Let us begin by saying that there are entire books written on the topic of feeding your newborn and if you need or want more information than what is provided here, your pediatrician can help. Feeding your baby is a special time for you and you little one. Regardless of whether you have chosen to breast-feed or use a bottle, be relaxed and enjoy the experience.

Breast Feeding

We strongly encourage any mother to breast feed if she has the interest to do so. Your breast milk is perfectly balanced to suit your baby and intolerance is extremely rare. Also, it provides certain minerals and vitamins that aid in digestion (that formulas try to include), as well as enzymes and antibodies (that help protect against illness) that can only be found in your milk. Breast feeding may decrease the risk of developing allergies. The American Academy of Pediatrics recommends breast feeding for the first year of life.

The key to successful breast feeding is to relax and take things as they come. Nature will usually take care of the rest. The more you concern yourself about breast feeding the less likely you are to be successful. Just relax. Remember, nursing your baby is a learned art. We suggest you read some handbooks for nursing mothers that are available in your local bookstore.

A comfortable chair with a back and armrest is recommended. A footstool is also helpful. The baby should be in a semi-sitting position for nursing. His head should rest in the bend of your elbow and your arm should support his back. Have the baby take as much of the areola into his mouth as he can, not just the nipple.

Occasionally if your breast is too full you may have to express some milk in order for the baby to grasp the areola. Try to prevent your breast from pressing against his nose by using your finger to hold the top part of the breast from the baby's nose so the baby may breathe more easily. If your baby is sleepy during the feeding, stimulate by undressing the baby, changing the diaper, or tickling the baby under the chin.

Although many babies seem disinterested during the first day or two and will frequently fall asleep while trying to feed or occasionally even refuse the breast, you will soon notice your newborn becoming more alert, active, and more hungry. There is very little distinction at this stage between satisfying his need for love and affection and satisfying his need for nourishment. As he attempts to fulfill these needs by nursing, he begins to stimulate the production of breast milk, a process which may take several days to get fully underway. Try not to become discouraged during these first few days. Your baby has fluid stored in his tissues which his body uses as nursing becomes established. It is the body's consumption of the fluid that prevents dehydration and accounts for the weight loss that every infant experiences in the first three to five days.

The early milk, or colostrum, is significant nutritional value and contains antibodies which may help the infant resist some early infections. Milk production is usually established by the third or fourth day.

Nursing should last about 20 to 30 minutes. Initially keep the baby on each breast three to five minutes and gradually work up to a longer time. Alternate breasts, but use both breasts at each feeding, so that you always start off using the breast you finished with on the previous feeding.

Nurse whenever the baby is hungry but try not to let the infant go longer than four hours during the day, waking if necessary. Try to wait two hours between feedings to avoid "snacking" which will exhaust you. Usually the adequacy of the feeding can be observed by the longer intervals of sleep between feedings and adequate urination. The baby should wet 6 to 8 diapers in a 24 hour period. As the baby gets older, he will usually sleep 3 to 4 hours between each feeding.

A new mom should take good care of herself while nursing. Try to get plenty of sleep, continue your prenatal vitamins, and drink lots of water. You can eat what you want, but do not go on a diet to lose weight since your baby may not receive adequate nutrition. Do not take any medications (prescription or over-the-counter) without checking with your doctor. Smoking or consumption of alcohol while breast-feeding is not recommended.

Nipples should be washed only with water and if they become cracked and painful, expose your breasts to the air as much as possible, even using a hair dryer on low heat (and not too close) if it seems to help.

Breast engorgement is another common problem that is readily relieved by continued and more frequent nursing. Manual expression of milk, warm (or sometimes cool) soaks, or a hot shower may be helpful.

Here are a few other tips:

1. If you pump your breasts, try to do it when your baby would normally eat.

2. If you are going to freeze your breast milk, leave some space at the top of the container because it expands, and date all containers.

3. Fresh milk may be stored in the refrigerator for up to 4 days.

4. Frozen milk may be stored in the freezer for up to 2 months (up to 6 months in a deep freezer)

5. Defrosted milk may be used within twenty-four hours.

6. NEVER microwave breast milk; it will change the milk's composition and can burn the baby's mouth.

If you need any assistance in breast feeding, there is help! You can call the office or local La Leche League for free phone support:

Sylvia: 686-4307 Anneka: 313-1165 Jane: 392-1551

Chrissy: 395-4516 Karin: 452-4239 Kristin: 395-5844

Kristina: 262-8020 Theresa: 799-4347

In Pender Co, call Lisa: 283-5187

In Brusnwick Co, call Kelly: 933-4037

In Onslow Co, call Kailee: 347-7582

Lactation consultants are available in the hospital. You can call the lactation office at 343-2430.

There are also private practice lactation consultants who will provide home visits for a fee.

Vicki Carlson: 910-201-4624 Julia Pindell: 910-791-2853

Norma Escobar: 910-538-6455

Recommended books include: Breastfeeding by M. Renfrew and C. Fisher; The Complete Book of Breastfeeding by M. Eiger and S. Olds; Nursing Your Baby by K. Pryor; and The Nursing Mother's Companion by K. Huggins.

Bottle Feeding

The main advantage of formula feeding is that it frees Mom from being the only source of food. This gives a new mother more flexibility and helps everyone else in the family bond with the baby.

There are a wide variety of formulas on the market. These formulas offer an excellent substitute for breast milk as the fats, carbohydrates, proteins, minerals, and vitamins have been carefully adjusted to resemble the composition of human milk. These formulas come in many convenient forms to suit all budgets and needs.

Iron fortified formulas are recommended for all bottle fed babies from birth to one year. The hospital rotates these formulas periodically. You may use the formula your infant receives in the hospital or switch to another brand.

Most babies will take 2-4 ounces every 3-4 hours, but this, like everything else, can vary. You should be comfortable to get the most out of feeding your baby. Cradle your baby in a semi-upright position and support his head. Do not feed him when he is lying down because this will increase the risk of choking. Hold the bottle so the formula fills the nipple of the bottle before giving it to him. This will prevent your baby from swallowing too much air. To get him to open his mouth, stimulate the "rooting reflex" by stroking the nipple against the cheek, near the mouth. NEVER prop a bottle in your baby's mouth and leave it there and never put your baby to bed with a bottle.

When preparing formula, make sure all of the utensils you use are very clean. Scrub the bottles, nipples and caps with hot soapy water and a bottle brush. Squeeze water through the holes in the nipples. Rinse everything well with hot water (again squeezing water through the nipple holes). Turn the bottles upside down on a towel or in a rack to drain dry, and store the bottles in that position until they are used. Always wash the top of the formula can with soap and water and rinse well before opening.

Always prepare your bottle before bedtime. It is much easier to make a new batch of formula at 3:00 in the afternoon than at 3:00 in the morning. Formula may be fed cold from the refrigerator if desired, but most babies prefer formula at room temperature or lukewarm. When formula is taken from the refrigerator, warm the bottle by placing it in a pot of warm water. NEVER WARM YOUR BABY'S BOTTLE IN A MICROWAVE. Test the formula to ensure that it is not too hot by letting a few drops fall on the palm side of your wrist. The nipple should also be tested for patency of the hole. The hole should be large enough to allow the formula to drop out steadily. If it drips very slowly, enlarge it by using the tip of a heated needle. If the holes are too large, the baby will gulp his formula and swallow an excess amount of air. If your baby consumes more than 45 ounces of formula per day, call us for advice.

Sterilization of water or bottled water is not necessary if you have city, county, or tested water. Thoroughly wash and rinse bottles and nipples and discard all formula in the bottle after the feeding. Follow the instructions above for mixing and storing in the refrigerator. NEVER RE-USE FORMULA FROM A PARTIALLY EMPTIED BOTTLE.

All commercially prepared formulas are available in three forms:
1. Liquid concentrated formula must be mixed with an equal amount of water (one 13 oz can of concentrate plus 13 oz of water makes 26 oz of formula). The formula is then poured into individual bottles which are capped and placed in the refrigerator. This formula must be used within 24 hours or discarded.
2. Ready-to-feed formula is available in pre-packaged bottles or cans. This formula is ready to use without any mixing; just pour into the bottle at feeding time, seal the can, and refrigerate. The contents of the refrigerated can must be used within 24 hours or discarded.
3. Powdered formula is the least expensive form and is very convenient to use, especially on trips. Just add two scoops of the powder to four ounces of water and shake well. There is no need to refrigerate the powder. Discard any unusual looking formula.

Whatever brand name formula or form of the product you select be absolutely sure that you prepare it as directed. Breast milk and all forms of properly mixed commercial formula contain 20 calories per ounce, so none of these are too weak or too rich for the infant; likewise the directions for mixing should not be altered to produce a weaker or richer formula.

Burping

Both breast-fed and bottle-fed babies sometimes swallow air during feedings and tend to get fussy and cranky when this happens. Frequent burps will help with this problem. If your baby is bottle-feeding, burp her after every 2-3 ounces. A nursing baby should burp each time she switches breasts. If your baby doesn't burp after several minutes, continue feeding her and try again when she finishes. Don't worry. No baby burps every time. These are general guidelines and your baby may need more or less frequent burping.

There are three good ways to burp a baby. One way is to pat the baby's back while holding him upright over your shoulder. Another way is to hold him in your lap in a sitting position slightly leaning over your hand, which is positioned to support baby's head (usually baby's chin is resting on your hand between thumb and index finger). You may also lay the baby face down across you lap and pat the baby gently on the back.

Solids

There are as many routines as there are grandmothers and pediatricians as to how, when, and what to feed the new baby. Every few years there is a new difficult-to-prove theory about what is best nutritionally for infants. At the present time, most experts feel that the longer one delays the introduction of solid foods, the less likely the infant will be to develop allergies to foods. However, there is also some evidence to indicate that later introduction of solids may only delay the formation of allergies. Nevertheless, at the present time we recommend EXCLUSIVELY nursing or bottle feeding for the first 4-6 months.

We will tell you at the regular office visits when to add other solid foods. However, with cereal, as with other foods, no more than ONE new food should be added at a time. Each new food should be given for at least three successive days before new foods are introduced in order to recognize specific allergies.

Rice cereal should be started in small amounts, 1-2 teaspoons of the dry cereal mixed in with formula or expressed breast milk. The amount can be gradually increased as can the thickness, and this can be offered once per day to maximum of 2 ounces of the cereal/formula mixture per day.

Strained fruits (applesauce, bananas, pears) should be started next because they are usually accepted best and are tolerated well. As with all foods, start with a small amount and gradually increase; keep the baby on one new food for three or four days before introducing another new food.

Strained yellow vegetables (carrots, squash, sweet potatoes), followed by strained green vegetables (peas, beans) can be introduced next in the same cautious manner as with fruits (one new food at a time). Fruits and vegetables may be given once or twice per day. Some parents prefer to begin with yellow vegetables before fruits so that the baby does not favor a sweet tasting food. This is purely a matter of personal preference and does not matter as long as only one new food is added at a time.

Strained meats are the least tasty, tend to contain more sodium, and are more difficult to swallow because of their drier nature. These are best not introduced until 8 or 9 months of age and then may need to be mixed with fruits or vegetables because of their taste and texture.

Egg yolks can be introduced at the same time as the meats, after 9 months, but wait another week or two to introduce the more allergenic egg whites.

Junior food, table foods, finger foods- By 9 months of age soft, mashable table foods and "junior baby foods" can be started. If these are handled well with no problems, simple "finger foods" can be started.

Please avoid giving your baby desserts, unusual fruits, and mixed baby food products.

Certain foods that are traditionally felt to have an allergenic tendency are withheld until 9 to 12 months of age (wheat, tomatoes, citrus juices, egg whites, milk products).

Vitamins

The AAP recommends vitamin D for exclusively breastfed babies. This can be given as Tri-Vi-Sol, 1 dropperful a day starting at six weeks to two months of age and continuing until at least half their intake is from formula. Otherwise, we believe that healthy babies receiving a normal, well-balanced diet do not need vitamin supplementation over and above the recommended dietary allowances.

Nighttime Feedings

Sometimes babies are put to bed with a bottle and are allowed to go to sleep while lying down suckling juice or formula from a bottle propped up on a pillow or folded blanket. Occasionally breastfed babies will be allowed to nurse for prolonged periods of time while going to sleep or afterward. Both of these are bad habits to get started; the constant contact of the milk or juice on the baby's front teeth for prolonged periods will lead to a very common and terribly disfiguring bacterial erosion of these teeth called "milk bottle cavities". This feeding position also causes fluid to accumulate in the middle ear which increases your baby's risk for an ear infection. Hold your baby propped in your arms during all feedings.