As you know, there are two ways to feed a newborn infant – breastfeeding or bottle-feeding of infant formula. Your choice of how you feed your baby will depend on your own preferences. Although there are many advantages to breastfeeding, including maternal-infant bonding, protection from some infections, decreased incidence of allergies and lesser chance of adult obesity, it is not necessary for you to nurse to insure having a happy baby. Our only concern is that you are satisfied with the way you plan to feed your baby. We are satisfied if you are happy with whatever method you have chosen.
Most infants do equally well with breast or bottle. Often it is the mother herself who gains most from nursing. There is a special joy in watching your baby grow and gain from your milk. There is the convenience of not having to prepare formula and monetary savings. Many mothers report that they can eat more and not gain weight while nursing. Additionally, there is generally a longer space between the birth of one baby and the next when the mother breastfeeds an infant.
When infants are bottle-fed and the infant eats well at each feeding, the feedings are generally 3–4 hours apart. The use of sterile water or a pacifier may help you get the baby used to this time schedule if you desire.
When babies are breastfed, they will probably be hungry sooner and more often – about 2 1/2–3 hours between feedings. It is usually better to allow “demand” feedings. This is accomplished by nursing the baby whenever he/she seems hungry. This is acceptable as long the baby is not continually “snacking” from the breast and never receiving a “full” feeding. In general, it is better not to use bottles in the first few weeks of life since it may cause “nipple” confusion for the baby. If the baby is very passive and not demanding, make sure that at least 6–7 full feedings are given in 24 hours. The use of a “relief” bottle is not a good idea until the baby is fully committed to the breast. At three or four weeks of age, one bottle every day or two will be accepted by the baby and not interfere with his/her desire to nurse.
If you would like to breastfeed, you make this aspect of childcare a satisfying and fulfilling experience. Successful breastfeeding is not a complicated procedure but there are some “techniques” that can make feedings easier for you and your baby.
During the first few days in the hospital, you should feed on both breasts using our recommendations as follows. Breastfeeding should start with 10 minutes on each breast for every feeding on the first day after delivery. The position for holding the baby should be changed from one feeding to the other. The key to successful nursing is the prevention of sore nipples. This can be accomplished by careful attention to the way the infant grasps the nipple.
The mother must make sure most of the areola (the darkened area surrounding the tip of the nipple) is well into the baby’s mouth. The sensation the mother should feel while the baby is suckling is one of “sucking or drawing” with minor discomfort and not one of “biting” with a sharp pain when the baby-nurses.
When the baby first latches on, the mother will feel an initial discomfort but that should subside within 10 seconds or so.
Nursing positions include:
It is helpful to use two positions at each breast when the baby demands more time nursing. Varying positions not only prevent nipple soreness but also stimulates milk production and empties the breast more efficiently to alleviate engorgement.
There are two main problems that might arise that could make nursing painful. They are breast engorgement and sore nipples. Breast engorgement is a severe fullness of the breasts which makes the breasts hard, hot and painful. It usually occurs when the milk “comes in” on about the second to the third day. Engorgement is both swelling of the breast and an overabundance of milk. It is the swelling that causes the most trouble since the swollen ducts shut down and don’t allow the milk to flow out easily.
The most important way to prevent this from happening is to nurse as soon as possible after delivery as often as possible in the first few days. “Rooming-in” is also a good way to get in the extra feedings that are so helpful. Also, it is very important to nurse at least once a night to prevent the back-up of milk. Do not forget to alternate feeding positions as described above, to enhance the drainage of milk.
If despite all your efforts engorgement does occur, the key is to decrease breast tissue swelling and keep the breasts well-drained. If the breast can be pumped by the manual pump, electric pump or hand expression both before the feeding to make the nipple easier to grasp, and after the feeding to leave the breast softer.
Pumped breast milk can be stored in Playtex nurser bags in the freezer for 4 months. In that way, when the milk comes in for the next feeding, there will be enough room to accommodate it and there will be less pressure build-up that may prevent drainage. The engorgement problem usually lasts only a few hours to one or two days. An interesting way to decrease breast engorgement consists of placing raw cabbage leaves inside the bra against the breast. When the leaves become wilted, replace with new cabbage leaves. The reason this works is not known, but it definitely relieves engorgement. When engorgement decreases, the breast becomes less swollen and the milk flows normally.
As stated above, to prevent sore nipples one must pay close attention to getting the majority of the areola into the baby’s mouth, and not just the tip of the nipple.
The deeper the nipple tip and areola is in the baby’s mouth the less trauma there will be to this sensitive area. This deep grasp is also the most efficient way for the sucking the area around the areola from either side and pushing it completely into the baby’s mouth when he/she opens the mouth to start sucking. If the baby loosens its grasp and the nipple starts to slip out, gather the areola again and push it back into the mouth. Be very conscious of this during the first few days of nursing. It really makes a big difference and prevents sore nipples which can be difficult to heal.
After nursing your baby, either A&D Ointment, Masse, other lanolin cream or vitamin E Oil should be applied liberally to both nipples. Prior to the next feeding, this should be wiped off gently with a tissue and NOT washed off with soap and water. Washing your nipples only increases drying and promotes cracked nipples.
By the time you are discharged from the hospital, breastfeeding should be well established. Once you are home, you can continue to increase your feeding time so that you are nursing approximately 20 minutes on the first side and up to 20 minutes on the other side. We will do our best to guide you so that nursing will be both a pleasurable and fulfilling experience.
Nursing time varies greatly from infant to infant. If your baby is wetting his/her diaper and having bowel movements you can feel comfortable that he/she is getting adequate feedings. You should remember to alternate the first breast at each feeding – starting with one side at one feeding and the other side at the next feeding. The total feeding time usually does not exceed 45 minutes.
Breastfeeding mothers must continue to take both the prenatal vitamins and iron supplements that they were prescribed during their pregnancy.
There are many formulas available on the market that are excellent sources of nourishment, vitamins, and minerals for the infant. Usually, the infant will take 2–5 ounces at each feeding the first few weeks of life every 3–4 hours. By 2 months, the baby takes about 3–5 ounces 5–7 times a day. As you can see there is great variation in the amount of formula each infant takes at a feeding. If the infant is gaining well, 1–2 pounds a month, then we don’t worry about how much he is taking at each feeding. Our goal is that there is an adequate interval between feedings and the infant is not “snacking” all day. By the age of 5–6 months, most infants will be drinking 7–8 ounces formula 3–4 times a day. It is at this time that we introduce solids to the baby’s diet.
The most commonly used formulas available have either cow milk or soy base. They are both equally well tolerated by infants and the choice is a combination of our recommendation and your personal needs. Occasionally it becomes necessary to use a more sophisticated, hypoallergic formula. These two are readily available although they are more expensive.
Formula Preparation Method
If you plan on using formula concentrate, you can pour half of the amount of formula you need into a clean bottle (washed with hot soapy water is not acceptable because there are no government controls on its purity). After 6 weeks of age, regular tap water can be used without boiling. Most formulas also have powdered preparations which can be mixed with pre-measured boiled water. This is very convenient and easy to transport formulation.
If you are using the quart can of pre-mixed formula (ready-to-feed), it can be poured into a clean bottle (as described above) and the chill taken out by warming it under hot tap water.
Never Warm A Baby's Bottle In The Microwave!! Temperature Quality Is Deceptive and Severe Mouth Burns Can Occur.
If you are using the ready-to-feed individual bottles, which are available for most formulas but are more expensive, these can be used at room temperature.
Nursing bottles with disposable linings seem to be the easiest way to prepare formula for daily use. They are always clean and readily available with minimal effort. Prepared bottles should be used within 2 days. Partially consumed bottles can be reused no more than 4 hours after first starting the bottle.
Continued Use of Formula or Breast Milk
A tradition was developed several years ago whereby it was thought that switching a baby from formula or breast milk to whole milk was indeed a “stepping stone” of life. Current scientific thinking is quite to the contrary. Recent research has shown that babies do better on formula or breast milk for the first year of life.
The average formula-fed infant will do well if burped a few times in the middle of the feeding and once at the end. The infant that is breastfed will have less burping difficulty if burped after 3 minutes on the breast and then burped once again after finishing that breast. The same is repeated for the other side. The baby will decide if an extra burp is necessary by crying or stopping the feeding in the middle. Occasionally an infant is bothered by gas bubbles and has to be burped more frequently.
What was once known as “colic,” episodes of unexplained irritability, fussing or crying associated with feedings, is sometimes excess gas or maybe gastro-esophageal reflux which is a back-up of acid into the esophagus from the stomach. Infants with this condition tend to spit up more than usual, cry excessively after feedings and not sleep peacefully between feedings. If your infant shows these symptoms, please bring it to the attention of your pediatrician that together you can formulate a plan to decrease his/her discomfort.
Vitamins and Solids
We do not recommend vitamins for infants under 6 months of age. Both formula and breastfed babies have an adequate vitamin intake. Fluoride drops are suggested for infants residing in areas where water is not fluoridated. We usually start babies on solid foods between the ages of 5 and 10 months depending on whether the baby is bottle-fed or fully breastfed.
Care of the Navel and Circumcision
When you leave the hospital, the baby’s cord will have started to dry and turn dark brown to black. There is usually a yellow area at the base of the attached cord which may look wet. This is normal and might even persist after the stump falls off. To promote drying of the cord and speed its separation from the navel, corn starch (either made with baby powder or from your kitchen shelf) should be sprinkled around the base of the cord at each diaper change. We prefer corn starch powder (any brand) instead of alcohol wipes which often irritates the surrounding skin.
As the cord separates, (usually in about 7–14 days) a small amount of bleeding may occur. This is of no consequence. Continue using corn starch or baby powder. Until the cord falls off, it is advisable to fold the baby’s diaper below the cord (like a bikini) to prevent it from getting saturated with urine. This will also promote the drying of the cord so that it will separate sooner. If the cord develops a foul smell, please notify your pediatrician (no emergency) to prescribe an antibiotic powder.
Immediately after circumcision, the tip of the penis is usually covered with gauze coated with petroleum jelly to keep the wound from sticking to the diaper. Gently wipe the tip clean with warm water after a diaper change. Medically speaking, all that is needed is a thin film of Vaseline or antiseptic ointment covering the penis for a few days after the circumcision with each diaper change to prevent irritated skin from sticking to the diaper. Redness or irritation of the penis should heal within a few days, but if the redness or swelling increases or if pus-filled blisters form, the infection may be present and you should call your pediatrician immediately.
A new baby may be bathed each day with baby soap that does not contain hexachlorophene (Ivory and Dove's soaps are fine). In general, a baby’s bath is just like your own. When bathing the infant, we recommended starting with the cleanest area first, the face and head, and finishing with the dirtiest area, the diaper area. All skin surfaces you can touch with your hands should be washed with soap and water except for the face which should be washed with plain water. Remember to wash all folds in the diaper area especially with baby girls. Until the umbilical cord has fallen off and has dried up, bathing should be accomplished by sponging. Afterward, a tub bath is permissible. Putting a specially made baby tub on a table will make it more comfortable for you.
Most babies like to be bathed when they are not hungry or fussy, so plan your schedule accordingly. After the bath, you might want to lubricate the baby’s skin with a very small amount of baby lotion. It should be used sparingly so as not to clog the baby’s tiny pores and should never be used on the face. Using powder on the baby boy’s diaper area is up to the mother’s discretion. Always make sure to sprinkle the powder on your hand and then on the baby – not directly on the baby’s body. This prevents the baby from accidentally inhaling the powder. The powder should not be used on the baby girls’ diaper area. We recommend using creams or ointments only. Powder dries the vulva and causes the folds to stick to each other.
At three to six weeks of age, babies often develop “infant acne.” This is not a serious condition and can usually be minimized by washing the baby’s face with water only, washing his/her clothes and diapers in a mild soap detergent (Ivory Snow or Dreft) and not using bleach or fabric softener of any kind in the laundry. The perfumes in these products tend to irritate newborn infants’ skin.
Infant acne is usually mild, self-limiting and goes away without any treatment within a couple of weeks. If the acne seems unusually severe or spreading to the head and neck, please let your doctor know (not an emergency). We may be able to prescribe an ointment to decrease the severity.
After arriving home, most babies will have soft, seedy stools. Some babies will have 7–8 stools a day, while others will move their bowels less frequently. If the stools are very watery with no solid parts and very frequent or hard enough to cause discomfort, you should check with your pediatrician. A new baby that does not pass any stools and seems to have only slightly wet diapers might not be getting sufficient feedings. This is something that has to be addressed as soon as possible otherwise the infant will not gain and in fact, may lose weight.
Some infants have a difficult time passing the stools and do seem to be uncomfortable. There are two possible explanations for this problem. Either the formula they are taking has a constipating effect or they may need their anal opening stretched slightly to allow them to have bowel movements more easily. Please let your doctor know if you suspect any of these problems with your infant.
Frequently, infant girls have a vaginal discharge of white mucous with blood spots. This is caused by the withdrawal of maternal hormones. This can last on and off for a month and is perfectly normal.
As a reminder, the powder should never be applied to the genital area of baby girls. We recommend creams such as A&D Ointment, Vaseline and Balmex. Desitin Cream is not recommended because it contains a powder base.
Sneezing, Hiccoughs and Vomiting
Sneezing and hiccoughing are very common in the first few months of life. There is no significance to this and no treatment is required. A burp or a drink of water might stop the hiccoughs, but very often you will find that they will continue for a while and then disappear on their own. Spitting and occasional vomiting is also very common in the early months. This is usually due to overeating or the need for an extra burp. Vomiting often alarms the new mother but is of no concern if it is only occasional and the baby is otherwise well. If the baby vomits excessively and/or cries almost continually, please check with your pediatrician.
All babies (both boys and girls) may have some breast engorgement due to hormonal changes during the pregnancy. There may also be some milk secretion from the breasts. The milk should never be expressed from the baby’s breast because doing so can cause a severe infection. The engorgement is of no concern except if redness occurs. In that case, notify your doctor immediately especially if any fever is present.
Most babies have a yellow tinge to their skin color as well as a yellow-tinge to the whites of their eyes starting on the second or third day of life. This jaundice is physiologic (a normal finding in newborns which is of no real concern) and will fade without any treatment. We will follow this carefully while your baby is in the hospital nursery and give you instructions upon discharge.
A newborn may initially be expected to sleep approximately 2–4 hours at a time. During the first month of life, sleep may total 12–20 hours a day but in most instances will total 15–18 hours. New parents often feel uncertain about the best way to keep a baby safe during sleep. They may wonder whether it’s all right to use a hand-me-down crib, what kind of covers a baby needs, or whether to put the baby down on his/her back or abdomen. The most up-to-date research indicates that the following precepts are good guidelines for parents:
It is very important that babies sleep on their backs until they can turn over both from their stomach to back and back to stomach. It has been confirmed through numerous studies and research that having a baby sleep exclusively on their back decreases the occurrence of Sudden Infant Death Syndrome.
Other helpful guidelines include:
Most babies are fussy for their first few weeks at home. This is especially noticeable during the late afternoon and early evening when the majority of infants have what is called a “fussy period.” The motion of some kind, such as rocking, often helps. If the fussiness seems excessive, please discuss it with your doctor. Crying may increase during the first 6–8 weeks. At times it will be easy to recognize crying as a sign of hunger or the need for a diaper change, but often there may be no identifiable reason for crying. You will learn by experience, when to pick up and console the baby and when to feel confident that the crying will stop without intervention in a few minutes. If the baby is fussy, relate this to the baby’s temperament and not to parental inadequacy.
Preventing Fatigue and Exhaustion
For most mothers, the first weeks at home with a new baby are often the hardest of their lives. You probably feel overworked and even overwhelmed. Inadequate sleep will leave you feeling fatigued. Caring for a baby can sometimes be a lonely and stressful responsibility even though you’re thrilled with the arrival of your new baby. You may wonder if you will ever catch up on your rest or work. The solution is asking for help. No one should be expected to care for a new baby alone.
Every baby awakens one or more times a night. The way to avoid sleep deprivation is to know the total hours of sleep you need per day and to get that sleep in bits and pieces. Go to bed earlier in the evening and nap when your baby naps. Your baby doesn’t need you hovering while she/he sleeps. While you are napping, take the telephone off the hook and put a sign on your door saying MOTHER AND BABY SLEEPING. If your total sleep remains inadequate, hire a babysitter or bring in a relative to help. If you don’t take care of yourself, you won’t be able to take care of your baby.
Great Tips for Injury Prevention
Interesting to Note
Babies sometimes get a hair or thread from a “sleeper” twisted around a toe or finger. This can be very dangerous because circulation can be cut off from the digit. If the hair cannot be completely removed, either by unraveling, using a scissor or melting the hair with Nair or another depilatory, your pediatrician should be notified immediately or the child should be taken to the emergency room. In order to prevent this from happening, sleepers should be washed and stored with the feet “inside-out.” In this way, the feet can be examined for hairs or loose threads before dressing the baby.
Car Seats for Infants
Any car seat that has passed motor vehicle standard #213 is recommended for use and should be properly installed in your car. The American Academy of Pediatrics has promoted a “First Ride – Safe Ride” campaign to encourage parents to use a car seat when taking the baby home from the hospital and every ride thereafter. Laws enforcing the use of car seats are now in effect in all 50 states. It is your responsibility to comply with the car seat law in order to ensure your child’s safety in a car. This includes using a car seat when you use a private car service.
Fever in Baby
A fever in an infant under the age of 8 weeks may be an indication of a serious illness. Please call the doctor's office if a temperature of 101 or over (not associated with an immunization) occurs so that your baby may be evaluated in case any necessary treatment must be started immediately.
Weight-In and First Month Check-Up
You need to weigh your baby when he/she is approximately 2 weeks old. At this time your doctor will evaluate your baby’s feeding patterns and give you the opportunity to ask questions. Try to make your one-month check-up appointment as soon as possible after delivery so that your doctor can give you an early morning appointment before the sick children start arriving.
When to Call the Doctor
Your baby’s healthcare provider expects questions from new parents on just about every topic. They’d rather have you call than worry about something needlessly. However, doctors don’t appreciate it when you call them after office hours about something that isn’t an emergency. Examples of these include constipation, fussiness, poor appetite, refills on prescriptions, pinworms, teething, diaper rashes, thrush, or a cough that has persisted for days or perhaps has just begun, but without any other difficulty. A vaporizer will certainly do until morning. If it is an emergency call your doctor right away.
Sudden fever in an otherwise well infant (over 8 weeks) or child may be treated with Tylenol, other acetaminophen preparation or Ibuprofen (over 6 months of age) and sponging or bathing in lukewarm water. If fever persists call the pediatrician. Symptoms such as dehydration, rapid or labored breathing, a soft spot that bulges when your baby’s quiet and upright or more than eight diarrhea stools in eight hours are emergencies and you should call the pediatrician immediately.
May we wish you and your entire family our sincere congratulations on the birth of your new baby!!
Many Healthy Years!