Feeding

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

In the first one to three days, the baby may tend to be more sleepy than hungry. Don’t be discouraged, the baby will soon become more interested in eating. In the first few weeks, feed the baby whenever he is fussy and hungry. On the average bottle feeders will eat every three to four hours, whereas breast feeders should average two to three hours.

The amount the baby takes will vary. Do not try to force a baby to take more than is desired. And remember, whether breast feeding or bottle feeding, hold the baby comfortably close.

Breastfeeding

Breastfeeding can be a wonderful experience for mother and baby. In the hospital, you will receive instructions and help on how to initiate breast feeding including proper latch-on and positioning.

Several points to remember about proper positioning are:

• Use pillows to help support the infant at breast height. Elevating your feet on a small stool helps to relieve back discomfort.
• The infant’s head, shoulder and buttocks should be in alignment.
• The infant’s top and bottom lip should be flanged out. Try different positions throughout the day to facilitate complete emptying of the breasts.
• For proper latch-on, the infant should have an inch or more of the areola in his mouth.

Your breasts initially produce colostrum, which despite seeming to be a small volume, is rich in nutrients and antibodies. Your milk supply will come in approximately 3-5 days after delivery. Milk production works on the principle of supply and demand. The more your baby breastfeeds, the more milk you will produce. Babies who are given supplemental bottles of water or forumla breastfeed less frequently, decreasing the breast milk supply. Babies need to be breast fed at least 8-12 times in 24 hours in the first 2-4 weeks. Most infants will feed every 2-3 hours. It takes the average infant approximately 10-15 minutes to empty a breast.

There are several signs that will ensure you your baby is getting enough breast milk:

• 6-8 wet diapers in 24 hours
• 2-5 stools in 24 hours
• audible swallowing during feeding
• baby is satisfied between feedings

As a breastfeeding mother, you need to eat a healthy, well balanced diet and drink plenty of fluid. Contrary to popular belief, there are no specific foods that must be avoided by a nursing mother. There are very few illnesses or medications which are contradictions for breastfeeding. If you are given medication by another physician, please contact our office if you have been told to stop nursing. We can help you determine whether pumping may be helpful for a short time until your ilness or course of medication has resolved or another medication might be more compatible.

“Growth Spurts” are when a baby suddenly wants to nurse more often. This frequent nursing is the way in which the baby increases his mother’s milk supply. Growth spurts commonly occur at 10 days, 6 weeks, and 3 months of age. A growth spurt usually lasts 24-48 hours.

Once your breast milk supply is well established, you may choose to express breast milk. Expressed breast milk will keep in the refrigerator for 5 days and 6 months in a freezer.

Remember, breastfeeding is learned. Some references you may find helpful are:

• New Mother’s Guide to Breastfeeding, by Joan Meek
• The Nursing Mother’s Companion, by Kathleen Huggins
• Nursing Your Baby, by Karen Pyor

Bottle Feeding

Babies can grow quite adequately on any of the commercially prepared formulas. Vitamin supplements are not necessary for formula-fed infants.. However, an iron fortified formula is necessary for adequate iron intake. Formula should be used for the first 12 months before cow’s milk is introduced.

Prepared formulas keep in the refrigerator for up to 48 hours. You may warm the formula to room temperature in a pan of hot water or with a bottle warmer, but be sure to check the temperature of both the nipple and formula before giving to the baby, as it is very easy to burn the baby’s mouth. Do not warm the formula in the microwave oven because of uneven heating of the formula and the bottle.

Bottle fed babies, as breastfed babies, should be fed on a demand schedule allowing flexibility. Generally, bottle fed infants will eat every three to four hours. Burping is necessary for bottle fed infants because they swallow air during feedings. A baby’s intake will vary at times. Do not force him to complete the bottle. Bottles should never be propped or given in a crib. Bottle propping may cause accidental choking and robs the infant of the physical contact and nurturing which are important parts of nutrition.

Sleeping Positions

There is scientific evidence that there is a greater risk of SIDS (Sudden Infant Death Syndrome) in infants sleeping on their stomachs. The doctors of Pediatric Associates, in agreement with The American Academy of Pediatrics, recommend that infants be placed on their backs to sleep.

Burping

Whether breast or bottle feeding, babies swallow air, some more than others. Attempt to burp your baby once or twice during feeding. He may not always need to burp. If the baby seems to be guzzling a lot of air, or seems to be “full” before the end of the feeding, you may need to burp more often. This is done by placing the baby over your shoulder and firmly patting or rubbing the lower back, or by placing the baby across your lap face down and patting or rubbing the back. It is common for the baby to spit up a mouthful of milk when he burps.

Spitting Up and Vomiting

Many babies spit up after each feeding or while burping. It is helpful to keep the baby upright and not to be too vigorous in playing with the baby for about 30 minutes after feeding. More frequent burping may also be necessary. When laying the baby down to sleep, have the head of the bed elevated. Babies may also have forceful “projectile” vomiting on occasion. If your baby does this frequently or repeatedly, you should inform the doctor.

Gassiness

Most babies have a moderate amount of gassiness. If the baby is burping well and passing gas easily, there is no problem. If, however, the baby is having a lot of stomach cramps and crying due to the gas, you should inform the doctor. Breastfed babies who are gassy or colicky may improve by making sure to empty the first breast completely before offering the second side. This pattern increases the percentage of hindmilk the baby receives. Hindmilk has higher fat content with less lactose. Sometimes high lactose containing milk causes bloating and gas.

Weaning

You should nurse your baby as long as you like. There is good scientific evidence of the benefits of breastfeeding during and through the first year of life. If you want to wean to a bottle, you should use either expressed milk or infant formula. It is best to discuss this with the doctor before changing. When mothers return to work, it is helpful to wean slowly. Change only one daily feeding to a bottle. Wait several days to adjust to the new schedule, then change another feeding to the bottle. Some mothers like to change over all the feedings except for the morning and evening breast feeding. Usually, the breasts are able to accomodate well to less regular feedings. To wean completely, just continue to substitute bottle feedings. Your milk production will decrease and finally stop and the baby will be weaned.

Pacifiers, Water and Solids

In the first few months of life, babies sometimes just want to suck, even though they may not really be hungry. This is normal, and pacifiers may be very helpful in filling this need. Although babies do not need extra water, there is no harm in giving one to two ounces of water between formula feedings, on occasion. Breastfed babies do not need extra water. After the first month, you do not need to boil the water unless you use well water

Solids (cereals and baby foods) are not added to the diet until after six months of age. Rice cereal is usually offered first. Baby food fruits and vegetables may be added slowly over the next month or two. Start with several spoonfuls per feeding once daily. Gradually advance to two times a day, with greater amounts if the baby wants. There is no set amount of solids that a baby should take, but remember, breastmilk or formula are the most important part of an infant’s diet.

Non-citrus juices may be offered in the early months for a snack or may be helpful if the baby is constipated.

Because your baby may have a sensitivity or allergy to a particular food or juice, indicated by vomiting, diarrhea, stomach pains, gas or hives, we recommend trying only one new food or juice at a time. Give that new food for at least three days before introducing something else new. Foods the baby has taken with no problems can be given at any time and in any combination.

Vitamins and Fluoride

Fluoride is necessary for the development of the teeth, from infancy to 13 years of age. The water supply in the City of Richmond, Henrico and Chesterfield Counties and most of Hanover County is adequately flouridated so no supplementation is necessary. If you use well water, the baby will need fluoride drops to be started after six months of age. Fluoride is not transferred through the breastmilk so breastfed babies will also need supplemental fluoride after six months of age. In addition, breastfed babies get vitamin A, D and C in combination with the flouride.

Ful term babies who are taking a normal amount of formula do not need additional vitamins as the daily vitamin requirement is provided in the formula. Premature babies may need vitamins in addition to the formula.

Bowel Movements

Stools normally vary in both color and frequency. In the first few days the baby passes dark pasty “meconium” stools. In 3 to 4 days, breastfed babies begin to pass yellow, seedy, mustardy stools. Breastfed babies will not have true constipation because of the make up of breastmilk. Occasionally, these babies will have infrequent stools as a part of the maturation process. They do not require any adjustment in diet during this time. Bottle fed babies may pass green, brown, or yellow stools. Stools may occur after each feeding or only once every few days. The frequency is not that important. The stool consistency may be runny, soft, pasty or formed. All babies may strain a bit to pass a stool. If the stools are not hard pellets and not causing a lot of pain and distress, they are okay. If they are hard pellets, you may add one teaspoon of Karo syrup to four ounces of formula twice a day. Do not use suppositories or enemas without consulting the doctor.

Care of the Cord

While the cord is still attached, keep it clean. Fold the diaper down so as not to cover the cord. This will help the cord dry and allow it to fall off usually by three weeks of age. You may see some slight bleeding for several days before and after the cord falls off. Call the doctor if the navel area becomes red, appears infected, or develops a foul odor.

Care of the Genitals and Circumcision

Most maile infants born in this country are circumcised in the newborn period. Newborn circumcision is a rapid and generally safe procedure when done by an experienced operator. The most common complications are local infection and bleeding. Benefits include improved hygiene, decreased incidence of cancer of the penis and decreased chance of urinary tract infection.

If you desire circucision, let your obstetrician know and he will do the procedure on the second or third day. For several days after, the penis may be irritated and stick to the diaper. For that reason, cleanse the area with warm water and lubricate the whole end of the penis with Vaseline at each diaper change for five or six days after the circumcision.

If uncircumcised, gently pull back the foreskin to wash the area with a warm washcloth. For girls, separate the labia gently and wash the area with a warm washcloth. There is often a slight mucus or bloody vaginal discharge in the first week of life. It is due to the hormone changes and is of no concern.

Diaper Area

To help avoid diaper rash, change the baby frequently and was thoroughly but gently after each change. It is preferable to simply use soap and water on a washcloth. Be certain to use a dry cloth to dry the area. Baby wipes are convenient when away from home but sometimes cause irritation. If a rash develops, try to keep it exposed to the air as much as possible during the day. Destin or A&D Ointement can be helpful. If the rash continues to get worse or develops sores, consult the doctor.

Skin Care and Bathing

Until the cord falls off (one to three weeks), sponge bathe the baby using a mild soap (Camay, Dove or Baby Magic). The face, hands and bottom need the most attention. After the chord falls off, regular tub baths are okay. Wash the hair and scalp with a mild shampoo but not on a daily basis. Don’t be afraid to was over the “soft spot” on the head. Rinse well and avoid using oils on the scalp.

You should use plain water on the face, avoiding creams, lotions, soaps or oils. It is not unusual for there to be a red, pimply rash on the face off and on for up to three months of age. Lotions and creams may make this worse; just continue to use plain water and keep the skin dry. If the baby has dry skin in other areas, mild skin lotions are okay to use.

Baby powder, while sometimes helpful in the diaper area, must be used carefully as it can be inhaled and irritate the lungs.

Coughing, Sneezing, Hiccuping and Crying

All babies sneeze, yawn, belch, hiccup, pass gass, cough, and cry. Sneezing is the only way a baby can clean his nose of mucus. Hiccups are spasms of the diaphragm muscle and may occur after each feeding. Coughing is the baby’s way of clearing the throat. Crying is a way of saying “I’m hungry”, “I’m wet”, “I’m thirsty”, “I want to turn over”, “I’m too hot”, or “I’m to cold”, “I have a stomacheache”, or “I’m bored”. You will learn to know what the baby means. Even a well baby will probably cry for a little while each day and could cry for an hour or so occasionally without doing himself harm.

Nasal Congestion

Many babies develop mucus in the nose in the first few months of life. Their breathing may sound very “snorty”. Using a vaporizer or humidifier is helpful to keep the mucus loose so the baby can sneeze it out. Use the rubber bulb aspirator to suck out the mucus. If it is too thick, you can help dissolve and loosen it by using saltwater drops. You can buy this saline solution with a dropper in any pharmacy or use the homemade recipe that follows. Put two drops in each nostril, wait 30 seconds, then use the bulb suction. Most babies don’t like this being done, but it is helpful. You can do this as often as necessary, but the best times are right before feeding and before bedtime. You may also raise the head of the bed to help keep the congestion from pooling in the back of the nose. We try to avoid using medication (decongestants, cough/cold remedies or antihistamines) in babies less than a year old.

Recipe for Hypertonic Saline (saltwater) Solution:

1. Boil 1 quart of tap water and let it cool (or use distilled water, which does not need to be boiled).
2. Add 2-3 teaspoons of pickling salt or “sea salt”. (DO NOT use regular table salt — it has unwanted additives.)
3. Add 1 teaspoon of baking soda as a buffer (bicarbonate) to eliminate most of the stinging nature of the salt.

Eyes

Your baby may appear to be cross-eyed or to have a lazy eye. This is not uncommon and usually resolves in the first three or four months of life. You may notice some increased tearing from one or both eyes as well as some dried mucus in the eyes in the morning. This is often due to a blocked tear duct, preventing tears from draining normally into the nose. To help relieve this, keep the nose clear using the nasal aspirator bulb. Wipe the mucus from the eyes with a warm washcloth and massage the inner corner of the eyes with your finger several times a day to help loosen the tear duct and improve the drainage. This problem may develop off and on in the first few months of life. In contrast, eye infections usually cause the eye to be red (bloodshot) and produce a yellowish thick drainage all through the day. If this occurs, contact the door.

Restless Periods and Sleeping

Babies vary in their need for sleep. Some babies prefer to sleep between feedings while others stay awake. Most babies will have a fussy period each day. Between 6 p.m. and 10 p.m. is a common time. Nothing is wrong and you should be patient and reassuring to the baby. Movement such as rocking and walking with the baby can be helpful. The more anxious you are with the baby, the more tense and fussy the baby will be.

Jaundice

Many babies look yellow in the first week of life. This is due to a buildup of bilirubin in the baby’s blood and tissues. Bilirubin is a yellow pigment and a normal breakdown product of red blood cells. Bilirubin is cleared in the liver and then passed in the urine and stool. Often in newborns the immature liver does not clear bilirubin fast enough; therefore, it is distributed throughout the body making the skin look yellow. This develops over the first two to five days of life. If too much bilirubin builds up, it can make the baby sick. Often the doctor will test the bilirubin level by a blood test. If the level is high, he may place the baby under special “bililites” which help bring the level down. Once resolved, the baby is not troubled by jaundice again. After you go home, if the baby appears to be increasingly yellow, contact the doctor.

Clothing and Going Outdoors

It is okay to take the baby outside in reasonable weather. Babies do not always need to be bundled heavily, inside or out; however, their heads should be covered when outside. If you need heavier clothing when going outside, the baby does also. You are the best judge of that.

Too many people handling the baby exposes him unecessarily to many germs and viruses. Those who do handle the baby should wash their hands frequently as viruses are passed by fingertips more than by coughing or breathing on the baby.

Smoking

Children are very sensitive to any irritants in the air. They may develop nasal congestion, runny nose, coughing or wheezing. The congestion may lead to ear infections or bronchitis. Even occasional smoking in the house may be enough to cause trouble. Smoking outside or away from your child is not helpful because the odor remains on hair and clothing. Be considerate of the baby’s breathing and, hopefully, others will too.

Siblings, Fathers and Pets

Young siblings of a newborn will feel some resentment toward the new arrival. Not only does mom fix her attention on the baby and expect an older child to take care of himself, but there is the fear of being replaced by the baby altogether. It is important to bring the older child in to help with the newborn so that he feels part of the team and gets to bond with the baby. It is also crucial for parents to spend time alone with the older child away from the baby to let him know that he is still important and not being replaced.

Dad can also feel left out at times. It is important to bring Dad in as much as possible to feed, change diapers and hold the baby. His help will also allow mom some time to rest or be with the older child.

Pets can act very much like older siblings when a new baby comes home. However, they adjust rapidly and soon accept the baby and can become very protective.

In the first two months of life, call the doctor if

1. Rectal temperature is 100.5°F or more. This chould be anything from a cold to a very serious infection. Since it is difficult to tell which, the doctor would need to evaluate the baby.
2. Forceful vomiting occurs more than once (not just “spitting up”) or if feeding is refused several times in a row.
3. Diarrhea occurs with increasing frequency.
4. Coughing is constant.
5. The baby is listless or unresponsive.
6. There is any unusual rash.

Car Seats and Travel

A safe, secure car seat of the proper size is the most important item you should have for your baby. The best place for the car seat is in the middle of the back seat, positioned so that the baby is facing backwards (to the rear of the car). This is because in a head-on collision, the baby’s head won’t be thrown forward (whiplash). It is never safe to hold the baby in your arms. Virginia State Law requires a child to be in a car seat up to 40 pounds or four years of age. After that seat belts are required. A consistent routine of buckling up your baby and yourself for every drive will avoid trouble in getting them to buckle up later on.

Infant and child restraints:
Effective July 1, 2007
3 New Changes to
VA Child Passenger Law

1. All children under age eight must be properly restrained in a child safety seat or booster seat.
2. Rear-facing child safety seats must be secured in the back seat of a vehicle.
3. Children can not ride unrestrained in the rear cargo area of a vehicle.

• The safest place in a car for all children is the rear seat.
• Never place a rear-facing infant seat (child under one year and 20 lbs.) in the front seat of a vehicle with a passenger-side air bag.

Violations will result in a $50 fine

Does this affect me?
The law applies to anyone (i.e. parents, grandparents, babysitters, friends) who provides transportation for a child in any vehicle manufactured after January 1, 1968.

What type of safety seat should I use?
Rear-Facing Seat
Birth to at least 1 year AND At least 20 pounds

Forward-Facing Seat
Age 1 to about 4 AND At least 20 pounds

Backless Booster Seat and High Back Booster Seat
About age 4 to age 8 AND Under 4-feet 9-inches tall

What about my older children?
All children between their 8th and 16th birthday must be properly restrained by a child restraint system or a safety belt. Violations will result in a $50 fine.

Remember…
Law enforcement officers can and will stop and ticket any driver of a vehicle where children under 16 years of age are not properly and safely secured.
For more information about the law or child passenger safety contact the Virginia Department of Health, Division of Injury and Violence Prevention 1-800-732-8333 or visit www.vahealth.org/civp.

Back to Top