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Feeding Fundamentals

Not only will a healthy diet allow your baby to grow properly, but mealtime will help the two of you bond. Here’s how.

The number one rule to follow when it’s mealtime with your child? Feed your baby like a baby. Infants need a diet that is very different from that of an older child or adult. The food you give your little one now will help her grow and develop properly as well as set the stage for healthy eating habits. Starting with the wonders of breast milk right through to the time when she’s got pureed peas all over her face (and yours!), your baby will love to eat, so use it as a time to bond with her and give her everything she needs to grow.

Breast Is Best

In the first months of life, the best food for infants is breast milk, as is recommended by all healthcare providers, including the American Academy of Pediatrics (AAP) and the National Association of Pediatric Nurse Practitioners. It provides your baby with all the nutrients she needs for these early weeks of rapid growth and development. In fact, exclusive breastfeeding for the first six months is the best way to keep your baby healthy: Breast milk is more easily digested than formula, and studies have shown that it can decrease the occurrence or severity of diarrhea and similar conditions and may protect your baby from ear infections and other common infant illnesses.

The best way to get breastfeeding off to a good start is to begin in the hospital after delivery. Here, a nurse or lactation consultant can help you learn the basics, including latch-on and positioning. You may want to try several positions to see which is most comfortable for you, although many mothers find that holding their baby in the crook of their elbow with the baby on her side facing the breast works best. This position allows you to hold your breast for your baby so that she latches on correctly.

Take your time getting latch-on right; it will help prevent many breastfeeding problems (see “Common Breastfeeding Concerns”). To help your baby latch on, hold your breast with one hand while gently positioning her so that it is facing her mouth. Let her “root” towards your breast; sometimes a drop of breast milk on her lips will help her find it more easily. When she begins to feed, she should take most of your areola (the dark part of your breast), not just your nipple, in her mouth. Make sure her tongue is not blocking your nipple, and, the first few times your feed her, have your partner check to be sure that her lower lip is flared out on your breast.

Babies usually breastfeed every 11⁄2 to 2 hours during the first week or two of life. Once your milk supply is established, however, that time span will lengthen, and by the end of the first month, you two will find a mutually satisfying schedule. It may change during periods when your baby is growing quickly, but this usually lasts just a few days.

Many breastfeeding mothers worry about whether or not their baby is getting enough milk. The best way to judge this for yourself is by watching her. During the first few weeks of life, you’ll learn to recognize her signs of fullness, like less vigorous sucking. If she seems satisfied after feeding, sleeps between feedings when she’s a newborn and has between six and eight wet diapers and one or more bowel movements each day, then generally you can assume that she is getting enough milk. Your baby’s steady growth is also a good indicator: She’ll be weighed and measured at each well-child visit, but you can always schedule an in-between check up if you’re worried.

Even Dad can take part in breastfeeding. Once you get the hang of it, he (or other family members or caregivers) can give the baby an occasional bottle of pumped breast milk or formula. He can also help set the stage by bringing you a nursing pillow or some water as well as burp and hold the baby after a feeding. Breastfeeding moms need plenty of support, and Dad can be right there to lend a hand.

Bottle-Feeding Basics

Breastfeeding does not work for all families, and the only alternative is commercial formula (homemade formulas cannot provide the right mix of nutrients) from the supermarket or a warehouse store (like Costco). There are two main types of formula: cow’s milk and soy. Ask your healthcare provider which she recommends for your baby.

You will also need to choose from among ready-to-feed, liquid concentrate and powder versions. Ready-to-feed is the most convenient—it’s literally open and serve—but the most expensive. Liquid concentrate is less pricey and easy to prepare, and powder is cheapest, has a longer shelf life once the can is opened and is ideal for traveling since individual feedings can be mixed whenever you want. The kind you choose depends on your family’s needs.

Your third decision: which bottle and nipple to use. In choosing a bottle, consider its durability and ease of cleaning (those with extra curves or unusual shapes are tougher to clean). When it comes to nipples, it’s a good bet to select one that allows the formula to drip slowly out when it’s turned upside-down—this will prevent choking. However, these nipples may tire some babies and limit the amount they eat, so you may have to switch at some point.

The amount of formula a baby drinks increases gradually over the first 4 to 6 months. During the first few weeks, she may take as little as 14 to 16 ounces a day (divided into 8 to 12 feedings); that will rise to more than 30 ounces by month 3 and up to 40 ounces or more by 6 months.

Keep a close eye on your baby’s appetite. When she’s hungry, she’ll root, bring her hands to her mouth and make sucking motions. Feed her as long as she’s eager to drink, and when she starts losing interest, burp her and then try again. If she’s getting enough to eat, she’ll have seven or eight wet diapers each day.

A Solid Start

The AAP recommends starting solids at 4 to 6 months of age, but it depends primarily on your baby’s development. Ask your healthcare provider to help you make this decision. Your baby is probably ready for solids if: She has doubled her birth weight and weighs at least 13 pounds; she is formula-fed and drinks more than a quart of formula per day; or, if she is breastfed, wants to be eat more than 8 to 10 times a day and often seems hungry. Your baby’s head and neck control should also be developed enough that she can turn toward food when she’s hungry and away from it when she’s not.

The first solid food for babies should be rice cereal mixed with breast milk, formula or water: It’s easy to digest and unlikely to cause an allergic reaction. The first time you try it, choose a time of the day when both of you are relaxed and there are minimal distractions, like in the late afternoon between feedings. (It’s okay to vary this time from day to day at first.) Make sure that your baby is sitting up and you feed the cereal with a spoon to minimize the risk of choking.

You might feed your baby a small amount of either breast milk or formula before trying the cereal: She’ll likely be more eager to learn to eat off a spoon if she’s not extremely hungry. At first, she’ll only take one or two small spoonfuls and most of the cereal will end up everywhere but in her mouth, but be patient. If the first time really doesn’t go well, then try again in a week or two; it may take a few weeks for solids to really stick. Once rice cereal is a go, try other single grain cereals like barley and oats. Save wheat and mixed cereals for last as these are more likely to trigger allergies. After cereals, you may introduce either single strained fruits or vegetables, and lastly, meat. Eggs are a common cause of allergies, so wait on these until your baby is close to a year old.

When you start a new food, a few teaspoons are all that’s needed. Introduce the same food in increasing amounts for 3 or 4 days before trying something new so that you can watch for allergy symptoms like rash or diarrhea. Consider starting with vegetables before fruits: If your baby develops a taste for sweet foods, she may not want to bother with those that are less palatable. Either way, keep trying with vegetables—it may take 5 to 10 introductions before she accepts them. Variety is crucial. Babies and young children who are offered lots of different foods are usually less picky later on.

By 9 months, most babies can use their thumb and forefinger to pick up a piece of food and place it in their mouth. To help her learn to feed herself, give your baby finger foods that are soft and don’t require chewing, like tiny pieces of crackers; cereal; or well-cooked, cut-up pasta or vegetables. Talk to your healthcare provider before starting finger foods, and remember to cut everything into very small pieces to avoid choking.

And to Drink ...

When you first begin solids, maintain your baby’s breastfeeding or formula schedule. Once she’s eating solids at several daily feedings, 32 ounces of breast milk or formula each day is reasonable. By 10 to 12 months of age, most babies drink 18 to 26 ounces per day.

As for other fluids, avoid milk until your child is a year old; before then, it can cause allergies. Between 1 and 2 years of age, your baby should drink whole milk because she needs the fat for growth. Don’t give her juice—it’s too sugary—until the sixth month and then only in very limited quantities (1⁄4 cup at most, once a day) and in a cup, not a bottle.

If you provide nutritious, appetizing and appropriate foods for your baby, she will learn to eat until she’s full. Pay attention to her appetite to avoid over- or underfeeding her, and never force her to eat. Remember, your child will grow in spurts, so her appetite will vary depending on whether she is in a growth period or at a plateau. If you give her healthy choices, your baby will figure out how much to eat, forming the foundation for good eating habits in the future.

Common Breastfeeding Concerns

Having some trouble breastfeeding? You’re not alone. Here’s how to solve some very common problems.

• SORE NIPPLES - are often the result of awkward positioning or a poor latch-on. This discomfort is different from the tenderness you may experience in the first seconds of nursing; that usually goes away a week or so after birth. If the soreness persists, try different positions until you and your baby are both comfortable, and make sure your latch-on is correct. (Call a lactation consultant if you need help.)

• ENGORGEMENT is a condition that sometimes occurs in the early days in which the breast becomes full and hard with milk. Try cold compresses (or a bag of frozen peas) on your affected breast between feedings for comfort; a cool leaf of cabbage may also be soothing. To avoid it, feed your baby every two hours or so, or use a breast pump to empty your breasts at each feeding.Feed the cereal to your baby with a spoon. Putting it in a bottle and enlarging the nipple is not recommended as this interferes with the normal developmental need of using the tongue to control the food.

• MASTITIS is a breast infection that often starts when the breast is not completely emptied at a feeding. The affected area turns sore, red and hard. If these symptoms last for more than a day, call your healthcare provider; antibiotics will often solve the problem. To prevent mastitis, empty your breasts at each feeding (pumping may help). Try holding a warm washcloth to your breast before feeding or pumping; this may help the milk come out more easily.

• Concerns about LOW MILK SUPPLY often come up when the baby is about 2 months old. At this point, your body has learned how much milk to produce, and your baby may only nurse for five minutes at a time. This is not a sign of decreased milk supply: Rather, it means that you and your baby are breastfeeding successfully! You may also notice that your baby has fewer bowel movements, which might be making you nervous, too. This is totally normal; it means that your milk no longer has colostrum in it, which was having a laxative effect on your infant. Remember, if your baby is breastfeeding 8 to 12 times a day; you can hear him swallow during feedings; he is active and alert; and he is growing well, you have an adequate milk supply.

• FLAT NIPPLES, also called inverted nipples, do not protrude or become erect when stimulated or cold. In almost all cases, you can still breastfeed, however, latch-on may give you some trouble. If it does, you might try wearing breast shells between feedings or pumping just before a feeding to bring the nipple out.

Rita Pickler, PhD, RN, PNP, associate professor and chair of Maternal Child Nursing at Virginia Commonwealth University in Richmond, has been a nurse in the care of children for more than 25 years and a nurse educator and researcher for 15 years.