Nutrition

Breast feeding

Feedings:

Breastfeeding

Most babies will be satisfied with breast milk or formula alone and will not require solids during the first few months of life. Park Street Pediatrics highly recommends and strongly supports families wishing to breastfeed their infants and will work together with trained lactation specialists both in the hospital and office settings. Breast milk is superior to infant formula feedings and is uniquely designed to meet the nutritional needs of your new infant.  It is easy, inexpensive and convenient, there are no bottles to wash or powders to prepare and provides a special bonding between infant and mother.  Breast milk is easy to digest and there are fewer problems with digestions, constipation and diarrhea.  Breast milk has been associated with reducing the risk of respiratory infections including otitis media (ear infections), gastroenteritis, atopic dermatitis, childhood leukemia, inflammatory bowel disease, sudden infant death syndrome and may decrease the risk for developing obesity in adulthood.  Mothers who breastfeed have a reduced risk of developing Type II diabetes, breast and ovarian cancers.

As a general rule, we recommend feeding on demand for your baby in the newborn period. Babies will regulate their intake very adequately and will balance feeding and sleeping needs. Every family is different and sometimes a schedule will work better for you, the baby and other members in the household. We encourage you to try different methods to find what works better for your.  In general babies usually breast feed at least 8 – 10 times a day, feeding every 2-3 hours and occasionally a little more frequently (cluster feedings). You should wake your baby for feedings if he/she sleeps beyond 4 to 5 hrs in the first few weeks of life.  Your breasts should feel full before feedings and softer after nursing.  There should be several wet diapers and several bowel movements per day.  Many newborns will loose a little weight during the first few days of life, but subsequently are expected to gain ½ to 1 ounce per day during the first few weeks of life. Your pediatrician will monitor the progress of your infant with routine exams, following growth chart patterns and taking the time to listen to any issues and observations you might have.  This is the recipe for success.   Finally, if your doctor prescribes medications, please check with our office, or you can visit these websites for compatibility/safety information :

Toxnet Medlineplus

 

Here are a few key steps in getting started:

  • Wash hands with soap and water
  • Hold your baby close to your breast and turn baby so you are tummy to tummy
  • Hold a breast in your hand and gently stroke the baby’s lips with the nipple until the baby opens wide, your baby’s rooting reflex will make him turn to your touch.
  • Pull the baby onto your breast helping him or her to take in as much of the brown area of the nipple as possible.
  • Feeding sessions initially may last 20 to 40 minutes and may decrease to 10 to 15 minutes as your baby becomes more efficient at nursing later on.
  • To remove the baby from the breast, place your finger in the corner of the mouth to break the suction
  • Proper positioning of your baby on the breast and using different positions to hold your baby while nursing will reduce nipple soreness.

When situations arise where you need to be separated from your baby either because of work duties, school or other functions, you may wish to pump and store your milk ahead of time.  There are a number of different breast pumps available to meet your needs.BreastPumpHand_17472749

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Breast Pump Comparison

Breast milk may be stored in the refrigerator for 48 to 72 hours and may be stored longer when frozen (3 to 6 months depending on storage techniques).

A good way to remember how to handle expressed breast milk is the rule of 3s.  3 hours at room temp 3 days in refrigerator and 3 – 6 months in the freezer.

Remember to first cool breast milk in the refrigerator before freezing and always label with the date that it was pumped. You may thaw milk in the refrigerator or in warm water just before using, but this must be used within 24 hours.  While freezing breast milk is acceptable, it may decrease some if it’s protective antibodies.

You may introduce expressed breast milk in a bottle, or formula, if necessary at 2 to 3 weeks of age several times a week.  This is enough to get your baby used to a bottle, but not so much that it will compromise your breast milk supply.

Quick tips for common issues that may arise during breastfeeding:

1.      Sore nipples and painful breast feeding

Promoting proper latching on with positional changes of the infant at the breast and occasional use of pure lanolin or cooling gel pads on sore nipples often help.

Engorged breasts may respond to warm showers and towels followed by gentle expression of breast milk or alternatively expression with the use of an electric breast pump.

Sometimes simply applying breast milk onto sore or cracked nipples may promote healing and prevent infections.

2.      Mother’s perception of insufficient milk production

Supportive feedback by our pediatric office monitoring appropriate urine and stool production and weight changes will help clarify things.

3.      Let Down Squirts

Occasionally a newborn will be noted to be pulling away when feeding because of being overwhelmed from squirted letdown.

A simple change in maternal feeding position into a semi-reclining one may often resolve this problem.

4.      Mastitis:

Mastitis is an infection of the milk duct.  It usually beings with symptoms like a sore painful breast accompanied by feeling feverish with or without chills, similar to a flu-like illness.  Occasionally mothers note a small lump, which is warm to the touch, near their nipples.  If a mom uses a breast pump, she may notice that her milk on her affected side is unusually thick or may, in some instances, clot or clump in the collection bottle.

Solution: You may be able to prevent the development of the full blown picture by applying warm compresses, massaging the lump towards the nipple, resting in bed and nursing or pumping as much as possible on the affected side.  If the infection continues your doctor may need to prescribe antibiotics. Ibuprofen will help reduce swelling and fever and if taking antibiotics, taking acidophilus may help ward off yeast infections which can promote more plugging of your ducts.  Continuing to breastfeed while you are under treatment will help.  Very rarely, untreated mastitis can get worse and develop into a breast abscess that is difficult to treat, so take steps early to prevent this from occurring.

5.      Distracted or Interrupted Feedings

Distractions during breastfeeding may cause incomplete and increased frequency of feedings

A quiet and regular breastfeeding routine, which minimizes distractions for your infant, may resolve incomplete feedings and the increased feedings.

6.      Infant Biting of Nipples

Infant biting of nipple in those older patients (6-9 mo) may be dealt with by interrupting feedings.

In older infants biting of nipples may simply be addressed by interrupting feedings.  A quiet environment and regular routine help solve this problem as well.

7.      Food allergies caused by proteins in maternal breast milk are uncommon

Current evidence does not fully support maternal dietary restrictions during lactation.  However, if a mother feels strongly about dairy or other foods being the source of their infant’s problems simply eliminating the food in question for two weeks may help to answer this question.  These diets are difficult to maintain and can lead to early breastfeeding cessation so always talk to your doctor and lactation consultant when embarking on this path.

8.      What’s up with Herbal Remedies and Supplements

Many mothers worry about producing enough milk.  The general rule is drink plenty of water, juice or other non-alcoholic fluids, resting and nursing on demand. The jury is still out on whether herbs work to increase milk production.  No medical studies prove the effectiveness of these boosters, however many cultures have identified herbs and plants that may help.  It is reasonable to believe that some may help, however herbs and plants can have side effects.  Common ones used are Fenugreek, blue thistle, raspberry leave, fennel and brewers yeast.  These have been found to be safe herbal over the counter remedies that may increase milk supply.  Many natural food stores carry Mother’s Milk Tea, which combines herbs.

Herbs to avoid:  Among milk drying herbs you will find aloe, barberry, gingseng, ginger, goldenseal, green tea, cola nut, parsley, rhubarb, sage, yerba mate.

9.      Maternal Medications while nursing:

While it is generally best to avoid most medications while nursing, when it becomes necessary to take something, please call our office to see if it is compatible with nursing.  Use of acetaminophen, ibuprofen, nasal sprays (aphrin) are generally well tolerated.  Many antibiotics are usually also safe to use. Please contact our office, or check the links above for compatibility.

10.  Jaundice and breast milk

A condition called breast milk jaundice occurs in 1 in 250 babies appearing between 5 – 7 days of age, peaking between 10 – 21 days and possibly lasting up to 4 weeks or more after birth, and is a common occurrence.  40% of babies are diagnosed with some form of jaundice.  It is caused by a build up billirubin in the babies blood as the newborn’s liver, whose job during pregnancy was handled by the mother’s, is handled on it’s own.  This usually resolves on it’s own, however further intervention is occasionally required with phototherapy.  It is rarely necessary to stop breastfeeding a child with breast milk jaundice; your doctor will monitor your baby’s progress.

For infections – most antibiotics usually are safe (examples include amoxacillin, cefzil, keflex, penicillin, augmentin, suprex)

If you are taking other medicines, please call our office, or click links below.

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11.  Two known medical conditions to note

There are only two known medical conditions that may require weaning a baby from breast milk, these are Galactosemia and Phenylketonuria disorders which can lead to developmental disabilities. Newborns are tested for both of these conditions in the first days of life with routine state screenings. For more information, check our newborn screening section.

12.  Weaning

When the decision to wean is made, a gradual weaning is best for you and your baby.  Here are some tips:

Dropping one feeding ever week or so, will decrease the risk for engorgement and inflammation of breasts and is less stressful and easier for you and your baby.

Dropping the first and last feeding of the day at the end of the weaning process.

Replace those dropped session with another kind of special time.  Whether it be going for a car ride at nursing time, or having the father assuming some of the tasks or introducing a transition object such as a new toy, lullaby tape or book.

It may take a while for your milk to dry up.  It is not unusual to continue lactating after weaning.  Changing bras and the use of nursing pads to soak up leaking milk may help.

Other things that can help the weaning process:

Taking the weaning child on long car rides at nursing times.

Introducing a transition object:  example: a toy or a lullaby tape or book which the child can associate with bedtime or naptime rather than nursing.

Breastfeeding resources

LLLI

CompleatMother

BabyCenter

You may also visit our library of recommended readings

Bottle FeedingBottleFeed_16385413

If you should decide to bottle feed your baby we will help you choose the appropriate formula. The amount taken per feeding will vary and increase over time. Usually your baby will feed every 3-4 hours and feeding schedules will vary so you need to be flexible.  Commercial formulas come in several varieties.  Cows milk based formulas with iron are our first choice.  Low iron formulas contain insufficient amounts of iron for your growing baby and should be avoided.  Soymilk based formulas also provide adequate nutrition and are a good alternative for children who cannot tolerate cow’s milk protein.  Elemental formulas such as Alimentum, Nutramigen, Progestimil and Neocate are reserved for children with severe protein allergies.  Formula changes should be based on discussion between you and one of our staff members.

Generally it is unnecessary to sterilize bottles for formula.  Routine dishwashing and handling is sufficient.  Frequent hand washing prevents infection much more efficiently than any amount of sterilizing.  Babies may be fed formula at room temperature. Some babies will also tolerate formula right out of the refrigerator.  If you would like to warm formula, do so by running warm tap water over the outside of the bottle.  Other methods, including microwave heating, may decrease nutritional value of the formula; by altering it’s components.  Additional microwave heating might form hot pockets in the milk, making it extremely hot.

vitamins

Vitamins:

 

Vitamins as well as iron and fluoride supplements will be reviewed with you at the first office visit. Recently vitamin D requirements have been increased to 400 IUs per day in young children.