Breast feeding vs formula feeding
The American Academy of Pediatrics encourages breast feeding as the first choice for nutrition for newborns. Babies that are breastfed have fewer infections and allergies during their first year of life than babies that are fed formula. Breast milk is also easier to digest and helps in minimizing gassiness and colic symptoms. There are also some very practical reasons to breast feed your baby: human milk is relatively low in cost, it needs no special preparation, and it is instantly available.
If though for medical reasons, work issues, or personal preferences you decide not to breast feed, infant formulas are a safe alternative. We will help you select the appropriate formula for your baby according to your baby's needs. We recommend that you talk to us before making any formula changes because we may be able to better guide you through the process.
How often do I breastfeed?
The first feed should take place in the delivery room, if mother and baby are stable. The second feeding should take place again in the next 2-3 hours. Many babies will be rather sleepy for the first 24 hours and may not eat as vigorously. Try to feed your baby every 2-3 hours. Do not let the baby sleep more than 4 hours during the day without a feeding. Also, try not to feed less than 2 hours apart because then we create the pattern of "grazing" that leads to constant feeding.
How long should each feeding last?
We recommend nursing for about 10-15 minutes per side. The goal is to complete a nursing in about 30 minutes. Place baby first on one breast, burp after the first 15 minutes and then proceed to place on the other side. Remember to alternate which side you use first, in order to avoid engorgement. Once the milk supple is well established, the feeding may become shorter because of more efficient feeds. Most babies will get about 90% of what they need in the first 10 minutes of a feed.
How do I know my baby is getting enough milk?
The main indicator of good intake is the number of diapers. Breastfed babies should have at least 3-4 stools per day and at least 4-5 voids per day. Babies also should seem satisfied after a feed and for the most part fall asleep after a feed. We will also be keeping close track of the weight gain. Baby's first visit will be at 1 week of life. The main reason for that visit is to check the weight gain. By two weeks of life, most babies have regained their birth weight. Once your milk supply is established, your baby should gain about 1/2 oz to 1 oz a day for the first 3 months of life.
What about using bottles?
It is best for the babies to exclusively nurse for the first 6 months of life. However, you can express breast milk either manually or via breast pump. Expressed milk can stay in the refrigerator for up to 24hrs. If you know ahead of time you will not be using it in the next 24 hrs, it is best to freeze it immediately. Breast milk can stay in your freezer safely for about 6 weeks. If you have a separate deep freezer, it can stay in the freezer for up to 3 months. When it comes time to use the milk it is best to warm it up to room temperature. Best way to warm it is to place the bag or bottle in a container with warm water and to rotate it frequently. Do not heat breastmilk in the microwave as it kills some off natural antibodies in the breastmilk (general avoidance of microwaving bottles should also be avoided as it can create hot pockets Thawed milk should be used within 24 hrs. Do not refreeze milk after it has been thawed.
Possible nursing problems
Sore and cracked nipples
The best way to avoid cracked and painful nipples is to insure proper latching. If your nipples or other parts of your breasts are sore during nursing, please consult a lactation professional. After nursing, wash your breasts with plain water. Let your breasts air dry for a few minutes. Then apply Lanolin cream or a small amount of breastmilk on your nipples. Avoid plastic nipple shields or plastic lined nursing pads.
Try to keep the feeds frequent in order to avoid engorgement. Also make sure baby nurses out of both breasts. If not, then express the milk out of the non-used breast with a pump or manually. You may also want to try some warm compresses night before nursing and during nursing.
Mastitis is an infection of the breast tissue caused by bacteria. It may present with redness, tenderness, and pain. You also may get a fever, chills, nausea, or fatigue. Contact your adult doctor as you may need to go on an antibiotic. You can still nurse with mastitis as the milk itself is not infected and will not pass to your baby.
Infant formulas are a safe alternative to breast milk. We will be recommending a formula for you when we see your baby in the hospital. The FDA has strict restrictions on all commercially prepared formulas so they all have very equivalent nutritional value and supplements.
Your baby will be on formula for the first year of life. Most infant formulas are available in ready to feed, powder, or concentrates. Follow the directions on the containers. Make sure the bottle and nipples you use are clean. It is ok to wash your bottles with hot water and soap and then rinse with hot water. You may prepare the formula ahead of time but make sure it is refrigerated. Formula that is refrigerated has to be used within 24 hours. It is best to warm refrigerated formula to room temperature. You may do so by emerging the bottle in warm water for a few minutes. Do not microwave the formula as it can create hot spots that can scald your baby's mouth. Once formula is at room temperature, it is only good for about 2 hours. If you have not used it in that time frame, it is best to discard it.
How much do I feed?
Most babies will take 1-2 oz of formula per feeding and will eat every three to four hours for the first 1-2 weeks. Give the baby about 20 minutes to eat. If the baby is eating two ounces in less than 15 minutes, then you may consider increasing the amount you give for the next feed. Most babies will eat about 4 oz at a time by the time they are one month old. Keep in mind that every baby has its own pace. Do not force feed your baby to finish the bottle.
Common feeding concerns
Most bottle fed babies will swallow air during feedings. At times, this extra air may make them fussy. Try to burp frequently during the feeds in order to eliminate the extra air and to avoid any discomfort.
Hiccups are a very normal reaction. They may occur more often after eating. They are not harmful to the baby. One way to help eliminate them is to keep the baby upright immediately after a feed.
Spitting up is also very common in infancy. Most babies will spit up at one time or another. It is the frequency and the amount they spit up that we want to monitor. If your baby is having projectile vomiting or is very irritable, you need to contact us immediately. A few things that help with spit up are keeping the baby upright during the feeds, placing the baby in an upright position following a feed, avoiding vigorous play or moving after a feed, and making sure the flow on the bottle is not too fast or too slow. If the hole on the bottle is the proper size, a few drops should come out of the bottle when you invert it and then it should stop.