New Parents Survival Guide: Feeding the Monster

Well, we have a baby and they are going to eat. Hopefully you have given some thought to giving the little tike some food. We basically have two choices: breastfeeding and bottle-feeding. Which one of these two you choose depends on many factors. I am going to try to point out as impartially as possible, the pros and cons of each so you can make an informed decision that best suits your lifestyle.

Breastfeeding is the way Mother Nature intended babies to be fed and it has been proven for the entire time of man to be an effective way of feeding a baby. Over time we came up with substitutes for breast milk for vari- ous and assorted reasons. Here are the arguments.

Pros:

1. It is the natural way to feed your baby. Hard to argue with this logic, and I’m not even going to try.
2. It is cheaper than formula. This is a great reason to breastfeed. Formula is very expensive and will easily cost you thousands of dollars over the course of the baby’s first year of life. Breastfeeding is essentially free of charge. If you also factor in the cost of bottles, dishwashing detergent, and time to prepare formula it gets even more expensive.
3. It is healthier for your baby. Scientifically this statement has been proven over time; breast milk is better digested and easier on babies’ stomachs. They have fewer issues with constipation and reflux. Babies receive antibodies to diseases that Mom has had in the past passed to them through breast milk. These antibodies protect them until their own immune system starts to work at full capacity.
4. It is a great way to bond with your baby. Many moms that have done both bottle and breastfeeding state there is no comparison with the bond you develop with your baby when you produce their milk and provide all their needs. Moms giving their baby a bottle will bond with baby, but will miss out on this experience.
5. There are no bottles to wash since the baby is not using a bottle.

Cons:

1. Breastfeeding is time consuming as babies eat all the time. Their first couple of months they will eat every two to three hours and it may take them up to 45 minutes each time in the beginning. This means you will be feeding your baby up to six hours each day for the first month or two. As Mom is the only one able to breastfeed the baby no one else is able to help.
2. Breastfeeding can be uncomfortable. Most people find it uncomfortable at the beginning and eventually get used to it, but some moms just never like the sensation of breastfeeding and it does not get better for them.
3. It can be a little embarrassing at first. Babies do not always pick the most convenient times to want to eat and you are not always going to be in a room by yourself. Some women have a much harder time with this than others.
4. Breastfeeding can be very hard to do while working. Face it, most women have to work these days and it is hard to have the baby there at work with you. Depending on your job it can be hard to even find a place or time to pump breast milk to feed the baby.
5. It is all up to Mom. Someone else can feed breast milk to the baby through a bottle but all of it is has to come from Mom. With time this can get a little demanding and exhausting.

Whatever the pros or cons of breastfeeding versus bottle-feeding are, the real choice comes down to what Mom wants to do. All the pros in the world are not going to be worth it if Mom just does not want to breastfeed. There will be no bonding that occurs if you are doing something you hate. Babies will do fine breastfeeding or bottle feeding and you need to make sure that you surround yourself with people that will support and help you no matter what your decision is in this matter.

One of the common questions pediatricians get asked is what Mom can eat and drink while breastfeeding. A good rule of thumb is not to eat or drink anything you would not give a one year old. That rules out alcohol and drugs but everything else is fine. Individual babies may get bellyaches with certain foods but this will vary from baby to baby. Some of the most frequent offenders will be chocolate, caffeine, spicy foods, and broccoli, but everything is a possibility. If you find that your baby gets upset when you eat a certain food then you should try to avoid that food while you are breast- feeding.

So we have a newborn that is hungry and wants to eat. We need to feed him some milk in one form or another. If you have chosen to breastfeed, the first couple of days are going to be a little rough. The baby has no real idea how to eat and you have never done this before, so you have no idea how to help them. Almost all hospitals now have breastfeeding consultants that will be more than happy to help you get the hang of breastfeeding. They are great at teaching you methods to get your baby to latch on, for positioning them, and how to support Mom. The first couple days of breastfeeding you will just be produc- ing colostrum. Colostrum is loaded with great antibodies, but is not very filling for your baby. If your baby starts to lose excessive amounts of weight, have blood sugar problems, or become jaundiced, your pediatrician may recommend that you give them some formula along with breast milk until you begin to produce more breast milk. Take your doctor’s advice rather than the breastfeeding consultants; the pediatrician is trained to care for infants and to take responsibility for the baby’s well being. After about 3-4 days your breast milk will kick in and your baby will not need any additional source of milk.

If you started out with formula you had an instant source of milk. The baby just needs to get the hang of a bottle, which they will figure out very quickly. When we first start feeding a baby they will typically take about half to one ounce every 2-3 hours. Over the first several days they will go up on the amount of milk they will drink. By the time they are a week old most babies will be taking two to three ounces every three hours. By the time they are a month old they will be taking four to six ounces every three to four hours. With the breastfeeding baby they typically take similar amounts of milk, you just do not have a way of measuring it. Newborn babies will usually breastfeed for 10-15 minutes per side. As the baby gets better at breast- feeding they will be able to take more milk in less time. By the time they are 2-3 weeks old it will only take them 7-15 minutes to eat (they may be there longer because they tend to fall asleep and just like to be warm and snuggly). The same is true for bottle fed babies. It will take quite a while to feed them just a little amount of formula, but after a couple of weeks they will be able to drain a bottle in just 5-10 minutes.

Let’s talk about types of milk for your baby.

As this book addresses babies from birth to two years of age we only need to discuss three types – breast milk, formula and whole milk.

Breast milk is fairly self-explanatory; it comes from Mom’s breasts and there are not really different types. Just because it is nature’s way to feed your baby does not necessarily mean that you will be able to breastfeed even if you want to. There are a few problems that may come up with breast- feeding. Some moms just do not produce any or enough milk. We are not sure why in most cases, but sometimes it is because Mom has had breast surgery such as augmentation or reductions, has unusual amounts of stress on her body or on some type of medication. Some moms produce enough fluid but it does not have enough calories for the baby to grow well. This will become evident when you see your pediatrician and have a baby that is eating well but is failing to grow normally. Finally, some babies just cannot tolerate breast milk because they are allergic to the protein in the milk. These problems will usually be found by or can be discussed with your pediatrician and they will let you know what, if any, options you have as far as improving breastfeeding or changing to a formula.

Formula is a little more complicated than breast milk because of the huge amount of varieties that you have to choose from. A baby should be started on a cow’s milk based formula, because it will be the closest to human milk (a little piece of trivia: donkey’s milk is the closest to humans, but harder to acquire). There are many types of cow’s milk based formulas to choose from and every pediatrician or mom in the country probably has their preference. Let me just say that the formula industry is a big money earner and there is a lot of money spent on advertising by different formula companies to win business. Even your pediatrician’s preference is probably going to be dictated by what a formula company has told them, how they have been treated by the company’s representatives and of course their own personal experience. In an attempt to remain unbiased let me tell you that the companies are a lot like fast food. The ones that put the most money into advertising are the most expensive; they argue that they are also the ones that put the most money into research and quality control. This can be true but the difference in cost versus actual benefit may be questionable. My advice is that you ask your pediatrician what their recommendations are and why. Not all babies can tolerate cow’s milk based formula and that is where the other types come in and the more expensive formulas you may see at the store. Switching to these other formulas should really be something that you should talk to your pediatrician about first before you make a switch. There are soy based formulas, formulas that have had the lactose removed, formulas with rice added to them, formulas that have had the proteins broken down so they can be used in babies allergic to milk protein, and formulas just made of amino acids. The specialty formulas are much more expensive and are not best for your baby if they do not need them.

Formula or breast milk should be the only type of milk your baby is given for the first year of life. Yes, whole milk is in the refrigerator already and is cheaper, but it does not have the vitamins, minerals, iron or type of protein a baby’s body needs to grow properly. At one year of age it is fine to switch your baby to whole milk. Because whole milk is not a complete food source, a baby only needs about 12-20 ounces of milk a day. A baby does need to use whole milk until two years of age because it needs the fat for its brain to grow properly. At two years of age you can switch to two percent milk.

Many books will tell you exactly how much milk your baby should drink or how long they should breastfeed each time. There is no “exact” amount of milk that a baby should drink; each baby’s needs are different. As long as your baby is growing and developing well, the amount they eat is fine. The numbers that are printed in books are just guidelines so you have an idea of how much a baby should eat.

Here are some guidelines to give you an idea of the eating estimations for each age.

• 1-2 days: ½-1 ounce ever 2-3 hours
• 3-5 days: 1-2 ½ ounces every 3-4 hours
• 6-30 days: Increasing to 4-6 ounces every 3-4 hours
• 1-2 months: 6-8 ounces on demand which is usually every 3-4 hours
• 2-6 months: 6 plus ounces (this is typically the most milk they will drink in their lives) as desired. These babies are able to go up to 12 hours without eating.
• 6-12 months: As much as they want to eat each time but realize that they will drink less each time because they are now getting food as well. Most babies will get 20- 36 ounces per day.
• 12-24 months: these babies will now be on whole milk and need 12- 20 ounces per day. Whole milk is not a complete food source like breast milk or formula and needs to be limited.

For the first four months of life your baby should not get anything to eat or drink except formula or breast milk. There are special conditions in which your doctor may add something else, but they should not have any- thing else unless directed to do so by your doctor. A baby does not need any water except what is given in their milk because too much water can lower their body salts and can lead to health problems. A baby does not need any juice and should not be given any until they are six months of age. No mat- ter what people tell you, feeding your new baby cereal or baby food will not get them to sleep through the night and can lead to health problems. Babies that have an early introduction of cereals and foods to their diet have been found to have worse allergies, eczema, asthma and constipation. We have learned many things about parenting since your parents raised you so listen to your pediatrician.

When the baby is four to six months old it is time to introduce them to solid foods. There are several ways to introduce solids to your baby and I am merely going to explain my way. Most pediatricians follow these guide- lines closely with just the odd variation here and there, which is usually dependent on the way we were trained. A baby is developmentally able to start baby foods between the ages of four and six months. All babies do not arrive at this time simultaneously. I have found that a good way of telling if a baby is ready to eat solids is if they watch you intensely while you are eating and are opening their mouth like they want to eat some. If you start trying to feed your baby with a spoon and they just sputter and gag on the food they are not ready yet. Wait a week or so and then try it again. Just keep trying until they suddenly become able to swallow without gagging and choking, but you do not have to try it everyday. I personally recommend trying once a week to see if they are ready.

Babies with a family history of eczema, food allergies or asthma or who have had wheezing or eczema themselves should wait until they are six months to start on solid foods. There have been several studies that show by waiting until six months the incidence of these conditions decreases. The American Academy of Pediatrics, the World Health Organization and most breastfeeding authorities recommend waiting until six months.

We all recommend you only feed your baby solids with a spoon. There are many things you will find at the stores to feed your baby solids with but these are not recommended by pediatricians and can cause serious prob- lems. Do not add food to the bottle, do not use syringe-feeding systems and do not use little bag contraptions that let them suck on the food and “filter” it through. If your baby cannot eat with a spoon they are not ready to eat solid food yet.

I recommend that parents start off with rice cereal mixed with either expressed breast milk or formula as a training food until the baby gets good at eating with a spoon. It will vary from baby to baby how long it takes them to master the act of swallowing but once they get good at swallowing the cereal, it is time to start them on baby foods and never eat rice cereal again.

Baby foods are categorized as stage I, stage II, stage III, graduates, and finger foods. That is also the order that we will progress through them with a little blurb describing each type of baby food. Stage I foods are the little jars that tend to be the most runny of the baby foods and are all single entity in content. Stage II is a slightly bigger jar, has a thicker consistency, and starts to mix food types together. Stage III is an even bigger jar, has food with little pieces and chunks and again mixes types of foods together. Graduates are mainly there as table foods substitute if you do not want to take the time to cut up your food in small enough pieces or are eating something not for babies. Finger foods are going to be the things that babies start to feed themselves with their fingers like teether biscuits, veggie puffs, vanilla wafers, and crackers.

Babies prefer sugar in the beginning, so I like to introduce foods in the order of least sugar to most. This is an area that we as doctors often disagree on without any real medical studies to back any of us up. I have just found that if a baby has had fruits first it is very hard to get them to eat less sugar containing foods like green beans afterwards. Therefore I recommend starting with green vegetables, then orange and yellow vegetables and finally fruits. Because we are introducing new foods into their diet, we may find the baby develops an allergy to one of these new foods. Therefore I recommend that you only introduce a new food every 3-5 days. With this schedule you would do green beans for 3-5 days, then peas for 3-5 days and so on. Food allergies will usually present as hives (which are red swollen splotches on your baby’s body) or as patches of dry, red skin called eczema. It will take about a month and a half to get through all the single entities and then you can mix and match the types of food. Once a baby goes through all the types and acts like the small jars are not enough food, it is time to go up to the next stage. This is my way and there are as many different ways out there as there are pediatricians; the funny thing is they all are right in their own way.

Every baby is different and you should not compare how much your baby eats with what other babies are eating. They should eat enough for them. As they eat more and more solid food, they will drink less milk. We usually want a baby eating three times a day by the time they are nine months old, but the amount they eat could vary from three stage I jars per day to nine stage III jars per day.

When babies are between six and nine months and able to sit up on their own and eat their baby foods, then it is time to introduce some finger foods. We usually start out with bulky, finger foods that dissolve in their mouths. These are foods like teether biscuits, zwieback toast, and vanilla wafers. Once a baby gets good at these foods, then it is time to move to things that can be bitten like crackers and then on to small things like gold- fish and cheerios. In this period it is fine to start introducing some table foods that are the consistency of baby food.

After six months of age babies can start drinking some juice or water. We do not want them to get more than about six ounces per day. It is also important to note they do not “need” any as the fluid they need is given through their milk, but the juice and water are a great way to introduce a baby to a sippy cup and rewarding them for learning a new skill.

I usually want my babies to be eating table food by the time they are one year old. Many parents will want to give them the little graduate meals because they are easier to prepare and are convenient and these are fine as well. The amount a baby will eat will vary from baby to baby. Make sure they are getting a variety of meats, vegetables and fruits, dairy and grains.

A baby will grow at a consistent rate for the first 12-15 months and their appetite will be fairly predictable. Around the time they are 15-18 months of age they start growing in spurts. During this time the amount they are grow per year slows way down and there will be times they do not seem to eat much at all. This is when all parents freak out and think their baby is going to starve to death. The baby will be fine; I have not lost one yet to voluntarily not eating. Just keep offering them a good variety of foods and they will eat when they need to. This period is probably our healthiest because we eat based on our metabolic rate. The worst thing we probably teach our children is to eat three meals whether they are hungry or not.

THINGS TO REMEMBER:

1. Only formula or breast milk for the first 4-6 months
2. Only formula or breast milk as a milk source for the first year
3. Whole milk from one to two years old
4. I introduce food as green veggies then orange and yellow vegetables, then fruits
5. NO HONEY FOR THE FIRST YEAR
6. Only give solid food with a spoon
7. No table food until they are six to nine months old
8. Never taste baby food, it is disgusting!
9. If your parents and grandparents really did the stuff they say you would have died.