Common Infant Nutrition Questions
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Common Infant Nutrition Questions
SHOULD I BREAST FEED?
Experts in infant nutrition all agree that breast milk is the ideal food for babies. It has just about everything the child needs for optimal nutrition. A baby will usually grow well and be healthy if it is given nothing but breast milk, vitamin D and iron during the first year of life. One of the advantages to breast feeding is the avoidance of food allergies. Allergy to breast milk is practically non-existent. Cow's milk allergy, on the other hand, occurs in as many as 7% of infants. There is some evidence that breast fed babies have fewer respiratory and intestinal infections than bottle fed babies. Breast milk has factors (lactoferrin, immunoglobulins, anti-staphyloccal factor and white blood cells) which inhibit the growth of harmful bacteria in the intestine. Breast feeding is much less expensive than formula and may offer some psychological advantages to bottle feeding although this is difficult to prove. Certainly, a mother who nurses is going to develop a closer bond to her child than one who props a bottle up in the crib.
CAN ALL WOMEN BREAST FEED?
The majority of women can breast feed, although for some women it's easier than for others. The size of the breast doesn't seem to have much to do with the ability to nurse. Some women just plain don't have enough milk no matter how hard they try. There is a great variability in the quality of breast milk which depends to some extent on the mother's diet. Women who go on a low fat diet to try to loose the weight they gained during pregnancy will often produce low fat milk and, as a result, the baby may not thrive. Some babies (especially premature infants) do not have a vigorous enough suck to nurse. Some women have inverted nipples which makes nursing difficult although not impossible. At times the nipples get so sore that nursing becomes intolerable. A plugged milk duct or breast infection will sometimes cause a mother to stop nursing. If this happens, call your obstetrician for advice.
In order to stimulate your milk supply it is important to nurse frequently (as often as every two hours) at the beginning, and to nurse on both breasts at each feeding. Start the next feeding on the side the baby finished on. It is important that a nursing mother get enough rest and avoid too much stress. Drinking a lot of water may decrease ones milk supply rather than increase it as commonly believed. There are medications available that may help to increase your milk supply. Try to not supplement with water or formula or use a pacifier during the first few weeks unless the baby seems to not be getting enough from nursing.
We are fortunate to have several certified lactation specialists in this area that are willing to help mothers who are having trouble nursing. They have established a "Lactation Warm Line" where you can call for free advice at (801) 227-3349. One of the specialist (Jan Sumsion) offers a walk-in lactation class at Orem Community Hospital every Tues. at 1:00, Thurs. at 11:00 A.M. and every third Wed. at 7:30 P.M. The charge is $10.00. Shelly Hawker (801-226-3697) is a private consultant. There are women from the La Leche League who have also made themselves available to help mothers with breast feeding. You may call my office for their numbers. There are several good books on nursing. The one most highly recommended by the above specialist is "THE NURSING MOTHER'S COMPANION" by Kathleen Huggins, R.N.,M.S.
HOW LONG SHOULD I BREAST FEED?
The first six months would be the most important time to nurse. After that there seems to be little documented advantage. Some mothers prefer to breast feed for as long as two years which is okay.
HOW CAN SORE NIPPLES BE PREVENTED?
Sore nipples are usually caused by improper positioning of the baby on the nipple or by nursing too long. It has been shown that babies get most of the available milk in the first five minutes and all of it by thirteen minutes. Babies may want to nurse longer just because they have a drive to suck. It would be a good idea then to limit nursing to about fifteen minutes on each side the first few days, and then work up to longer periods depending on how tender you are. Later on, as the nipples get tougher, you may want to nurse longer just to satisfy the baby's need to suck, or use a pacifier. Washing the nipples with water, soap or alcohol before each feeding causes drying and cracking and is not necessary. Covering the nipples while they are still wet will sometimes cause more soreness. Allow them to dry by exposing them to the air or use a hair dryer. Creams or lotions are not recommended but rubbing some milk on the nipples may help keep them soft. A yeast infection of the nipples can be very painful and can occur even if the baby doesn't have discernable thrush. Both you and your baby may have to be treated with Nystatin.
WHAT IF I DECIDE TO PUT MY BABY ON FORMULA?
Many infants in the U.S. are started out on formula and most of them do well. The formulas on the market today are very good. Most of them are made of cow's milk which has been modified and fortified to meet all the child's nutritional requirements. They have been processed for easier digestibility. They have polyunsaturated vegetable fats instead of butter fat and have been fortified with vitamins, zinc, iron and other important elements. Many formulas come with the recommended amount of iron or low iron. I recommend that all babies be on formula with iron.
WHEN SHOULD MY CHILD BE TAKEN OFF FORMULA?
Homogenized milk given to a baby in the first few weeks of life can cause a serious chemical imbalance which may result in convulsions. A baby may be able to tolerate homogenized milk after a few months of age, but I recommend a child be on formula until 9 to 12 months of age. Too much homogenized milk has been shown to cause microscopic intestinal bleeding and is a common cause of iron deficiency . A baby should be on a good variety of iron containing solids before going off formula.
SHOULD I STERILIZE THE BOTTLES?
It is impossible to raise your baby in a germ-free environment. Within hours a newborn's skin, mouth, and intestinal tract are colonized with bacteria. I see no reason to sterilize a baby's bottle. A good washing and thorough rinsing is enough. You don't need to boil the water.
SHOULD I GIVE MY BABY A PACIFIER?
Babies have a need to suck which may exceed their need to eat. It lasts about four months and then subsides. Giving a baby a pacifier (Binky or soother) is a great way to calm him down when he is upset, help him to go to sleep or to delay a feeding for a short time. The disadvantages are that, when given to a new baby who is trying to nurse, it may cause "nipple confusion" because the mouthing movements used while taking a pacifier are different than those used while nursing. Wait a few weeks until nursing is well established before introducing one. Pacifiers have been linked to the spread of infection in day care settings, and the practice of tying one around the neck has resulted in strangulation of some babies. If you choose to use one, I would recommend you take it away by about 4 to 6 months to avoid the baby becoming too attached to it.
HOW DO I KNOW IF MY BABY IS GETTING ENOUGH TO EAT?
If the baby is gaining weight at a normal rate he is getting enough food. Generally speaking, if a baby sleeps three to four hours between feedings he is getting enough. An average baby takes 2-3 oz. per feeding between one and two weeks of age, and about six to eight ounces by the end of the third month. Overfeeding may cause symptoms of vomiting, colic, gas and diarrhea. It may also create a habit of over eating which may persist into adult life and lead to obesity.
WHEN SHOULD SOLID FOODS BE STARTED?
It is generally agreed that solids should not be started until four to six month. Solids are sometimes started earlier in an attempt to help babies sleep better at night in the belief that they will "stick to the ribs" better than milk. Studies have shown that most babies given solids at night do not sleep any better. It is common for babies to go through a "hungry period" which starts at about two weeks of age and lasts about three weeks. During this time they are waking up every few hours and seem hungry all the time. Giving solids won't help and may prove to be difficult because babies under two to three months have an extrusion reflex which causes them to push out anything that is put in the mouth. It's not usually considered a good idea to put solids in a bottle or use an Infafeeder. The lining of the intestine isn't fully formed until about six months of age. During that time it is easier for food proteins to get into the blood stream and sensitize a baby to that food. For this reason, the longer you can wait to introduce solids the less likely the child is to develop food allergies. Most parents can tell when a baby isn't satisfied with just milk. A large baby with a vigorous appetite may have to be started on solids before four months.
HOW SHOULD I INTRODUCE SOLID FOODS?
It important that when new foods are introduced into the diet that not more than one new food a week is given. This gives you time to watch for any signs of allergy which may show up. The order in which foods are introduced isn't terribly important, but I recommend that rice cereal is started first, then the other cereals are introduced one at a time, then the vegetables and then meats. Most babies don't care much for plain meat but will take the meat and vegetable combinations. I save fruits and juices until last for two reasons: first I don't want the child to develop a" sweet tooth," and second, there is little nutritional value in fruit and juices....they are mostly sugar and water with a little vitamin C. Another reason is that breast milk has just barely enough protein for good growth. If many non-protein foods like fruit, puddings, deserts and juices are given, the baby may not grow as well.
WHAT DO BABY FOOD STAGES MEAN?
Stage 1 foods contain single grains, fruits or vegetables, but none of the foods that commonly cause allergy such as milk, wheat, egg, citrus or corn. Stage 2 are combination foods to provide babies 6 months and older with added flavor and variety in their diet. Stage 3 are foods with a wider range of texture so babies about 9 months old can use their new teeth to chew. They come in a larger (6 oz.) jar.
DOES BABY'S FOOD HAVE TO BE WARM?
There is nothing wrong with giving a baby cold formula or solids if he will take it. Some babies will refuse cold formula or solids but some prefer them cold.
WHAT FEEDING SCHEDULE SHOULD I USE?
New babies should be fed on demand, i.e. whenever they act hungry. As far as solid foods are concerned, it seems to make little difference whether the baby is fed one, two or three times a day at first. Of course, as solids become more a part of the diet you will want to work into a three-times-a-day schedule. It's hard to make specific recommendations as to what foods to serve at which meals. Most mothers give cereals in the morning and sometimes at night. Some give vegetables and meats at noon and some at night. In truth, it doesn't seem to matter.
Toddler or "second stage" food is more chunky than strained food, but is not any more nutritious. Don't be in too big of a hurry to start these and other coarse foods such as crackers, hot dogs, whole kernel corn and peanuts for fear the baby may aspirate them into the lungs. There is no set age for introducing these foods. You just have to observe how well you child handles foods of increasing coarseness.
CAN I MAKE MY OWN BABY FOODS?
I think it would be risky to alter a baby's formula by adding extra water, Karo syrup, brewer's yeast, protein powder, molasses or anything else without consulting me first. It's hard to make cereals which will match the commercial brands for nutrition, taste, texture and digestibility. Vegetables can be pureed in a baby food grinder or a blender. They could then be frozen in ice cube trays, put in plastic bags, then thawed and used whenever needed. A little salt or sugar may be added to infant foods. Meats are hard to grind fine enough for young infants.
DOES MY BABY NEED VITAMINS?
Formulas are supplemented with all the vitamins a baby needs once it is taking one quart a day. Breast milk has enough of all the vitamins except vitamin D if the mother is receiving enough in her diet. For a breast fed infant I recommend a non-prescription mixture of vitamins A, D and C (Tri-vi-sol or a generic equivalent) until six months old and then going to a prescription preparation containing all the vitamins plus fluoride (like Poly-vi-flor). At about age two I would change to a chewable tablet if the child doesn't eat fruits and vegetables well. The child that is a good eater and is offered a good variety of foods to eat doesn't need extra vitamins.
DOES MY BABY NEED FLUORIDE?
After years of controversy, most scientists, the American Dental Association, the American Medical Association and the American Academy of Pediatrics have concluded that fluoride will significantly reduce the occurrence of cavities and is safe when given in the recommended amount. It is true that large amounts of fluoride are toxic but so are large amounts of iron, vitamins D and A, calcium, salt and even water.
Fluoride is often included in vitamin preparations but can be given separately as drops or tablets. A prescription is required. It should be given until sixteen years of age. It should not be given with milk because it will combine with the calcium. We used to start fluoride at birth, but it is now recommended that it be started at six months. The dose is determined by the amount of naturally occurring fluoride in the water. In this area where we have almost none, the dose is ; 0.25mg from 6mo. to 3yrs., 0.5mg from 3-6yrs., 1.0mg from 6-16 yrs.
DOES MY BABY NEED IRON?
Babies are born with enough iron stored in their bodies to last about three to four months. Iron deficiency may develop if iron containing foods are not introduced at this time. Signs of iron deficiency include: anemia, irritability, poor appetite, disturbed sleep patterns, and pica ( eating things such as dirt, paint, plaster etc.), but a child can be iron deficient without any of these signs. Iron deficiency in infancy has been linked to lower I.Q. scores and lower scores in school achievement tests later in life. Breast milk doesn't have much iron in it, but what iron is present is well absorbed so that iron deficiency is uncommon in breast fed infants. Babies on formula should be given the kind with iron. Baby cereals, meats, and egg yolks are good sources of iron.
WHAT ARE THE SYMPTOMS OF FOOD ALLERGY?
Many children have food allergies, and most allergies which show up in the first six months of life are food allergies. Common manifestations of food allergy include : cough, nasal congestion, colic, vomiting, diarrhea, eczema, wheezing, pneumonia, failure to grow well, refusal of food, hives, diaper rash, irritability and colic. If a baby develops any of these symptoms I would take him off the latest food you started him on, wait for the symptoms to go away and then try the food again to see if the same symptoms return.
DO FAT INFANTS MAKE FAT ADULTS?
This question has not been entirely answered yet. One's genetic makeup probably has more to do with whether one is obese than anything else. If both parents are obese the child has a high probability of being obese. We are more aware of obesity in infants than ever before, but as yet do not know to what extent we should try to control it. Certainly overfeeding should be avoided. Some parents commonly give children food whenever they are in pain, frustrated or angry even though they are not hungry. Eating then becomes a means of dealing with stress and may play a part in adult obesity.