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Newborn Care: Feeding

Feeding is one of your baby’s first pleasant experiences. At feeding time, your baby receives nourishment both from the food and from your love.

Both of you should be comfortable. Make sure your baby is warm and dry. Choose a comfortable chair. Hold your baby in your lap, with his head slightly raised and resting in the bend of your elbow. Whether you are breastfeeding or bottle feeding, hold your baby close to your body in a comfortable position.

All newborns lose weight during the first few days regardless of how they are fed. This is a loss of excess fluid and not of body substance. Newborns are saturated with fluid, like a sponge soaked in water. The bigger they are, the more they hold, so to speak. Do not be concerned if your baby loses as much as 10 percent of the birth weight before starting to gain weight.

Some babies are congested at birth or shortly thereafter. Babies are obligate nose breathers, meaning they can only breathe through their nose and not their mouth. If your baby is having trouble feeding because of congestion, place a couple of saline drops in his nostrils and use the aspirator to suction out the nose before feedings. Saline drops are available over-the-counter, or your pediatrician can tell you how to make them.

 Breast Feeding
Unquestionably, breast milk is the ideal food for a newborn. It provides the proper nutrients in the right proportions. It offers definite immune benefits, is instantly available and is free. Breast-fed babies are less constipated, have less colic and diarrhea, experience fewer colds, ear infections and skin rashes, and are less likely to develop allergic problems. There are very few medical conditions that prohibit breastfeeding.

It is recommended that breast-fed babies receive supplemental Vitamin D, which can be found in over-the-counter infant multi-vitamin drops.

 How to Nurse

  1. Get comfortable. Lying on your side leaning forward slightly or sitting in a well-cushioned chair are comfortable positions.
     
  2. There are two positions to hold your baby for breastfeeding. You can hold your baby completely on his side (belly to belly with yours), or you can hold your baby under your arm like a football.
    • For the belly-to-belly position, place your thumb and index finger in a U shape and lift your breast.
    • For the football position, place your thumb and index finger in a C shape and lift your breast.
       
  3. Tickle the baby’s lips up and down with the nipple until your baby opens his mouth. Be patient and wait until the mouth opens wide. Quickly draw your baby close in to you. You want your baby to suck behind the nipple on the brown area. Sucking on the nipple is painful. If painful nipples persist, be sure you are following this technique.
     
  4. Hold back the breast from your baby’s nose with your fingers so he can breathe easily while nursing.
     
  5. You can use both breasts for each feeding, alternating the beginning breast at each feeding; or, you can use one breast for each feeding, alternating the breasts every other feeding.
     
  6. In general, babies empty a breast in 10 minutes. You may nurse as long as you like on each side, but do not allow the breast-feeding to be used as a pacifier. As time goes by, you will become familiar with the feeling of an empty breast and will change to the other side for the second half of the feeding. Remember, if you have sore nipples, you need to recheck the technique to be sure your baby is not sucking the nipple itself.
     
  7. When finished, press down gently on the part of the breast next to the corner of your baby’s mouth or gently insert your fingertip into the corner of the mouth, breaking the suction. This allows for gentle removal of the nipple.

 

  How Often to Nurse

  1. Often with the first feeding, the baby is not very wide-awake, hungry or interested. If your baby keeps falling asleep during feedings try to find methods that will wake him up to finish feeding, such as changing his diaper between breasts, undressing him or tickling his feet.
     
  2. Make every attempt to feed your baby the immune-rich colostrums whenever he is awake. Usually the milk comes in on the third day. Sometimes you won’t even know the milk has come in except for the slurping you hear while your baby is sucking. Your breasts will then begin to feel more comfortable as the milk leaves the breast.
     
  3. It takes several weeks to establish a stable milk supply. Most babies will want to nurse very frequently. This does not mean you do not have enough milk. The more your baby wants to suck, the more your breasts will be stimulated to produce milk. However, do not nurse your baby more frequently than every 2 hours from the start of one feeding to the start of the next feeding. As babies are able to last longer between feedings, your milk supply will adjust itself to the demand of your baby. Be careful of using frequent formula supplements, as too many of them will decrease the times your baby sucks, thereby decreasing the amount of milk you produce for the next day.
     
  4. Since the only real stimulus to milk production is emptying the breast, frequent nursing helps build up your milk supply. You can, however, get to a point of diminishing returns if your baby is nursing every hour. Fatigue, tender nipples and shortened filling times may reduce the quality of milk. Talk to your pediatrician if this happens or consult the lactation consultant at your hospital. He or she can be a great source of support and information.

 

  Care of Nipples

  1. Wash hands thoroughly with soap and water before touching your nipples.
  2. Wipe nipples with clean water before and after nursing.
  3. Leave bra open and nipples exposed to air for five to 10 minutes after nursing.
  4. Remember, if nipples are sore, the nursing technique needs to be adjusted.

 

  Going Back to Work
Mothers who are returning to work or who will be spending time away from their babies can supplement breast-feeding with bottle-feeding. Expressed breast milk or formula can be fed to babies in an infant bottle.

Even though exclusive breast milk feedings have been shown to be ideal, any amount of breast milk is helpful. The breast milk provides immune protection through antibodies, which are not found in formula. Breast milk feedings as little as once a day can be beneficial. Your body and milk production will soon adjust to the level of breast-feeding that you choose.

Some experts believe if you know you will need to supplement when returning to work, it is helpful to offer one bottle per day beginning after your baby is 2 weeks old. This will ensure a good breast-feeding foundation and help your baby be receptive to the bottle when needed. The bottle is often best received when given by a support person other than the baby’s mother. It may also be helpful to give the bottle during the time of the day your baby will receive it when mom returns to work.

For those mothers returning to work it is often recommended to obtain an electric breast pump. These can be rented from hospitals or purchased at baby stores. After the immediate newborn period and when you are sure your baby is gaining weight well, you can begin to express additional breast milk for storage. Also, when you return to work you can take your pump with you. Many work places provide mothers time and space to pump at work. Breast pumps and infant bags have cooling compartments to keep milk cool until you get home. There are also car adapters, which allow for breast pumping in the car (not while driving please).

 

  Storing Breast Milk
After expressing breast milk, it is recommended to store it in a refrigerator for immediate use or in a freezer for later use. If necessary, breast milk can stand at room temperature (66-77° F) for up to 4 hours. Otherwise, if you plan to use the milk within 24 hours you can store it in the refrigerator or cooler bag. If you are storing breast milk for later use you can freeze it in a zero degree freezer for up to six months.

Breast milk can be defrosted in a refrigerator over night or by running it under warm water. Refrain from running the bottle under hot water or heating it in the microwave as some proteins in the breast milk may be destroyed at high temperatures. Once breast milk is thawed, feed it to your baby within 24 hours. Be sure to shake well prior to use to evenly distribute all milk components. Discard any unused milk, and never refreeze unused or partially consumed breast milk.

 

  Formula Feeding
Another option for infant feeding is infant formula. Formula can be used alone or along with breast-feeding as a supplement. Infant formula companies continue to make advancements in an effort to make formula more similar to breast milk. The most recent advance has been the addition of DHA and ARA to formulas. These are amino acids previously found only in breast milk and are felt to aid in visual development. If you choose to formula feed you can feel comfortable that these products will provide adequate nutrition for your baby.

Formulas come in three forms:

  • Powder -- intended to be mixed with water
  • Concentrate -- liquid formula to be mixed with equal parts water (1:1 ratio)
  • Ready to feed -- a fully prepared formula, which can be opened and fed directly to your baby

It is important to be aware of which type of formula you are using and pay close attention to the mixing instructions. Adding too much or not enough water can lead to improper nutrition, and can also lead to serious illness.

Formulas are also available in a variety of milk options. Most infants begin with a cow’s milk based formula. There are also soymilk, lactose free and predigested formulas that may be recommended by your pediatrician in different situations. All infant formulas have the same calories, iron and nutrients unless specifically stated. Do not change your infant’s formula without first discussing it with your pediatrician.

It is recommended that formula or breast milk be used the entire first year. Whole milk does not provide adequate iron, vitamins or nutrients and may be irritating to your baby’s stomach.

The amount of formula your baby eats will vary. Newborns generally take between 1 to 3 ounces every 3 to 4 hours. Babies may want to eat more than they need to, which may result in large spit ups. If this occurs, feeding your baby smaller amounts more frequently may be helpful. Sometimes your baby may not be as hungry at a given feeding time. He may take less, but will probably make up for it at the next feeding. However, if the decrease in feeding is abrupt or persistent, you should contact us. Your baby’s intake will gradually increase as he grows. Signs that your baby is ready to increase his intake include desire for more to drink after a bottle is complete, or a desire to eat again more frequently.

 

  Water
Formula can be mixed with tap water from either the municipal water supply or a safe well. Bottled water may also be used, and purified or distilled bottled water is optimal. Do not use nursery water to prepare formula until your baby is at least 6 months old.

Well water should be checked before giving it to your baby. If you are unsure of the quality of your water supply, you should not give it to your baby or drink it yourself.

Do not give your infant water to drink from any source until they are at least 6 months old, unless it is part of properly mixed formula. Too much water in an infant's system can cause seizures and other medical problems.

 

 Sterilizing Bottles
Because of improvements in sanitation and municipal water supplies, it is no longer necessary, in most cases, to sterilize your baby’s bottles. Bottles, caps and nipples should be thoroughly cleaned with hot soapy water or washed in an automatic dishwasher. Sometimes the high temperature in the dishwasher will seal the hole in the nipple. If the milk does not flow easily when the bottle is inverted, you should re-puncture the nipple or buy a new one.

 

  Spitting
Spitting can occur because your baby has overeaten or swallowed too much air while vigorously eating. A mouthful or two is not a cause of concern. Some babies who are spitters need special handling after they eat. Instead of putting them in an infant seat, which brings the knees up, putting pressure on the stomach, it sometimes helps to have them stretch out on their backs or sides with the head of the crib slightly elevated. If you do this, put a folded towel or blanket under the mattress, not under your baby.

If you are concerned about the amount of spitting or if you think your baby is spitting up most of the feeding every time, then you must bring him in to your pediatrician to be weighed and examined. A baby who spits up, but continues to have good weight gain and is not fussing is usually fine.

If the spit up is a large amount, discolored (yellow or green) or projectile (shooting out of the mouth with force), you should contact us.

 

  Burping
Burping is a way of expelling swallowed air. Even though he was fed properly with the nipple always full of milk, a baby sometimes needs a little help in expelling swallowed air.

Hold your baby upright over your shoulder or sitting upright on your lap and gently rub or pat his back. Laying your baby over your lap on his stomach while patting the back is another method.

In the first few weeks, burp your baby after about every five minutes or after every ounce until you learn how often he needs it. Do not worry if your baby does not burp, sometimes there is no burp to be had.

 

Updated February 2016


Caring For Your Newborn
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