Breast-feeding is certainly best for your baby. You have probably heard or read about the advantages of breast-feeding.
- Its constituents are best suited to meet the nutrition for the baby and is easily digested
- Infections are less because milk comes directly from mother to the baby and therefore there is no chance of any germs entering it as it would from a bottle (even if you sterilize the bottles some germ contamination can still occur)
- It contains many substances that help the baby’s body to resist the germs (viral and bacterial)
- Besides these, there are many other advantages including stronger bonding between the mother and the baby
Most of the mothers that I come across in my practice do want to breast feed their babies, but some mothers do not succeed. The main reason is wrong advice from relatives and friends. Some mothers do want to breastfeed, but cannot breastfeed their babies because they have to go out to work. In this chapter, I will be discussing about breast-feeding as well as about formula feeding.
Breast-feeding
A baby should be put on breast as soon as she is born and is crying vigorously. In case of caesarian section, the baby can suck from the breast as soon as the mother wakes up from the effect of anesthesia, i.e. about 4 to 6 hours after birth. She can keep on lying down, while someone else holds the baby and let the baby suck from the breast. You should tell the nurses in the nursing home or hospital that you want this to be done. Ask them not to give the baby a bottle at all. Only exception is when the mother is too ill and not able to feed the baby.
For the first 1 or 2 days, milk secretion is very little in quantity and yellowish in color. This is known as colostrum. If the baby sucks well on the breast, then this amount of milk is enough for her. Initially she will probably demand it frequently, but very soon, you will find that enough milk will be secreted and your baby will sleep well in between the feeds. Actually the more the baby sucks on the breast, more milk will be secreted, as when the baby sucks, mother’s body gets the signal that milk is needed and therefore more milk will be produced.
At times, there is a problem initially in making the baby latch on the breast and thus she is not able to suck. This usually occurs if the baby has been given bottle feed before putting on the breast, but it may occur otherwise also. It may be because the way you are holding the baby, you and your baby are not comfortable or it may be due to flat nipple. You can try giving baby breastfeed while lying down.
Flat or inverted nipple is one of the commonest reasons for difficulty in making the baby latch on to the breast. The treatment for this should start when the mother is pregnant. She should pull the nipple out a few times a day after applying some cream. When the mother, who has flat nipple, is having difficulty in trying to feed the baby in spite of all the attempt of pulling out the nipple, she can use nipple shield for a while. After a few days, she will find that the baby will be able to suck without the nipple shield. Once the baby latches and sucks well on the breast, there is no reason why she will not succeed in breast-feeding.
If your baby is born prematurely then the baby may not be able to suck well on the breast. In such a case, you may have to express the breast milk and give it to the baby with a bottle or a spoon. However if the baby is very premature the baby will have to be given expressed breast milk with a feeding tube. This is always done in a hospital or nursing home and by the nurses, who are experts in feeding these babies.
When the baby sucks over the breast, see that the areola (the dark portion around the nipple) is in the baby’s mouth. Sucking directly over the nipple alone causes cracked nipples. Also too much cleaning the skin over the nipple also causes dryness of the skin which causes cracked nipple. It is not advisable to clean the nipple before each feed. Cleaning once a day while taking bath is enough. Once cracked nipples occur, as this is very painful, it becomes very difficult to feed the baby. You can apply some lubricating cream over the nipple, after feeding, to ease the pain and help in healing. If the cracking is very severe, then you may have to stop feeding the baby for a day or two and give the baby expressed breast milk with a spoon or bottle. Do ask someone, who has experience in breastfeeding to help you.
How often to feed the baby and at what interval?
Nowadays, we tell the mothers that the baby should be fed whenever the baby is hungry i.e. cries for feed and wants to suck. We call this demand feeding. You will find that after the first week of life your baby will usually set up her own routine. Some babies will finish their feed within 10 to 20 minutes at one go, while others will take a longer time. Some babies will have a set pattern of feeding; that is they will feed for 10 minutes, rest for 10 minutes, again feed for another 10 minutes, and then rest for 30 minutes. During this 30 minutes they may sleep (light sleep) and then wake up and feed for a short interval and then sleep for 3 to 4 hours. I observed this pattern with my baby and many other mothers have told me that their baby have had a similar pattern of feeding. When babies keep on demanding feeds again and again at short intervals, some mothers think that the milk secreted by breast is not enough and therefore they supplement breast milk with bottle feeds. This is one of the reasons because of which many mothers do not succeed in fully breast feeding. If your baby is passing urine frequently, and gaining weight after the first week of life, your baby is getting enough milk.
Usually by 3 months of age, babies drink milk at interval of 3 to 4 hours. They will probably sleep for 3 hours, stay awake for 3 hours, and then again sleep for 3 hours. At night, many babies do sleep for 6 to 7 hours. During this time, they may wake up only once for feed and then sleep again after that.
In 24 hours, a 3-month-old baby will sleep for about 15 hours. However not all babies follow the same pattern and if your baby follows a different pattern you do not need to worry about that.
How often will a baby pass urine and stool?
In the first week of life baby may pass urine 5 to 6 times a day but after that the number of times increases and by around 1 month of age baby will be passing urine 15 to 20 times a day. However, when one is using disposable nappies it is difficult to count the number of times baby passes urine. If you are not sure whether the baby is passing enough urine or not you may use cloth nappies to check.
As far as stool is concerned, the number of times the baby will pass stool varies a lot. A breast fed baby usually passes yellow semi liquid stools. Usually in the first week of life the number of stool passing may be 5 to 10 a day or sometimes more. At times the baby will pass small amount of stool when she passes gas. Usually the number of times that baby passes stool decreases as the baby grows. By 1 month to 2 months of age, baby may pass stool once a day or at times she may not pass stool for 3 to 5 days and after that she will pass large amount of soft formed stool. This is normal and not constipation, and does not require treatment.
What should be the diet of a mother, who is breastfeeding her baby?
A mother who breast-feeds her baby should eat a well balanced diet; which means she should be drinking plenty of milk or eating milk products, eating meat, beans and dals, vegetables and fruits. She should be taking more than what she takes normally. She needs about 400 to 500 calories extra than her usual requirement. Drinking milk or eating milk products are essential because the calcium content is necessary for the baby’s bones and teeth. If the mother does not like milk or cannot tolerate it, then she should take calcium tablets with vitamin D daily.
The mother, who breast-feeds her baby, usually loses the weight that she has gained during the pregnancy within 3 months. She should keep on checking her weight. If the weight loss is too much she should increase her calorie intake.
Should she avoid certain food items? Does anything she eat cause "cold" or "gas" in the baby?
Unfortunately, even nowadays, mothers are blamed for the colds or stomach pain that the baby gets. Mothers come to me with the guilt that they ate ice-cream or some other cold food item and probably because of that, their baby has caught a cold. There is no scientific evidence that any thing you eat affects the baby or any logic in it. Some say eating cabbage or too many chocolates produces gas in the baby but that also is doubtful. Any way there is never any need to eat too much of cabbage. If the mother has a cold and cough, baby may get this not through the milk but through the droplets when she coughs. Therefore, when she has cold and cough and she wants to prevent her baby getting the cold, she can wear a mask while handling the baby and wash her hands or use a hand sanitizer after touching her nose, so that the germs are not transferred via hands.
Expressing breast milk
You may need to do this if the breast becomes very congested and painful due to too much milk in it. Or you may want to express the milk and store it so that it can be used in your absence. You can do this with your hands or with a pump. You have to compress the breast gently behind the areola, in a steady rhythm and in clockwise fashion. It may take you around 15 to 20 minutes to empty the breast. Start with one breast and then empty the other breast.
It is essential to wash your hands and sterilize the bottles and cup, which you will use to collect the milk.
Storing the milk
You can store the breast milk in the refrigerator for 48 hours. Before giving the milk to the baby, the bottle can be warmed by keeping it in a bowl of hot water. Once warmed it should not be put back in the refrigerator. When a food item is warmed (not heated to boiling point) bacteria starts growing in it and they continue growing until the food is very cold. As cooling can take few hours, by that time, enough disease producing bacteria have grown and, if this food item is eaten or drunk these bacteria can cause stomach infection.
Giving bottle-feeds along with breast feeds
Many mothers do give formula feeds 2 to 3 times a day along with breast feeds. The reason the do this is because they want the baby to get used to the bottle as they think that otherwise baby will not drink from a bottle later on. The problem with getting a baby used to a bottle is that the baby will get so used to the bottle, that very soon she will stop taking breast milk.
Therefore, if you really want to breast feed your baby for more than 9 months of age, then you should never give a bottle to your baby. However if you want to feed your baby for a shorter time and for this reason you want your baby to get used to bottle, you should give bottle to the baby only after the baby is 6 weeks old. If you give bottle to the baby before this age, most probably you will not succeed in breast-feeding even for the short time you had planned for.
Formula feeding
You may have decided not to breast feed right from the beginning or may have resorted to formula feeding after unsuccessful attempts at breastfeeding or you may want to partially feed the baby with formula milk because you want to go out to work or have a busy social life.
Babies who are fed on formula milk do have more chances of getting infections and digestive problems but fortunately, if you take all precautions, this can be reduced to a minimum.
Which milk to use?
Fresh cow’s milk, goat’s milk or sheep’s milk etc. are not suitable for babies who are less than 1 year of age as these do not contain the type of nutrients that baby needs. Powdered formula milk is better as these have been modified to suit the needs of the baby. They are usually made from skimmed cow’s milk and treated in such a way that babies can digest it. Vitamins, minerals, vegetable oils and fatty acids are added so that these meet the requirement of babies.
Many different brands of powdered milk for infants are available in the market; you can use any of these. You should take your doctor’s advice to know if your preferred brand is appropriate for your baby.
Preparing the feeds
The bottles should be thoroughly cleaned and then sterilized by boiling. Milk should not be kept in the room temperature for more than 1 hour. After your baby has taken the feed, you must throw the remaining milk and rinse the bottle and nipple thoroughly. The water that is used for making the feed should be boiled or you can use bottled sterile water. Do not use very hot water for mixing the feeds, otherwise the vitamin-C will get destroyed.
Proportion of the water and the powder to be used should be strictly according to the instructions written on the tin of the powdered milk because if you add less amount of powder, baby will get less nutrients and thus will not gain weight and, if you add more than required, baby may get constipation and also can get dehydrated. Some brands of milk powder provide big size scoop, which has to be mixed in 60 ml of water while others provide small scoop, which has to be mixed in 30 ml of water.
Amount of feeds
Although the amount of milk that your baby will take is also written on the tins of milk powder, it is a very rough estimate. Some babies will take more and some less. So do not worry if your baby is taking less as long as your baby is satisfied and gaining weight.
How often to feed the baby?
As with breast feeds with bottle feeds also, we advocate demand feeding. However you should try to keep a three hourly schedule. That does not mean that if your baby is demanding feed before her feeding time you should not give it or if baby is fast asleep you should wake her up to give the feed. Do not offer a bottle each time the baby cries, or sucks her fingers or thumb, because if you do that, the baby may drink a small amount and rest of the milk will be wasted.
If the baby cries before the feed time, try in the beginning, to calm the baby by talking to her softly or rocking her or if necessary, give water. In giving water, do not add any sugar or glucose in the water. At times, you can use dummy (pacifier). If a dummy is kept clean, it is okay to use it (but do not use a dummy before the baby is 6 weeks old). Babies do like sucking so some may suck their thumbs or fingers while others will get used to the dummy (pacifier). Neither of these two habits do any harm unless it continues beyond three years of age.
It is very important that you should be sitting comfortably with the baby in your lap while feeding the baby. This will produce same amount of bonding between you and your baby as with breast feeding. Do look at your baby while you are feeding your baby and try to make an eye contact. Soon the baby will love to look at you while she is feeding and will have a very satisfying look. Never leave the baby on the cot with the bottle propped up with a pillow or cloth.
Looking after a baby, whether you breast feed or bottle-feed is time consuming. It is a 24 hours and 7 days job. However, it is one of the most satisfying phases of your life. For a careerdriven mother, if there are no financial constraints and if it will not affect her career too much, she should try to take some time off from her work and spend at least 1 to 2 years looking after her baby. I did that and I still consider that as the best time of my life.
Nowadays many grandmothers and even grandfathers are willing to look after their grandchildren so that their daughters or daughters-in-law can pursue their career. It is a very good gesture on their part. The only problem is that the mother misses out on the pleasure of looking after her baby.
Weight gain in the baby
For the first few days, the newborn baby loses weight and thereafter she starts gaining weight. By 15 days, most babies will regain their birth weight. Thereafter babies will gain weight as follows.
|
AGE |
Approx. weight
gain / day |
Approx. weight
gain / month |
|
0-3 months |
30 gms |
900 gms |
|
3-6 months |
20 gms |
600 gms |
|
6-9 months |
15 gms |
390 gms |
|
9-12 months |
12 gms |
360 gms |
|
1-3 year |
8 gms |
240 gms |
The above table gives an approximate idea. However the best way to monitor your child’s growth is by growth charts. These allow you to monitor weight, height and head circumference.
Vitamins, calcium and iron preparation
Baby, who is fully breast-fed, does not need these if the mother is taking proper diet. However if the mother does not take enough of milk and does not get enough sunshine as is common among women who use ‘abaya’ /’burqua’ one should give extra vitamin D to the baby after the age of six weeks.
Breast milk contains less iron but whatever is there, is well absorbed and babies who are breastfed usually do not get iron deficiency anemia unless of course mother herself has iron deficiency anemia and does not take iron containing food or iron containing medicines regularly.
In such cases, it is wise to start baby on iron drops at 6 weeks of age. All the babies should be given semisolid foods, which are fortified with iron and vitamins from four to six months of age.
Babies who are fed formula feeds do not need extra vitamin or iron drops as the infant milk formulae are fortified with required amount of vitamins and iron. However, preterm babies may need extra vitamins and iron drops. You should follow your doctor’s advice as to whether extra vitamins or iron should be given to such babies.
Water
In earlier days mothers were told that babies should be given water in between the feeds otherwise they will get dehydrated. Now it is realized that babies do not need extra water as they get what they need with the breast milk, even in hot climates. In fact, if you offer it to the babies, they refuse to drink it because they are not thirsty. Formula fed babies may feel thirsty and may take water; in that case, you can give water but do not add sugar or glucose in it. However, when babies are ill and have loose motions, water should be given in small quantity and frequently.
For breast-fed babies, it is best to give this with a spoon than a bottle. This has an added advantage of the baby getting used to spoon-feeding and so later, on when babies are given semisolid feeds with a spoon at 4 to 6 months of age, they will take it readily. When the baby has erupted teeth at around 5 to 6 months of age, then babies should be given water after they had milk feeds (bottle or breast feeds) so as to rinse the teeth and thus prevent tooth decay.
Weaning from breast-feed
For how long you want to breast feed your baby is something you have to decide. You can continue breastfeeding until up to 2 years and after that, you should try to stop it. By this time the baby will be taking semisolids feeds 3 to 4 times a day and will have learnt to drink water with a glass or feeding cup. There are some mothers who get the babies used to bottle before they stop the breast milk. I will never recommend doing that unless you are trying to stop breast feeds before 9 months of age, because later on, it becomes very difficult to stop bottle-feeding.
When you stop breast feeding it is unlikely that baby will take fresh milk or formula easily but if your baby is consuming products like milk cereals with a spoon, there is no need to give extra milk. When you stop breast milk, you should try to give more of such cereals to the baby.
You can also give homemade milk cereals made with fresh milk like rice kheer, suji kheer etc. . . These are tastier and the whole family can eat these.
Initially when you stop breast-feeding, your baby may cry more than usual. Someone else in the family will have to help you by taking the baby away from you and trying to give her something else to eat. You may also face the problem of your breast being congested. You can take paracetamol tablets to reduce the pain. Sometimes when you have decided to stop breast feeding the baby falls ill due to some other reason and at that time you may have to resort to feeding her again because babies who are used to breast feeding do not eat anything else when they are ill, but do take the breast milk. In such cases, you will have to try again after few days. Once your baby does not drink breast milk for 3 to 4 days she will forget about this and congestion in your breast will also reduce.
When a mother becomes pregnant while she is breastfeeding her child, should she stop giving breast feeds to her child?
No harm is done if she continues to breast feed. She will have to take about 800 to 900 extra calories to cope with her growing baby in utero as well in breastfeeding her baby in her lap. If she is fond of eating, and as most of us are, taking this much of extra calories should not be difficult. However if she has nausea and vomiting, and is not generally well, then she can stop breast feeding slowly; which means that she has to give more of other milk or semisolid food to her baby, until she gets used to it and does not demand breast feeds any more.
Weaning from bottle feeds
Weaning from a bottle should be attempted before one year of age, and it certainly should be stopped before 18 month of age. The sooner this is done, the better it is because of the harmful effect on the teeth. Babies are capable of drinking with a cup or glass after 9 months of age so there is no need to give bottle after that. When bottle feeding is continued for a long time, comfort sucking on a bottle becomes a habit and in that case it becomes very difficult to stop it. Unfortunately weaning from a bottle is not done until quite late. I have seen 5 to 6 years old children who go to bed with a bottle.
The reason for this is that the mothers or other members in the family either do not know the harmful effects of the bottle-feeding or are not convinced that it does any harm to the children. I realize that it can be difficult at times. Quite often, when you are trying to stop giving bottle to your baby and the child is crying for the bottle, someone in your family will probably get annoyed at you for refusing to give the bottle.
In that case, the child learns that when he cries, he gets what he wants. Therefore, the main prerequisite for success in weaning from bottle feeds is that other members in the family should cooperate with you.
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Child Care