrated solution is difficult for the baby’s kidneys and digestive tract to handle.  A formula that is too dilute will not provide the nutrition that your baby needs to grow.  The Dallas area tap water is safe for babies to drink without the need for boiling and provides the ideal concentration of fluoride for optimal cavity prevention.  If you are unsure about the safety of local water when you are traveling, then err on the safe side by boiling it or using sterile bottled water. 
Opened formula may remain in the refrigerator for use for no more than 48 hours.  Bacteria can grow rapidly in milk, especially when at room temperature or warmer, so throw away any milk that has been at room temperature or warmer after one hour.

You will need to select a nurser set of bottles and nipples.  Which style bottle you use is a matter of personal choice and budget.  Some mothers prefer disposable bottle liners and plastic holders rather than standard plastic bottles.  Other mothers, with access to a dishwasher, find plastic bottles easier and less expensive.  At first, buy only a few bottles and nipples.  Babies sometimes show a preference for one nipple type over another.  You may need to experiment to find just the right one.  If the milk flow is too slow for you baby, the nipple hole size can be made larger by sticking a white-hot needle into the center of the existing hole.  If the milk flow is too fast, make the nipple hole size smaller by boiling the nipples an additional five minutes.  Some lactation consultants report that the Avent brand leads to less nipple confusion for babies when mothers are supplementing their nursing with pumped breast milk or formula.

Your kitchen dishwasher is sufficient to clean feeding equipment; it is not necessary to buy a sterilizer.  It is dangerous to warm a bottle in a microwave oven.  The liquid can be heated unevenly and steam can accumulate under the nipple resulting in burns to your baby’s mouth and throat.  You can warm a bottle under warm running tap water or let it come to room temperature by taking it out of the refrigerator 20-30 minutes prior to the next feeding. 
When you feed your baby, sit in a comfortable place and cradle him in your arm, holding him close.  Tilt the bottom of the bottle upward so that there is always milk in the nipple and neck of the bottle to minimize him taking in a lot of air.  Be calm and relaxed.  Sit and enjoy your baby and talk to him.

Always hold your baby close during feedings.  Never prop bottles- babies need to be cuddled and held close for feeding.  Also, your baby could easily choke if you prop the bottle and may be at a greater risk of developing ear infections.  Alternate holding your baby in your right and left arms during feeding.  This helps you baby’s eye muscle development. 

Burp your baby every half- ounce in the early days.  Gradually, your baby will need to burp less often.  In general, burp your baby when he slows down or seems less interested in eating.  Ask the nursery nurses to show you different techniques if you are having any trouble.  Monitor wet diapers and bowel movements. Breast fed babies will have on average one reasonably wet diaper per day of age up to 6-8/day. Both breast and formula fed babies will initially pass dark green-black tarry textured meconium stools which will gradually get lighter in color over a few days. Breast fed babies will then have frequent yellow seedy or "imported mustard" stools with little odor while formula fed babies  often have a firmer textured stool which will be more brown in shade and have  more odor. Breast fed babies may have stools that vary in color from "Army green" to "University of Texas Orange"; this is all normal! Many babies grunt and groan and even cry when having a bowel movement and yet the stool is soft and unformed.  This is normal for at least the first 2-3 months.  As the babies’ abdominal muscles strengthen, they are increasingly able to hold their breath and push out the stool with less apparent distress. This discomfort can be relieved with a Baby-Lax suppository.  These are individually packaged liquid glycerin suppositories with a graduated top that you gently insert into the rectum and squeeze in the glycerin.  This will provoke a reflex contraction of the colon and relief of cramping as the stool is passed.  There is no long term harm in using these suppositories and the baby will not become dependent on them. If the child is passing a truly hard, large stool, you can soften  the stools by offering 2-3 Tsps. of light Karo Corn Syrup in four ounces of water once or twice a day.  This acts as a mild long-term stool softening agent.  If the baby is having significant constipation despite these simple measures, please let us know. 

BREASTFEEDING

We strongly believe in the benefits of breastfeeding for both you and your baby, and are here to help you get off to a good start.  Please ask for help at any time.  Each of the nurses who bring your baby from the nursery are available to answer questions and to give you help with breastfeeding.  If you are having difficulties and feel that you need more detailed assistance ask the nursery to call one of the Lactation Consultant nurses to come and visit you as often as necessary.  After you go home please call us with any questions about breastfeeding that you may have.  Also, be aware that the hospital Lactation Consultant nurses are often available to you for telephone or outpatient consultation after you go home; you can contact them by calling the nursery.  Remember, you and your baby are new at this.  Feeling awkward is normal, especially if this is your fist baby to breastfeed.  Breastfeeding is a learned skill for both you and your baby.  Be patient with yourself and your baby.  Ask for help until you feel comfortable getting your baby latched on by yourself.

FOR MORE DETAILED BREASTFEEDING INFORMATION, PLEASE REFER TO: New Mother's Guide to Breastfeeding published by The Academy of Pediatrics - www.aap.org

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