Feeding Your Baby - The Early Months • Back to Feeding Your Baby   Breastfeeding • Breastfeeding: An Important First • Health Decision Parents Make • Breastfeeding in the First Few Weeks • Weight Gain • Tips on Cup Feeding • The Cost of Not Breastfeeding • Help is Available Bottle Feeding • Formula Feeding • Guidelines for Formula Feeding • Milk and Your Baby • Bottle Preparation (sterilization) • Storing Expressed Breast Milk • Storing Formula • Tips on Bottle Feeding Your Baby Breastfeeding:  An Important First Health Decision Parents Make Breastfeeding is the normal, natural way to feed your baby. You will be able to produce enough milk. The keys to success are early, frequent feedings, and proper positioning and latch of the baby at the breast. Breast milk is a complete food for babies. Feeding only breast milk for 6 months is recommended, after which breastfeeding should be continued in combination with other foods. Breastfeeding can continue up to 2 years of age or longer, if you choose. To the top   Breastfeeding In The First Few Weeks A baby that is doing well: has soft or loose bowel movements (stools) during the first 2-3 days of life – 1-2 large or several small stools after first 2-3 days – 2 or more stools in 24 hours has pale, light coloured urine with almost no smell in the first 3 days – 1-2 wet diapers per day (occasional red staining is normal) as milk supply increases, usually by 4-5 days – 6 wet cloth diapers per day is feeding well, at least 8-12 times in 24 hours listen for quiet “caw“ sound of swallowing is back up to birth weight by 2 to 3 weeks of age gains 120-224 grams (4-8 oz.) per week during the first three months Note: Wetness is easier to notice in cloth diapers. A facial tissue can be placed inside disposable diapers to help you tell if the diaper is wet. Get help if any of these signs are NOT present! Phone your doctor or midwife if: your baby is very sleepy and hard to wake for feedings your nipples are sore and do not start to get better you have fever, chills, flu symptoms, or a red painful area on your breast. If you have these signs, continue to nurse often, apply warm, wet towels to your breasts before feeding and get lots of rest. To the top   Weight Gain It is normal for newborn infants to lose a small amount of weight (about 10% of birthweight) during the first 3-4 days after birth, whether they are on breastmilk or formula. Infants usually return to their birth weight in 2-3 weeks. Babies often have growth spurts at around 2-3 weeks, 6 weeks, 3 months, and 6 months of age. During these growth spurts, the infant may feed more often. Feeding often at the breast will increase the supply of breast milk to meet baby’s needs. Your breasts will make enough milk to supply this growth spurt. Your baby’s feeding routine will return to normal in a few days. Signs that baby is gaining well: weight gain is steady no repeated weight loss is seen lots of wet and soiled diapers baby is alert and happy baby is meeting development goals Do not worry if: Baby does not gain, or loses a few ounces, during one week. One weight measurement is not enough to cause concern. Weigh the baby again at the next visit. Your baby does not gain the same amount as another baby. Every baby has a different growth rate. You can only compare a baby to his/her own growth history, not to other babies. Typical Weight Gain Age Weight gain per week Birth to 3 months 4-8 ounces 4-6 months 3-5 ounces 6-12 months 1.5-3 ounces Double birthweight by 6 months Triple birthweight by 1 year When to get help: Baby loses weight over time. Sudden decrease in wet and soiled diapers Change in health or development If the growth charts show that your baby is gaining weight faster than you think the baby should be, do not panic. Every baby has a different growth pattern, and as long as weight gain is steady, then baby will be fine. There is no one perfect weight that every baby should be at a certain age. Never put baby on a diet to lose weight! Infant “diets” can put babies at risk of poor nutrition, dehydration, and slow growth and development. You can help your baby grow into a healthy weight by encouraging active play and offering a variety of healthy foods. To the top Tips on Cup Feeding There is no reason to give a bottle at an early age to teach a baby how to drink from a bottle. If the baby receives even one bottle before breastfeeding is well established, he/she may possibly start refusing the breast. Babies can begin drinking from a cup at 5-6 months. Use an open cup and begin with water. Your baby will spill a lot in the beginning. Cup feeding will not interfere with breastfeeding. Mom can still continue to breastfeed when baby can use a cup. To the top The Cost of Not Breastfeeding Infant Formula (artificial baby milk) is usually made from either cows milk or soymilk. These contain ingredients which are foreign to human babies. No formula can provide babies with the immune boosting properties of breastmilk. Infants who are not breastfed are at greater risk for: Gastrointestinal infection Urinary tract infection Respiratory disease Ear infection Eczema Allergies Inguinal hernia Poor immune response to vaccination Premature infants who are not breastfed are also at greater risk for: Necrotizing enterocolitis (infection in the gut and bowel) Less oxygen in their blood during feeds Children who were not breastfed are a greater risk for: Tonsillitis Celiac disease Diabetes Juvenile rheumatoid arthritis Lymphoma Allergic disease Neurological abnormalities (delay in brain development) Adults who were not breastfed are at greater risk for: Inflammatory bowel disease Crohn’s disease Multiple sclerosis Oral malocclusion Mothers who do not breastfeed are at greater risk for: Additional pregnancies Osteoporosis Premenopausal breast cancer Ovarian cancer Endometrial cancer Families who do not breastfeed: Spend more money on infant food Have more visits to the physician’s office with sick children Spend more money on medicine Take more time off work to care for sick children Societies that do not support breastfeeding: Have increased poverty More workplace absenteeism Increased health care costs Increased use of natural resources Increased environmental waste To the top Help is available from: a Public Health Nurse on the Health Action Line 1-800-660-5853, Monday to Friday, 8:30 AM to 4:30 PM Brockville General Hospital Maternity Ward - 24 hours/day 613-345-5645 ext 1162 Almonte General Hospital 613-256-2500 (ask for maternity ward) Perth and Smiths Falls District Hospital 613-283-2330 ext 1152 CHEO Health Information Line 613-738-4888, Monday to Friday, 4:00 PM to midnight and Saturday/Sunday/Holidays 8:00 AM to midnight Home Visiting support is available by a Public Health Nurse or a Public Health Nurse who is a Lactation Consultant by calling the Health Unit Action Line 1-800-660-5853 La Leche League 1-800-665-4324 for information on local resources Your midwife or doctor A breastfeeding support drop-in centre (Call 1-800-660-5853 for a date and location near you.) To the top Formula Feeding If you decide to formula feed your baby, use an iron-fortified formula. Learn how to mix the formula and prepare the bottles correctly. Errors in mixing the formula or preparing the bottles can be dangerous to your baby’s health. Avoid changing your baby’s formula, if possible. Switching formulas can cause upset stomach, gas, or fussiness. If your baby does well with one formula, keep offering that brand to him. It can take a while for your baby to adjust to a new formula. If using powdered or concentrated formula, carefully follow the directions on the label. Bring tap water, you are using to make the formula, to a rolling boil for 2 minutes. Remove from heat and allow the water to cool. Boiled water can be stored in the refrigerator in a tightly closed container for 2 to 3 days or stored in a sterile closed container for 24 hours at room temperature. If using well water to make formula, you need to have your well water tested for nitrates. Babies, especially those under six months, are at risk of getting very sick if they take in a lot of nitrates. Boiling well water makes the nitrate level in well water worse, not better. If you have a well that supplies water to your home, have the water tested at least two times each year for nitrates. If the water is high in nitrates, use commercial bottled spring water – not mineral water, distilled water, or carbonated water. DO NOT USE these types of water to make formula: softened tap water distilled water Use regular tap water or bottled water instead. Both tap water and bottled water need to be boiled to be sterile before making formula until baby is at least 4 months old. Older homes may have lead in the pipes. This water should not be used to make formula. What about “Follow-Up Formula”? Follow-up formulas are OK for babies over 6 months of age who are getting most of their calories from breads and cereals, fruit and vegetables and meat or meat alternatives. They should not be offered to babies under 6 months old, or to babies who are not eating a wide variety of solids. It is OK to give regular infant “starter” formulas to infants over six months of age. To the top Guidelines for Formula Feeding If you are worried about the amount of formula your baby drinks, check these guidelines or contact your doctor, public health nurse, or public health dietitian/nutritionist. Age Number of bottles each day Amount of formula in each bottle Total amount of formula required each day 0–2 months 6-10 2–4 oz. (60–120 ml) 23–27 oz. (700–800 ml) 3–5 months 6–7 5–6 oz. (150–180ml) Approx. 35oz. (1050 ml) 6–8 months 5–6 6–8 oz(180 – 240ml) Depends on the amount of solid food baby eats 9–11 months 3–4 6–8oz (180 – 240ml) Same as above Note:  These amounts are based on the average weight of babies within the age ranges. Your baby may drink more or less that the amount of formula suggested above depending on his weight. (Manual of Clinical Dietetics, 2000) To the top Milk and Your Baby Before 9 months of age, cow’s milk is NOT recommended. Cow’s milk does not have all the nutrients that babies need to grow properly. Giving cow’s milk before 9 months of age can cause anemia (low iron in baby’s blood). Anemia in infancy can have long-term negative effects on growth, development, behaviour and learning. You can introduce homogenized whole (homo) cow’s milk between 9 and 12 months of age, when your baby is eating a wide variety of foods. Continue to give baby homo milk until 2 years of age. Before 9 months of age, cow’s milk is NOT recommended. Cow’s milk does not have all the nutrients that babies need to grow properly. Giving cow’s milk before 9 months of age can cause anemia (low iron in baby’s blood). Anemia in infancy can have long-term negative effects on growth, development, behaviour and learning. You can introduce homogenized whole (homo) cow’s milk between 9 and 12 months of age, when your baby is eating a wide variety of foods. Continue to give baby homo milk until 2 years of age. These types of milk are NOT recommended for babies: Lower Fat Milks Do not use 2%, 1% or skim milk before 2 years of age. Babies need the higher fat in homo milk for proper growth and brain development even if their weight is good. Lower fat milks are OK for adults who are trying to cut down on fat in the diet. We do not want to cut fat out of a baby’s diet, and we do not want to cut calories out of a baby’s diet to control their weight—it can put their growth and development at risk.   Unpasteurized Milk (cow or goat) Unpasteurized milk contains bacteria that can seriously harm a baby. Never feed unpasteurized milk to your baby.   Goats Milk Goat’s milk may not have all of the nutrients that your baby needs.   Soy/Rice Drinks These kinds of drinks may be missing important nutrients and should not be used as a replacement for homo milk. Check with a dietitian for advice about safe vegetarian feeding for babies. To the top Bottle Preparation (Sterilization) Bottles for breastmilk or formula should be sterilized until your baby is at least 4 months of age. Wash all equipment with a brush in hot, soapy water. Rinse well. Boil bottles, nipples, and can opener in a large pot for 5 minutes. After the bottles have been boiled, they are ready for expressed breastmilk or prepared formula. Storing Expressed Breastmilk Fresh milk at room temperature(19-22 degrees C) – 10 hours(25 degrees C) – 4 to 6 hours Fresh breastmilk in fridge: 8 days Thawed breastmilk in fridge: 24 hours Freezer of a 1 door fridge: 2 weeks Freezer of a 2 door fridge: 3 or 4 months (temperature varies because the door opens and closes often) Deep freezer: 6 months (-18 degrees C) Storing Formula Do NOT leave formula out of the refrigerator for more than 1 ½ hours. Never re-use a bottle of formula or breast milk that has been offered to baby because bacteria can grow in the bottle. Also, saliva will go into the milk and start to break down the sugar & starches in the bottle. Keep prepared formula in the fridge only as long as package directions state. To the top Tips on Bottle Feeding Your Baby Burp your baby gently halfway through the feeding and at the end of the feeding. Make sure that the hole in the bottle nipple is not too big or the baby may take in too much air. (Turn the bottle upside down – the flow of milk should be about 1 drop/second.) Hold the bottle at an angle so that the nipple is full of milk while the baby is feeding. Do not prop the bottle – hold it with your hand. Make sure your baby does not get too hungry so he/she will not drink too fast. Know when your baby is full so he/she is not forced to overeat. Put your baby in a semi-sitting position (more upright than the usual position) during and after feeding. DO NOT lie your baby down while drinking a bottle. Milk or formula may slip into your baby’s airway causing him/her to choke. If your baby falls asleep while finishing a bottle, keep him/her upright on your shoulder or on your chest for at least 10 minutes. This allows any milk or formula still in his/her mouth to get safely to the stomach. NEVER put your baby to bed with a bottle filled with milk or juice. The milk or juice can pool in your baby’s mouth and cause the baby’s teeth to decay. To the top