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BREAST FEEDING
* Breast-feeding is the preferred
method for feeding your baby. It benefits you and your baby and provides your infant with the ideal, most natural source of
infant nutrition. Although it is natural, comfortable nursing may not be easy at first, as both you and your baby learn about
nursing. Most mothers and babies will develop a reasonable feeding schedule within two weeks. Do not be discouraged if your
baby does not seem interested in nursing at first or if you do not seem to be making much milk during the first few days.
*
Nurse in a position that is comfortable for you. Our nursing staff, and our hospital lactation consultants can be helpful
to you in positioning your baby. Your baby should directly face your breast, abdomen to abdomen in the traditional cradling
position or if you try nursing lying down with your baby. Alternatively, you may try positioning the baby in the football
hold, with the baby tucked under one arm, approaching the breast from one side. Place the hand you use to assist presenting
the breast to your baby sufficiently back from the nipple so that the baby can latch on to as much of the colored part of
the nipple (the areola) as possible. Milk is actually squeezed from the breast, and if only the tip of the nipple is offered,
soreness and poor feeding will result.
Women with flat or inverted nipples usually find that nursing, perhaps supplemented
by using a breast pump, will bring out the nipple. Also, plastic breast shields may be worn at the end of pregnancy and at
the start of nursing to help pull out the nipple.
* Guide the baby’s mouth to your breast by holding his or her head
from behind. Avoid pushing the baby’s cheek with your hand since the rooting reflex may cause the baby to turn toward the
pressure rather than toward your breast. Before removing the baby from the breast, gently break the baby’s suction by placing
your finger in the corner of the baby’s mouth. We recommend that you alternate the starting breast at each feeding. A safety
pin may be placed on the bra strap of the starting side as a reminder.
* The length of time required for a baby to
complete a feeding is variable. Babies get most of the milk during the first 10 minutes of continuous sucking, and in most
cases, a feeding may be completed within 20 minutes. Those babies who fall asleep after a few minutes of nursing need to be
awakened and stimulated (for example by changing the diaper or tapping the feet) until they have eaten enough. Success at
nursing can be measured by whether the baby starts a feeding with apparent hunger, seems content afterward, and produces at
least six wet diapers and several stools each day.
* If your baby does not seem to be satisfied, try more frequent
feedings (as often as every two hours). It is generally best to avoid giving your baby sugar water of formula until breast
feeding is well established (usually two weeks)- although occasional bottles will not cause a problem in most cases.
*
The first days after delivery, many mothers do not have large amounts of milk. Even the drops of colostrum are a benefit to
your baby, however. Milk production is stimulated by frequent nursing. Milk is eventually “let down” from the breast ducts
into the nipple, and sometimes the opposite breast drips, too. During the first few days of nursing, many mothers feel brief
uterine cramps when the baby begins sucking. The baby’s sucking and swallowing is often heard, with gulping noises as nursing
becomes successful.
* Sometimes when the milk “comes in”, the breast feel uncomfortable and engorged (swollen). If
the baby has difficulty latching on to the nipple because of engorgement, try expressing some milk out by hand (squeezing
the areola) or with a pump. Many hand-operated, battery-operated, and electric breast pumps are available to help you express
milk. Expressed breast milk can be stored in a refrigerator for 48 hours, or in a freezer for two months.
* Sore nipples
can be treated with a bland ointment such as A&D or by coating them with a small amount of expressed breast milk and allowing
them to air-dry. You may try leaving the flaps of your nursing bra open and wearing loose-fitting cotton clothing. If one
particular area of your nipple is sore from the pressure of the baby’s suck, changing or alternating nursing positions should
be helpful. Shorter, more frequent nursings are better for sore nipples than prolonged nursing sessions.
* Regular supplemental
bottles of expressed milk,
formula, or water are generally not appropriate for the first 2 to 4 weeks, as nursing is getting
established. Over time, supplements can offer the mother and the baby increased flexibility in scheduling and can provide
the father or other caretaker the joy of feeding. Many mothers are able successfully to combine nursing and bottle feedings,
for example if they return to work. If you need additional advice, please call our office staff or the hospital nursery staff.
*
We recommend that you give your breast-fed baby one dropperful per day of Tri-Vi-Sol or Vi-Daylin ADC vitamins. If your baby
does not drink any water, or if your water supply is not fluoridated, we may suggest a prescription vitamin with fluoride
at the time of the baby’s first office visit. Nursing mothers should continue to take their prenatal vitamins.
*
Breast feeding mothers should eat a healthy diet and drink plenty of fluids. If your urine becomes dark and concentrated,
consider drinking more liquids. Eat a balanced diet. All foods are acceptable if eaten in moderation, but if your baby becomes
irritable each time you eat a particular food, avoid that food for 3 or 4 days and then reintroduce it to see if the symptoms
reappear. Do not take medicine unless you have called us or your obstetrician first. Try to get as much rest and relaxation
as is practical, and try to enjoy your baby. Fatigue and worry are two of the most common causes of breast-feeding failures.
FORMULA
FEEDING
* When mothers cannot or choose not to breastfeed their babies during the first year of life, prepared infant
formula with iron should be used. At each feeding the baby will drink about half the number of ounces as it weighs in pounds.
For example, an 8 pound baby will work up to drinking about 4 ounces of formula (3 to 5 ounces) per feeding. Similac with
iron, Enfamil with iron, and SMA formulas are all acceptable. Soy formulas are all acceptable. Soy formulas and hypoallergenic
formulas are occasionally recommended for cases of formula allergy or intolerance.
* Ready-Nurser disposable bottled
formula is the most expensive type, but it is very useful for emergencies, trips, and for supplemental feedings when nursing.
These bottles may be kept at room temperature and offered to the baby without warning. Unused formula may be refrigerated
after opening and used at a second feeding.
* If you choose a Ready-To-Feed type of formula in a large can, wash the
top of the can with soap and hot water. Pour immediately prior to use into a clean bottle. An opened can should be refrigerated
and covered, and should be used within 48 hours.
* Concentrated formula and powdered formulas are less expensive.
Powdered formula is especially convenient when making only a small amount of formula at a time, for example when supplementing
breast feeding or traveling.
* Follow label instructions for proper dilution of the formulas. Although sterilization
is not necessary, cleanliness in formula preparation is very important. You may refrigerate prepared bottles or you may make
one bottle at a time.
* Most infants prefer formula that has been warmed to room temperature: simply allow hot water
from the faucet to run over the bottle for a few minutes. Babies will not be harmed by drinking cold formula, and some babies
(especially after 6 months of age) prefer their bottles cold directly from the refrigerator. Microwave warming is not recommended.
Not only can tightly sealed bottles explode, but scalding hot liquid may be inside a bottle that feels cool. If you must
microwave a bottle, warm at least 4 ounces, and leave the top open. Always shake the contents thoroughly and check the milk’s
temperature carefully before offering it to your baby.
* On hot days, water may occasionally be offered to the baby
between regular feedings. Sterilizing is not usually necessary, but when water quality is in doubt, boiling for 20 minutes
during the first three months is recommended.
* Lead concentrations in tap water can be reduced by allowing early-morning
water to run freely before using, and by loosely covering pots with a lid during heating. One teaspoon of sugar may be added
to 4 oz. of water for taste.
* Vitamins are contained in prepared infant formulas, and vitamin supplements are not
necessary until formula is discontinued (usually at about 1 year of age).
FEEDING SCHEDULES
* There is no
“right” feeding schedule that works best for all babies. We recommend a compromise between a strict feeding schedule and a
demand-type feeding pattern. Try feeding your baby every 2 to 4 hours during the daytime and allowing your bay to sleep as
long as he or she wishes at night. The size of your baby and his or her degree of fussiness may influence the frequency of
feeding. In most cases, babies initially feed once or twice each night. By 2 months of age, about one-half of new babies sleep
through the night (6 to 8 hours) without awakening.
SOLID FOODS
* Breast milk or formula alone is the best
diet for your infant during the first few months. Starting baby food early may cause allergies, hard or lose stools, spitting
up, or rashes. Early feedings may also cause your baby to gain too much weight too quickly. Contrary to common belief, adding
solids to the baby’s diet does not usually help the infant sleep through the night sooner. If your baby seems hungry, he or
she may be pacified by extra sucking, by drinking more milk or formula (either more frequently or in larger amounts), or by
drinking plain water. Solids are not usually recommended until the baby is 4 to 6 months old, or until the baby weighs more
than 15 pounds.
BOWEL MOVEMENTS
* The baby’s first stools contain meconium, a thick sticky substance that is
tarry and dark brown in appearance. The frequency and consistency of the baby’s later bowel movements may vary from day to
day. Some babies stool after each feeding, while others stool daily or every 2 to 4 days. Pasty, seedy, curdy, or runny (like
pea soup or heavy cream) stools are all normal. Normal stool color is mustard yellow, but it may also be green or brown. Breast-fed
babies usually have looser and more frequent stools than formula-fed babies.
* Straining while stooling is common
and does not indicate a problem. If the stools become hard like pebbles, or watery with only small flecks of soled, they are
not normal. When such stools occur 3 or 4 times in a row, please call for advice.
DIAPER AREA AND SKIN CARE
*
When changing diapers, wash urine and stool from the baby’s bottom with plain water. A bland soap may occasionally be necessary.
Packaged moist wipes are useful, but avoid those that irritate your baby’s skin. Petroleum jelly (Vaseline) may be used at
each diaper change to protect the skin from urine and stool.
Mild diaper rash is best treated with a bland protective
ointment such as Balmex, Desitin, or plain zinc oxide. These ointments can be removed easily by gently wiping them off with
baby oil. Successful treatment of diaper rash requires exposing the affected area to the air. Dry the diaper area will even
before applying ointment, and consider cutting the elastic leg bands out of disposable diapers to allow more air-drying. If
the rash becomes worse despite treatment, especially when it looks like a weeping burn or pus-filled pimples, the skin may
be infected, and you should call for advice.
* If your baby has been circumcised, no special care of the circumcision
is necessary. To protect the skin from urine and stool, petroleum jelly (Vaseline) may be applied at each diaper change for
the first week or so until healing is complete. An uncircumcised penis also requires no special care. Do not retract the foreskin
forcefully, as you may cause irritation or bleeding. Cleaning beneath a tight foreskin is not necessary for good hygiene during
infancy.
* Female babies sometimes have a thick creamy or bloody vaginal discharge, caused by mother’s high hormone
level during pregnancy. It is normal and should be no cause for concern. When discharge occurs, gently cleanse the baby’s
vaginal labia folds from front to back (top to bottom) with water or baby oil.
* Dry skin can be treated with a bland
baby lotion. If a heat rash develops, baby powder with a corm starch base may be applied. The baby’s skin should not be powdered
directly because he or she may breathe in the powder. Instead, sprinkle powder into your hand before wiping it onto your baby.
*
Many babies develop mild jaundice or yellowing of the skin that is harmless. On occasion, severe jaundice may require treatment.
If the skin has a “pumpkin” color if the yellow coloring is visible on the baby’s palms, soles or stomach, call for advice.
When looking for jaundice, the baby should be examined in daylight or under fluorescent light and should not be wearing yellow
garments.
CARE OF THE UMBILICUS (BELLY BUTTON)
* The umbilicus should be exposed to air as much as possible.
It is not necessary to apply alcohol or other antiseptic solutions to prevent infection - they may also prolong the time needed
for healing. Air drying can be done by placing the top of the diaper below the belly button. The scab will usually fall off
5 days to 4 weeks after birth. Associated bleeding or oozing at that time requires no treatment other than swabbing the area
clean.
BATHING
* Sponge baths may be given daily or every 2 days until the baby’s belly button is healed and
dry; you may then place the baby in a tub. Use a bland soap and rinse it completely from the skin to prevent irritation and
rashes.
CRYING
* It is normal for babies to have crying or fussy periods each day. Most commonly these episodes
occur during the early evening and can last for two or more hours. Babies who have excessive and intense crying are sometimes
said to have infant colic. Many home remedies are used but few are universally successful. In most cases, colicky babies show
marked improvement by 3 months of age. If you believe that your baby has colic, please call for advice.
SLEEPING POSITIONS
*
Babies should sleep on a firm crib mattress or a similar firm surface. Waterbeds, quilts, comforters, sheepskin, and other
soft surfaces are not safe for your baby. During the first 5 or 6 months the safest sleeping position for baby is on its back.
Some experts believe that the face-down position may interfere with the baby’s breathing.
PACIFIERS
* The neurological
sucking reflex in the newborn period can be strong, and allowing your infant to use a pacifier may help during fussy episodes.
After the sucking reflex passes, it is easier to wean from a pacifier than to discourage thumb-sucking. However, in breast-fed
babies, to avoid “nipple confusion”, it may be best to defer offering a pacifier until nursing is well-established.
TAKING
THE BABY OUT
* In emergency situations, the baby may be taken out at any time if dressed properly to prevent chilling.
Depending on weather conditions, planned walks maybe started when the baby is a few weeks old. Avoid visiting places that
are heavily crowded. Infants traveling in your car should always be strapped into an approved car seat. Do not be lazy. Your
baby’s safety is very important.
POSTPARTUM “ BLUES”
* After giving birth, some mothers experience crying spells
and feelings of depression in the hospital or shortly after taking the baby home. These spells may occur because of hormonal
changes following delivery, nervousness about starting the new job of being a mother, uncertainty about which or whose advice
to accept, and general fatigue. The “blues” are common and normal and will usually disappear after a few weeks. Supportive
family and friends can be a tremendous help.
CALLING THE DOCTOR
* You should call the doctor if your baby has
a rectal temperature of 101° F or higher (only rectal temperatures should be considered accurate), refuses to suck or feed
2 or 3 times in a row, appears limp or has poor color, is difficult to arouse, vomits most feedings, has persistent diarrhea,
or looks very jaundiced. You should also call the doctor if the baby seems ill to you or if you feel frightened about the
baby’s appearance or symptoms. When calling for an emergency, tell the office receptionist or service operator, “This is an
emergency!” so that there will be no misunderstanding about the level of your concern.
VISITORS
* Limit the
number of people who handle the baby to close friends and relatives during the first 2 to 4 weeks. People who have colds should
avoid contact with the baby whenever possible. Strict hand washing is advisable before handling the newborn. Cigarette smoke
is not good for you or your baby and should be avoided. Parents and visitors should avoid smoking cigarettes in areas where
the baby sleeps or plays.
THE BABY’S FIRST DOCTOR VISIT
* In most cases, your baby should first be examined
at the office or hospital post-partum program a few days after discharge. It is a good habit to make a list of your concerns
before your visit. And to avoid distractions, try not to bring your other children with you for this first visit. Call our
office to schedule your appointment while you are in the hospital or shortly after discharge. If doctors from our group did
not see your baby in the hospital, ask the hospital doctor to prepare a short summary of the baby’s course for you. We are
all looking forward to seeing you and your new baby. We hope you have fun being new parents, and we wish you all the best!
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