FEEDING

At Feeding Time

Feeding is one of the baby’s first pleasant experiences. The baby’s first love for its mother arises primarily from the feeding situation. At feeding time the baby receives nourishment from his food and nourishment from his mother’s love. The food, correctly taken, helps him to grow healthy and strong. The mother’s love, generously given, helps him to feel secure. Help your baby get both kinds of nourishment.

Both of you should be comfortable. Choose a chair that is comfortable to you. This will help you be calm and relaxed as you feed your baby. Your baby should be warm and dry so that he is comfortable too.

Hold your baby in your lap, with his head slightly raised, and resting in the bend of your elbow. Whether breast-feeding or bottle feeding, hold the baby comfortably close. Never feed your baby laying down.

A Schedule with Flexibility

Feeding schedules are usually most satisfactory if the hours are set roughly and the baby is allowed to eat when he becomes hungry: for example, any time between three and five hours after the last feeding. New babies usually need to be fed about every three hours but may often go four to five hours between feedings. It’s better not to wake the baby for feeding. A newborn, full term infant should not go more than five or six hours between feedings. Later on the baby may sleep longer. Should he occasionally wake up and cry less than two and a half hours after feeding, the amount of formula may be insufficient. When filling bottles put in about one or two ounces more than your baby usually takes.

Weight

Most newborns weigh between 5 1/2 to 10 pounds, with the average weight being about 7 1/2 pounds. During the first days of life, infants generally lose four to ten ounces before they start to gain weight. Breast-fed babies may lose slightly more weight at first without cause for concern. This weight loss is from the loss of excess body water and is perfectly normal. Most infants will regain their birth weight by ten days.

Many parents want to know if their baby is eating enough. The most accurate gauge of this is growth. That’s one reason your baby will need to see us often during the first two years of life – so we can monitor your child’s growth. Besides growth, there are several signs that will let you know your baby is eating enough. They are:

1. Satisfaction after eating;
2. Wetting six or more diapers daily;
3. Having stools.

If you are nursing, your opposite breast may leak during suckling (“let-down reflex”).

For Breast Feeding

Breast-feeding may be started at anytime during the first 24 hours after birth. Regard- less of the time of the first nursing, breast-feeding should be undertaken with understanding and confidence.

Before the time of birth and for the first two or three days of nursing, the breasts secrete yellow material called colostrum. With the onset of regular nursing, the breasts will be stimulated to secrete milk. As the breasts fill with milk on the second or third day, they will feel full and heavy. At about this time, it is common for the nipples to begin leaking milk. The baby should now be quite alert, interested in nursing, demonstrating the rooting reflex, and capable of handling the flow of milk.

Positioning

1. Correct positioning prevents sore nipples.
2. Use pillows for comfort
3. Vary your positions using cradle, football, or side-lying.
4. Support your breast using C-hold.
5. Infant’s arms hug the breast in all positions.
6. Check for straight alignment of infant’s ear, shoulder, and hip (cradle hold).

Latch On

1. Tickle infant’s lower lip with nipple and wait for wide-open mouth.
2. “RAM” infant onto breast (rapid arm movement) for adequate areolar grasp.
3. At least 1/2 inch of areola needs to be in infant’s mouth in order to prevent sore nipples and to promote adequate milk intake.
4. Infants nose should touch the skin on the breast.
5. Lips should be flanged out.

Frequency of Feedings

1. Infant demand feeds are the ideal. Infants look for their hands to suck, which indicates a call for feeding. Crying is a late sign of hunger.
2. However, if infant is sleepy, awaken infant to feed every 2-3 hours (from light sleep phase).
3. When infant becomes more alert, watch the infant and not the clock.
4. Infants need a minimum of eight feeds in 24 hours, ideally 10-12.
5. Some infants may nurse 8-14 times in 24 hours in the initial 3 weeks.
6. Do not awaken infant during the night except:
   • When you need relief from engorgement, or
   • If infant gets less than 8 feeds in 24 hours.

Duration of Feeding

1. Time at each breast will vary with each baby.
2. Try for 10-15 minutes the first breast and for as long as infant will suckle on the second breast.
3. Average feeding time, after you leave the hospital, can be 20-30 minutes, on both breasts. This can vary if baby is sleepy or aggressive.
4. Attempt to nurse on both breasts beginning with the breast nursed last at the previous feeding; or beginning with the fullest breast first.

Supply and Demand

1. Frequent feeds in early weeks help to establish the milk supply.
2. Growth spurts occur at 10-14 days, 6 weeks, 3 months and 6 months. At these times the infant will want to feed more frequently for 24 - 48 hours. NOT BOTTLES during this time. NURSE, NURSE, NURSE!

Nipple Care

1. Correct latch on is a must.
2. No soaps, creams or lotions.
3. Express colostrum or breast milk and smear on nipple.
4. Air nipples for 15 minutes after each feeding.
5. Vary positions of infant at breast.
6. Use nursing pads without plastic liners.
7. Change nursing pads when wet.

Sore Nipples

1. Check for correct positioning and latch on.
2. No shorter more frequent feeds.
3. Nurse on least sore side first.
4. Vary nursing positions.
5. Pump prior to feeding to bring in let down.
6. Wear breast shells for air and use blow dryer after feedings.
7. If nipples are cracked or bleeding, talk to consultant.

Engorgement

1. Occurs 2-5 days after birth when the mature milk is coming in blood and lymph supply to the breast is increased.
2. Discomfort may last from 48-72 hours.
3. Nurse every 2 hours for relief.
4. If infant will not wake to nurse, pump breasts.
5. If infant nurses on only one side, pump the other breast.
6. Heat (warm compresses, shower) and gentle massage prior to a feeding helps the let down.
7. Manually express or pump breasts prior to a feeding to soften areola if infant has difficulty latching on.
8. Use ice in between feedings and TyleNOl® to relieve discomfort.

Storage of Milk

1. Freshly expressed breast milk may be stored up to 3 days in refrigerator for full term babies, 24 hours in refrigerator for premature babies, 6 months in freezer (not in freezer door).
2. Thawed breast milk may be stored in refrigerator for up to 24 hours only.

How Do You Know Baby is Getting Enough Milk?

1. 6 wet diapers and 3-4 stools in 24 hours after the mature milk is in (approximately 5 days of age).
2. Infant has 8 or more feedings in 24 hours.
3. Notice some degree of softness to the breast after the feeding.
4. Audible swallowing can be heard during feeding.

Nutrition

1. Eat as well as you did when pregnant.
2. Do not eliminate gassy or spicy foods; be watchful.
3. Limit caffeine to two cups per day.
4. We strongly recommend no alcohol while nursing. Please contact us for further questions related to alcohol consumption.
5. Nicotine decreases the milk supply. We strongly recommend no smoking. Never smoke near the baby.
6. Check all medications with pediatrician or lactation consultant.
7. Get adequate rest.
8. Drink adequate fluids.

A second question, which arises, is, “Can I give the baby a bottle of formula once in a while?” For your comfort or convenience and/or to involve a baby’s father, a feeding of formula may be substituted for a breast-feeding.

If you are placed medication while breast-feeding, please let us know.

Formula Feeding

In the normal, full term infant, formula feeding is usually begun at 3-4 hours of age after the baby has been offered one glucose-water feeding. Initially, the baby will probably take less than two ounces of formula per feeding, but as the baby becomes more alert, the formula intake at each feeding will increase and, by the time of discharge, may approach 2-4 ounces per feeding.

The amount of formula your baby takes will vary from one feeding to another and will increase with age. Babies have a right not to be hungry just as you and I, and you should not force your baby to drink the last drop at every feeding.

Most babies feed for 15-20 minutes. You will probably find that sometimes your baby will take all of the formula and sometimes not. Don’t worry. This is normal. As your baby grows and gains weight, he will need more formula. When your baby regularly consumes all of the formula at a feeding, and sometimes cries for more, it may be time to increase the amount of formula: a satisfied baby usually will leave some formula in the bottle. Infants should stay on formula for the first year.

Infants and toddlers should not be allowed to take a bottle of milk or juice to bed be- cause of the increased risk of cavities in their teeth.

Testing nipples regularly will save time when you are ready to feed your baby. Nipple holes should be the right size to help baby suck easily. When the nipple holes are the right size, warm milk should drip as rapidly as possible without forming a stream. If the nipple holes are too small, baby may tire of sucking before he gets all the formula he needs. If the nipple holes are too large, the baby gets too much formula too quickly, and he may not get enough sucking to satisfy him. To enlarge nipple holes, push a red-hot needle gently through from the outside. An easy way to prepare the needle is to put the blunt end in a cork and heat it in a flame of a match. If nipple holes are too large, the nipple is worn out and should be replaced. Sometimes, nipples become gummy. Place the nipples in a pan of water, add a pinch of salt, and boil for a few minutes.

“Burping”

“Burping” the baby helps remove swallowed air. Even if fed properly, both bottle-fed and breast-fed babies usually swallow some air. The way to help your baby get rid of this is to “burp” or “bubble” him. Hold him upright over your shoulder and pat or rub his back very gently until he lets go of the air. Your baby can also be burped by being held in a sitting position, leaning slightly forward, on your lap, with your hand supporting the baby’s chest. Don’t be upset if your baby spits up a few drops while be burps.

It isn’t always necessary to interrupt a feeding to burp baby, but do it after each feeding. Of course, sometimes, baby may not burp because he doesn’t need to do so. Don’t try to force him. You may place him in his bed with his left side down to facilitate a burp.

After Feeding

After you have fed and burped your baby, place him in his bed. The American Academy of Pediatrics now recommends that all infants sleep on their side or back for the first year of life. If your baby spits up excessively, you may want to discuss sleeping positions with one of the doctors.

After bottle feeding, rinse bottles and nipples with cool water. Squeeze water through the holes of the nipples. Washing can be done later.