Babies

Breastfeeding

Breastfeeding is a special gift you can give your baby. It will give your baby the best possible start in life. Breast milk is easy to digest and provides nutrients in the amounts your baby needs to grow. Breast milk changes as your baby grows, protecting him or her from illness, infection and food allergies. Breastfeeding brings you and your baby closer, as it is a special relationship between a mother and a baby. Breastfeeding is convenient, the milk is always ready for your baby at the right temperature, and it is cost effective. Almost all women can breastfeed. However, breastfeeding takes time and patience in the beginning, both you and your baby need to learn how to breastfeed. Support from your partner, your family and other women who have breastfed can help. and after the first month or two, many women find breastfeeding easy, convenient, and enjoyable.

Getting Started

You will have many false starts, adjustments and restarts. You will also have many rewards. During the first few weeks of breastfeeding, avoid confusing your baby with other nipples such as pacifiers and bottle nipples. It does not matter whether your breasts are large or small. You will produce plenty of milk by nursing your baby frequently and by pumping your breasts. Frequent stimulation and removal of milk tells your body to make more breastmilk. Try not to worry. You will make the right kind of milk, in the right amount, and at the right time for your baby.

The first milk you produce is colostrum. Colostrum may look yellow and creamy at first, then it changes over the next week to a thin white liquid. Some women have a bluish white or light green color to their milk. Colostrum is rich in nutrients and antibodies that protect your baby. This milk also helps the bowels to work.
Breast milk is all your baby needs for the first 4 to 6 months of life. Avoid water or sugar water in the first several weeks after birth, as there are no nutrients to help your baby grow from these.

Breastfeeding Positions

There are many different positions in which to breastfeed, and you must find those which suit you and your baby. However, in the first two weeks you will need to guide your baby to ensure a good position and latch so he or she feeds properly.
Start off by sitting comfortably in an upright position, with as many pillows on hand as you will need. Put the baby on the pillow or your lap, depending on how low your breasts are, and turn your baby in to face you lying on his or her side -- tummy to tummy. It is almost impossible to breastfeed with your baby's head turned. When you latch the baby to your breast, bring him or her to you, not the other way around. When supporting the breast, make sure your hands are away from the nipple and not obstructing the baby's latch.

The Cradle Hold

This is a common breastfeeding position and works well when the baby has established a good latch. Cradle your baby in your arm with the baby's head in the bend of your elbow. Support your baby's body with your arm. Use your other hand to support your breast. Cuddle your baby close, facing your breast, with your baby's tummy and knees touching your abdomen.

The Modified Cradle

This is a modified cradle position and is the best position to start out with as it's easier to establish a good latch. The important part here is to hold the baby by the neck and shoulders, not just the head, so that the baby's head is slightly tilted back, ensuring a better latch.

The Football Hold

The football hold works well also for many women, particularly those women with large breasts, women with flat inverted nipples, or after a cesarean section birth. This position is also the most favored with women who are nursing twins. Hold your baby at your side, resting on your arm. Use a pillow to support your arm and to raise the baby to the level of your breast. Hold your baby's head in the palm of your hand with the baby's legs tucked in behind your arm by your side.

Lying Down

Lying down is a good position to learn in order to get some sleep while you breastfeed. This is also a good position to use after a cesarean section or with an older baby. Lie down on your side, supporting your back and head with pillows. Turn your baby on to his or her side to face you, with your baby's mouth at your nipple. Bring your baby to your breast, with the baby's tummy and knees touching your abdomen. Place a rolled up towel or small rolled blankets behind your baby to prevent the baby from rolling onto his or her back.

The Latch

Once your baby is in a comfortable position, he or she is ready to latch on. Brush your baby's lips gently with your nipple and aim for the roof of the mouth. Wait until his mouth is wide open, almost like a yawn. Bring your baby onto the breast so he or she takes a good deep mouthful, ensuring that your delicate nipple is at the back of the baby's mouth and not being damaged. This may take several attempts to get right at first. When the baby is correctly latched, the lips are flanged back and the chin is tucked closely onto the breast. The nose should be touching the breast but not pinched into it, if it is, tuck the baby's bottom in closer.

If the latch is correct there will be no sucking or dimpling of the baby's cheeks. The baby will begin with fast, short sucks which stimulate the nipple. When the milk "lets down" the rhythm will change to slower, deeper sucks and swallowing will often be heard. The jaw movement goes all the way to the baby's ears. Once of the most important signs that the latch is correct is that it is comfortable and does not hurt. To take your baby off the breast, or release the latch, insert your finger into the corner of your baby's mouth between the gums and break the suction. Do not attempt to pull the baby from your breast, as it is painful and can damage your nipples.

It is normal for your nipples to be tender during the first few weeks, even if you have breastfed before. After the first week your nipples should feel better, if not, often a small change in position improves the latch and makes a big change in comfort level for the mother.

How Often

Let your baby decide how often and how much to nurse. Every baby is different. Do not expect to follow a strict time table. Feed your baby whenever he or she is hungry. Learn to know your own baby's hunger cues. Signs of hunger may include sucking, smacking lips, searching with an open mouth, putting a fist into the mouth, or crying. Some feedings may be close together while others may be farther apart. A newborn will feed anywhere from 8 to 14 times in 24 hours. Frequent nursing will help establish your milk supply.

Your baby will have periods of rapid growth around two weeks, six weeks, 3 months of age and later. During these "growth spurts" your baby may want to feed more often, sometimes every hour! This does not mean your milk volume has decreased or that your milk is of poor quality. The more your baby nurses, the more you will produce. Your breast milk will increase to meet your baby's needs.

How Long

Let your baby decide how long to nurse. Some baby's finish a feeding quickly; others want to suck longer. When your baby has had enough milk, he or she will let go of your breast, stop sucking, or fall asleep. Babies seem to know how much is enough.

Let your baby finish nursing on one breast before changing to the other. The "hind" milk at the end of a feeding has more fat. This will help your baby feel fuller for longer. Your baby might nurse from both breasts at each feeding or only one. Alternate which breast is offered first. A safety pin on your bra strap will remind you which breast to start with for the next feeding.

Burping

Your baby may need to burp once or twice during and after a feeding, or not at all. If you need to burp your baby, hold your baby against your shoulder or face down in your lap. Pat or rub your baby's back gently. Any spit up is normal.

Breastfeeding Concerns

Sore or Cracked Nipples

These suggestions should help you heal your sore or cracked nipples.
Make sure your baby latches onto the breast properly. Most sore cracked nipples can be prevented by correct positioning or latch. Consult a lactation consultant if you need help.
Begin nursing with the breast that is less sore.
Apply a light coating of expressed breast milk on your nipples after a feeding and air dry. This helps to heal cracked nipples.
Avoid nursing pads made with plastic.
Between feedings, use ice or a cold wet towel on the sore area of the nipple to ease the pain.

Engorgement

Engorgement means very full, heavy, sore breasts. Engorgement usually happens two to five days after the baby's birth. It usually happens when milk is not taken out of the breasts often enough or in large enough quantities. Engorgement can be prevented by following these steps:

Before feeding from an engorged breast, you need to first soften the breast and nipple in order to have your baby properly latch on.
To soften the breast apply warm moist heat (use towels, clean diapers or take a shower) to your breast for two to five minutes. Massage the breast in a circular motion Start under your arm and work towards your nipple.
Hand express or pump enough breastmilk from your breast so the baby can latch onto the nipple.
Between feedings apply cold towels to your breast for comfort. Try lining your bra with cold green cabbage leaves.
If you need to, take medication such as acetaminophen for pain 20 minutes before feeding.
Seek the assistance of a lactation consultant.

Mastitis

Mastitis is a red, lumpy, painful area on your breast. It may appear with a fever, chills or other flu-like symptoms. symptoms are sudden. Mastitis might be caused by a clogged milk duct. If it is left untreated, an abscess can develop. If you have these symptoms:

The best treatment is to keep nursing your baby as often as possible. Start with the sore breast first. The breastmilk is still perfectly safe for your baby.
Take a warm shower or use warm wet towels before breastfeeding to help the milk flow. Gently massage the sore area with your finger tips while the breast is still warm.
Rest is important. You need a day of bedrest. Drink plenty of fluids.
Seek the assistance of a lactation consultant and/or your doctor. Sometimes an antibiotic is needed.

When You Cannot Breastfeed

Sometimes things make it difficult or impossible to continue breastfeeding. If this happens to you, do not worry and do not feel guilty. Formula feeding can be a good substitute for breastfeeding. What is most important is the emotional health of your baby -- love, cuddling and caressing.

Bottle Feeding

Bottle feeding is a perfectly good alternative to breastfeeding. Bottle feeding does have some clear advantages such as being able to monitor the amount of milk ingested by your baby, having longer periods between feedings, and feeding can be shared with the other important people in your baby's life.

Getting Started

Feed your baby every 3-4 hours. If the baby sleeps for longer than a four hour period during the day, gently wake the baby for feedings. Plan to feed your baby at least 6 to 8 times in a 24 hour period.

Don't worry if your baby only takes 1/2 to 1 ounce of formula at each feeding during the first few days. Gradually your baby will take a little more formula each day. By the end of the first week, your baby should eat 1 to 3 ounces at each feeding.

To get your baby's attention to begin a feed, gently stroke the cheek with your finger or the tip of the bottle's nipple. Your baby's head will turn and the mouth will open in response to the stroking. When you place the nipple in the baby's mouth, your infant should begin sucking. Hold the bottle at an incline so the nipple fills completely with formula. This will help prevent your baby from swallowing too much air. Never prop a bottle, it is a choking hazard. About halfway through each feed, stop and burp your baby. You may also try burping if your baby wants to stop eating too soon. Burping helps your baby get rid of the extra air in the stomach, which could cause the baby to feel full and uncomfortable. Spitting up a small amount of formula is normal and often happens at feeding time. Allow your baby to decide when he or she has had enough to eat. Do not force a baby to finish a bottle. Towards the end of a feeding, the baby may fall into a light sleep, and you may still notice some small sucking movements. This is just a reflex and does not mean the baby is still hungry.

Feeding time should be pleasant for both you and your baby. Hold the baby close and talk softly during the feeding. Skin to skin contact will also help you feel closer to your baby. This can be done by wearing short sleeves or partially undressing yourself and your baby. Your baby will enjoy the warmth and feel of your skin. Use this time to relax, interact and bond with your baby.

Choosing the Right Formula

Commercial infant formula based on cow's milk is the next best choice to breastmilk. The cow's milk has been altered to meet all your baby's nutritional needs. Iron-fortified formula is recommended because many babies can easily become low in iron. If you feel your baby has a problem with the formula check with your doctor. Do not switch formulas often because it can be too hard on the baby's system. The above chart gives guidelines for the amount of infant formula your baby might drink. Feed your baby whenever he or she is hungry. Don't expect him or her to follow a schedule. Remember each baby is different. Commercial iron-fortified infant formula should be offered until your baby is 9 to 12 months old.

NOTE: No extra vitamins drops or supplements are necessary for a baby on commercial infant formula.

Steps to Prepare Infant Formula

Commercial infant formula comes in three different forms: ready-to-serve, concentrated liquid and powdered. The powdered formula costs less than the others.

Wash - Wash your hands with soap and water before you begin. Wash all the bottles and equipment in hot soapy water. Rinse well with hot water.
Sterilize - it is recommended that you sterilize all bottles and equipment for your baby's first three or four months of life. To sterilize: cover the containers and equipment completely with water and boil for five minutes. Cool. Remove with sterile tongs. Disposable bottle liners do not require sterilization. For older babies, everything can be washed in hot soapy water and rinsed well or cleaned in the dishwasher.
Mix - Up to a 24 hour supply of infant formula can be prepared at one time. The water for formula should be boiled for five minutes then cooled. The formula label gives directions on how much concentrated liquid or powder to add to the water. Measure exactly. If too much water is added your baby will not get enough energy. If too little water is added your baby may become dehydrated. NOTE: If you live in a rural area check with the approperiate authorities to see if your water is safe for your baby.
Store - The prepared formula should be refrigerated immediately. Formula can be stored up to 24 hours in the refrigerator. The formula should never be left at room temperature for longer than one hour. Bacteria that can make your baby sick grows quickly in warm formula. When away from home, store the formula with ice packs or in a cooler.

How to Warm Formula

Warm the formula bottle in a container of lukewarm water. The bottle can also be warmed by holding it under warm tap water. Shake the bottle well. Check the temperature of the formula before feeding your baby. Put a few drops of formula on the inside of your wrist. It should feel slightly cool.

CAUTION: Microwaving formula may be dangerous and is not recommended. Babies' mouths have been seriously burned because of uneven heating. If you choose to microwave, use only microwave safe containers and heat for a few seconds. Shake the bottle ten times, then check the temperature of the formula.

Other Milks

Follow-Up Formulas

Commercial follow-up formulas are available for babies 6 to 12 months of age. The fat content is lower and protein content higher than in breastmilk or commercial infant formula. There is no reason to switch to these formulas. Breastmilk, followed by commercial iron-fortified infant formulas are the feedings of choice for the second six months of life.

Homemade Formula

Formulas made from evaporated milk are not recommended because they are missing important nutrients that your growing baby needs. They are harder to digest than breast milk or commercial formula. If you decide that a homemade formula is your only option, check with a public health nurse for the right way to make it.

Cow's Milk

Cow's milk should not be given to your baby before 9 to 12 months of age. At 9-12 months of age whole (homo) milk may be introduced. Do not feed your baby 2%, 1% or skim milk before two years of age as these milks do not contain enough energy or fat for a growing baby. Cow's milk protein may cause unseen bleeding in the intestine. The protein and minerals in cow's milk are hard for the young baby's kidneys to handle. Cow's milk contains too little iron. The type of fat found in cow's milk is also too hard for a young baby to absorb.

Unpasteurized Milk

Raw or unpasteurized milk may contain harmful disease-causing bacteria. Only pasteurized milk sold in stores is safe for your baby. If you are using raw milk obtained directly from a farm, contact your doctor for information on how to pasteurize this milk.

Goat's Milk and Other Milks

Goat, soy, rice, and nut milk (or drink) and non-dairy creamers are not recommended for babies either as a drink or in a homemade formula. None of these milks or drinks contain all of the energy or nutrients that a growing baby needs. Soy-based commercial infant formula is an acceptable alternative to breastfeeding for babies who can't handle a cow's milk based formula or live in a vegan (no dairy or animal products) family.

Baby Bottle Tooth Decay

A bottle given at naptime or bedtime can cause decay of baby teeth. The natural sugar in juice, formula, milk or sweet drinks stays in the mouth and can cause cavities. To prevent baby bottle tooth decay, always hold your baby when feeding a bottle. Take your baby off the bottle or breast as soon as he or she falls asleep. If your baby needs a bottle to go to sleep, use plain water. Try to wean your baby from the bottle by 12 to 16 months of age. The first sign of a problem is white or brown spots on baby's front teeth. See your dentist if you suspect a problem.

Basic Baby Care

Having a new baby is a wonderful experience and can be a terrifying one! Many new parents face the arrival of their new baby with great anxiety. The responsibility of caring for such a little person can be overwhelming. The following tips for diaper changing, calming a crying baby, cord care, dressing your baby and bathing your baby may help you through the early days.

Diaper Changing

If you're using a changing table, strap your baby in for safety. Never leave your baby unattended or out of your reach.
After unfastening the diaper, use it to wipe away most of a bowel movement, from front to back. Then clean away any urine and remaining feces with a wet cotton ball or diaper wipe. Pat your baby dry with a towel if you've used a cotton ball. If you're changing a boy's diaper, keep a fresh diaper over his penis as much as you can and aim the penis downward when putting on a new diaper to keep wetness from drenching his clothing.
Put on the clean diaper. If you're using cloth diapers, they're probably prefolded and ready to use, but you may need to fold them further until your baby gets bigger. (The extra fabric goes in the front for boys and the back for girls.) Slide the diaper under your baby so his waist aligns with the top edge.
Bring the front up between his legs, and hold it in place while you fold the sides in toward the center and fasten, by using either a Velcro diaper cover or a diaper pin.
Then, if you're not using a diaper cover, put a pair of waterproof pants over the diaper. Waterproof pants should fit snugly -- but not so snugly that they irritate your baby's skin.
If you're using disposable diapers: lay the diaper flat, with the tabs at the back. Slide the diaper under your baby so that the top aligns with his waist. Bring the front up between his legs and tuck it around his stomach. Unpeel the tabs, pull them firmly over the front flap and fasten the diaper. (Be sure not to fasten the tape to your baby's skin.) The diaper should fit snugly, but it shouldn't be tight.
When you're finished, undo the changing table straps and gently pick up your baby.

Dressing Your Baby

Don't overdress your infant. Although well-meaning people may tell you otherwise, use your own comfort level as a barometer—dress your baby as lightly or heavily as you dress yourself.
Observe the condition of your baby's skin and her degree of fussiness. Her skin condition and her cries will let you know when she is uncomfortable.
Dress your baby in soft, loose-fitting clothing to minimize friction against the skin. Avoid rough, course or tight fabrics, bands or straps, especially if it’s hot.
After baby's bath, pat dry her skin thoroughly before dressing her, paying special attention to the folds and creases in her skin.
Apply lotion or cream to the skin to seal in moisture and use powder to reduce friction before dressing your baby to create a smooth layer between your baby's skin and her clothing.
Before going out into the sun, dress your baby in protective, light colored clothing and a hat with a brim.

Calming a Crying Baby

Nurse your baby

Rock, sway or walk with the baby in your arms or in a sling or front carrier
Stroke your baby's head or tummy, or give a gentle full-body massage.
Patting the baby's back may release a trapped burp
Go outside for a short time. Fresh air and new distractions often do the trick
Swaddle your baby snugly in a "security blanket"
Sing or talk
Remember that too much stimulation can overwhelm your baby. Lower your voice, move more slowly, stop whatever hasn't been working and simply cuddle your baby in a dimly lit room.

Bathing Your Baby

This is a great opportunity for a "fun time" with your baby!
Be sure the room is warm (but not a sauna) and without drafts.
Have all the articles you will need for the bath and for dressing after the bath.
A sponge bath is given until the cord has fallen off and the circumcision is healed.
A full bath is given only 2-3 times a week. This is a change from daily full bath. However, it is a good idea to wash the face and behind the ears, neck, hands and bottom on a daily basis.
Don't use soap on baby's face.

Cord Care

The umbilical cord connects the placenta and your growing baby at the navel (belly button) area. The cord is closed with clamps and is cut shortly after birth.
To help the cord dry up so it can fall off (in one to three weeks) and prevent infection, cord care must be done.
Gently move a cotton ball or cotton swab, dipped in alcohol, around the bottom of the cord where it attaches to the navel. Be sure to get the alcohol on both the cord and the skin.
Cord care should be done each time you change a diaper & after bath time.
Keep the diaper from touching the cord.
Contact your physician if any of the following are noticed: pus coming from the cord area, a foul smell coming from the cord area, area around the navel is more red than usual or red streaks on the tummy around the navel, or if the skin on the stomach around the navel is extra warm to the touch.