Breast-Feeding and Bottle-Feeding

Babies grow very quickly during the first year of life. It is particularly important, therefore, that they get good nutrition during this peri­od. As a parent, you'll need to provide your child with healthful and complete nutrition.

BREAST-FEEDING

Throughout history, children have been breast-fed. But during the twentieth century, the number of people breast-feeding declined in many places, including North America. Luckily, breast-feeding has become more popular again. There are a number of breast-feeding organizations that offer free help and advice. Ask your doctor, midwife, childbirth educator, or local health department, or check the Yellow Pages for information.

MOTHER'S MILK: NUTRITION FOR INFANTS

Mother's milk alone is the best nutrition during the first 6 months of life, and may continue to be best for 3 months beyond that. Depending on your climate and your doctor, you may be told to supplement your breast milk with vitamin D, often in the form of cod-liver oil. Mother's milk contains enough of all the other vitamins.

The traditional recommendations about iron are being debated. As long as the baby is only receiving mother's milk, iron supple­ments are probably unnecessary. This applies to babies who were healthy and of normal birth weight. When you start giving your baby other foods (mixed nutrition), the amount of breast milk will start to decline, so the baby will receive less iron from breast milk. In addition, iron in other foods is not very well absorbed, so any cereals or other foods should be enriched with iron.

The nutrients in your milk are geared to the growth pattern of your infant. To accommodate rapid development of the brain, but slow growth of muscles and bones, mother's milk provides a lot of car­bohydrates and polyunsaturated fats, but fewer proteins and minerals. But nutritional quantities are only one side of the coin. It's just as important that what babies eat be easily digested and absorbed. Iron is absorbed over 20 times more easily from mother's milk than from formula. So, moth­er's milk gives children good nutrition and, at the same time, leaves little extra stuff for intestinal bacteria to feed on.

Mother's milk contains a lot of water, so it looks bluish and "thin," sort of like skim milk. The water protects the baby against dehydration. In hot climates and during fever, a baby's kidneys put less water out into the urine. Under those physical "stresses," it's a great advantage that mother's milk doesn't burden the baby with unnecessary amounts of salt and proteins.

MOTHER'S MILK: PROTECTION AGAINST DISEASE

Mother's milk also protects your baby against bacteria and viruses that can make him or her sick. For this reason, the recent decline of breast-feeding caused a lot of ill­ness and death among infants in countries that couldn't offer good health care. Good research also shows that babies in industrial­ized countries like the United States have fewer illnesses if they're breast-fed.

   Mother's milk counteracts infection in two ways. First, it regulates the growth of bacteria in the baby's "gut" and intestines. Breast-fed babies' feces smell sour, but they are less irritating to the baby's skin than the feces of bottle-fed children. Second, mother's milk contains antibodies that help protect against viruses and bacteria. This gives breast-fed babies good protection against infectious diarrhea and vomiting.

COLOSTRUM: A GOOD START

The early nursings provide your baby with colostrum, which is in your breasts even before you give birth. Colostrum is yellowish and seems "richer" and more nutritious. Colostrum does contain high concentrations of antibodies that help suppress dangerous bacteria, and colostrum is easy for the new­born to digest. These are two reasons that infants should be put to the breast as soon as possible after birth.

THE PREMATURE BABY

Breast milk is at least as important for preemies as for full-term babies. But these small children from birth  will probably need supplements of calcium, phosphate, protein, trace elements, and (after 6 weeks) iron. Your doctor will tell you what's right for your baby.

IMMEDIATELY AFTER BIRTH

Starting good routines right away iimportant for successful breast-feeding. The World Health Organization and UNICEF have developed certain recommendations for breast-feeding, which include:

·       Put the baby to the breast as soon as possible.

·       Let mother and baby be together at all hours.

·    Do not give water, sugar, and so on

(even formula!) to a breast-feeding new‑

born, unless it's medically necessary.

Midwives and childbirth educators should be able to give you guidance about breast-feeding. They should encourage feeding on demand, too (explained below).

After a normal birth, the newborn is very alert for a few hours. The baby wants to suck, and you are probably ready to start bonding. If possible, try to start breast-feed­ing in the first half-hour after the birth. That way, the infant will quickly receive the important colostrums. And the more fre­quently the baby feeds, the sooner the amount of milk will increase, and the sooner the baby will gain weight.

One of the most important duties of the father or birth partner in the time right after birth is to protect the breast-feeding woman from too many visitors, demands, and strains, which can disturb breast-feeding.

FEEDING "ON DEMAND"

In the old days, infants had their mother's breast within reach most of the time. They fed several times an hour during the day, and once or more at night. Babies want to feed that frequently because their brains need a continual supply of energy, which can't be stored for very long in youngsters. So, an infant's stomach shouldn't be empty for long periods.

Self-regulation (or feeding "on demand") means that the baby decides when to feed  you don't set a schedule. Your child probably knows instinctively how to control his or her feeding, and in time you can learn to interpret the different sounds and signals. Concepts like "disci­pline" and "spoiled" don't belong in the infant's world. Careful guidance toward a certain order, regularity, and routine, how­ever, is fine.

Feeding on demand gives the bab security and well-being by gaining a sense of accomplishment, and by learning that adults are responsive and trustworthy. Breast-fed children will want varying amounts of milk from one feeding to the next. So, they'll signal hunger at different intervals. This is quite normal.

Self-regulation makes it possible for the mother to adjust the amount of her milk to the baby's needs. Generally, the more the baby sucks, the faster the breasts will pro­duce more milk. If the baby has taken — or been given — too little milk, he or she will demand more frequent meals, and you will produce more milk.

NIGHT-TIME FEEDINGS

Feeding during the night is the biolog­ically normal thing to do. In some cases, the breast milk will start to dry up without night-time feedings. It is not true that feeding your baby at night will damage the teeth — antibacterial substances in mother's milk will protect them. What can damage the teeth, however, is to let a baby lie at night with a bottle of juice or formula in the mouth.

WEANING

The length of time that infants should live on mother's milk alone is under debate. Newer research shows that children 6 to 12 months old have about a 20% lower need for energy than the World Health Organization and UNICEF had earlier assumed. So, chil­dren are probably best served by mother's milk alone (except for any vitamin D sup­plement) for at least 6 months. Only at around 9 months of age might they need some other foods.

Weaning and introducing mixed nutrition should, therefore, start in the second half of the first year. You should let the baby help decide the timing. Breast-feeding needn't be stopped just because the teeth start to appear. It's fine to continue with some breast-feedings into the second year of life or longer, as long as mother and baby are happy with it.

BREAST-FEEDING TECHNIQUES

It is important to put a breast-feeding baby into a good position. Turn the baby toward you so that the neck is straight and he or she doesn't have to turn the head or bend for­ward. Put the bab^y on the breast so that the nipple and a lar^ge part of the areola (darker area) go into the mouth along the roof of the mouth. The baby should suck with wide-open jaws — onl^y then is the milk effectively massaged out of the tissue under the areola. The nipple itself is then being pulled quite a long way toward the throat. Try not to let the baby suck on your nipple with pursed lips —it'll be painful for you.

If milk doesn't start dripping out just as the baby is latching on, it may be helpful to stroke your breasts toward your nipples, with your hand, until the milk comes. This let-down reflex can be temporarily weakened if you're worried or tense. In that case, it will usually be enough to stroke the breasts.

A good position for you is lying on your side with a good pillow under your head. (Don't put your shoulders on the pillow.)Bend your lower arm and rest it so that your hand is level with your head. Lay the baby under your armpit, nice and close to your body. When you use this position, your body can rest, which makes breast-feeding easier.

HOW LONG SHOULD THE BABY BREAST-FEED?

For how long should the baby feed at each breast? How frequently? Should the baby be given both breasts at each feeding? Opinions differ widely, so mother and child will have to experiment. Self-regulation gives room for a lot of variety.

A good starting point is to make sure that your breasts don't become too full. If they over-fill, you'll have to empty the breasts com­pletely. Women with a strong let-down reflex will give most of their milk in 10 minutes. For other women, it might take twice that long. Let the child stay latched on until he or she lets go of the breast, and offer the other breast. If the child doesn't want it (or has fallen asleep), and the second breast is uncomfort­ably full, you will have to express or mas­sage out some milk, and offer that breast first next time.

Most infants adjust to a pattern of feeding every 2 to 4 hours during the day, and may want to feed more in the afternoons. The more frequent the meals, the less important it is to give both breasts at the same feeding.

How MUCH BREAST MILK SHOULD THE BABY GET?

The child's well-being is the surest sign that he or she is getting enough milk. This can be checked by steady weight gain and good growth. But remember, half of all healthy children are below the average weight and length for their age, and the other half are above!

"TOO LITTLE MILK"

It's very rare that you really cannot pro­vide enough milk — if you and your baby practice self-regulation. Breast size doesn't affect a woman's ability to breast-feed. Even if you're small-breasted, you'll probably be able to breast-feed your baby.

Some women do have a slow let-down reflex, and others produce less milk when under stress. It takes many days before the milk completely disappears — initially it's only the let-down reflex that is weakened. If you know this, you'll become less fearful of losing the milk.

If you're having trouble, try stroking your nipples a little until the milk comes. If you've had plastic surgery done to your breasts, the nipples may be less sensitive, and some of the milk ducts may have been cut. But even then, don't give up until you've tried good feeding techniques, fre­quent feeding, and seeking the advice of a breast-feeding advisor.

SORE NIPPLES

The best treatment for sore nipples is to try to avoid it. The baby should not latch on to your breast with his or her mouth and jaws around the nipple itself. Instead, the baby should open the mouth wide and suck the areola and underlying tissue backward toward the throat.

After the feeding, the breast should air dry with milk still on it. Don't wash the breast with soap or disinfectants. And, keeping your hands clean is important.

Creams have not proven to be useful in preventing sore nipples, nor has any form of toughening or stretching of the nipples before the birth.

MASTITIS

It's important to avoid too much pressure of milk in the breasts. If the milk is held in too long, it will start seeping out into the breast tis­sue, and could result in an inflammation called mastitis. This is not an infection to start with, so it shouldn't be treated with antibiotics unless it continues. Usually, part of the milk gland becomes overfilled. When that happens, the breast becomes tender, the skin gets red and warm, and the mother may develop a fever. Only when that has been going on for some time can bacteria enter and infect the breast.

So, try to drain the overfilled area of the gland frequently. (On the other hand, there's no need to empty your breasts completely each time.) Remember to let the let-down reflex work for you, and make sure that the baby opens his or her mouth wide and latch­es on correctly. During the feeding, gently massage the milk in the sore area forward toward the nipple. You can also massage like this when using a breast pump.

WILL BREAST-FEEDING CHANGE MY FIGURE?

Breast-feeding uses stored fats to produce milk. Prolonged breast-feeding may reduce the fatty layers on ^your hips and thighs, where fat built up during pregnancy. If you don't breast-feed, the fat is hard to get rid of by dieting, probabl^y because nature has cre­ated it as a "reserve" for breast-feeding.

The breasts change in varying degrees for all women who have gone through a preg­nancy. What probabl^y changes them most is overfilling during the first few weeks after birth, when the connective tissues are more stretchable. Prolonged breast-feeding doesn't change the breasts more than short-term feed­ing. The best advice is to breast-feed frequent­ly to avoid too much pressure in the breasts.

SMOKING

The nicotine in cigarettes does reach the baby through breast milk So, if you quit smoking when you were pregnant, please don't start again_ However, breast-feeding is so important for mother and child that even smokers should breast-feed. Try to keep the number of ciga­rettes low, and don't smoke right before breast-feeding. Of course, protect your baby from inhaling any "second-hand smoke," too.

CONTRACEPTION

It is true that breast-feeding delays both ovu­lation (release of the egg) and menstruation (your "period"). That said, breast-feeding is not a reliable form of contraception (birth control). As long as your baby is being given only breast milk, and is nursing at night, it isn't likely that you will menstruate. However, you can con­ceive another child during the first ovulation after you give birth, which takes place some­time in the month before you start menstruating again. Out of 100 women who haven't started menstruating again yet, and who are not using any contraceptives, 2 will get pregnant again within 6 months of giving birth.

As soon as you start introducing mixed nutrition, the likelihood that you'll conceive again goes up. And, even if you haven't start­ed menstruating in the second half of your baby's first year, the chances for getting preg­nant again go up to about 5 in 100 if you don't use birth control.

When you've started menstruating again, you cannot rely on breast-feeding to prevent new conception, no matter how short a time has lapsed since you gave birth.

If you want to use contraception, talk with your doctor or family planning clinic about the best methods for you. Condoms, diaphragms, and barrier methods are usually fine. If you want to use the pill, consult your doctor or family planning clinic about the best type to use while breast-feeding.

TIME OFF WORK TO BREAST-FEED

If you work outside the home, you may want or need to go back to work before you've finished breast-feeding. Check with your employer usually the personnel department or benefits administrator is bestabout whether they will allow you time off during the day to breast-feed (or use a breast pump). Perhaps you can arrange for "flex­time" in which you arrive early and/or stay late, taking some time off in the middle of the day. Compan^y policies vary, and many small employers don't have a specific "breast-feed­ing policy," so you may need to negotiate.

BOTTLE-FEEDING

We know' that breast milk is best for babies. All warm-blooded animals make milk, but there are large differences between their milks. The fact that adult humans drink cow's milk, and produce formula based on cow's milk, doesn't necessarily mean that that's the best milk for humans it's just easily available.

The first milk your breasts produce, colostrums, is full of important ingredients to nourish and protect your baby. So, even if you have decided to bottle-feed, it's good to ^give your baby these first important drops of milk.

CHOOSING A FORMULA

You should talk to your doctor or mid­wife about which formula is best suited to your baby. Your baby may not be able to digest some types of formula, but will thrive on others. It is normal to experiment with a few formulas before you find one that suits your baby.

Most formulas are based on cow's milk, so if your baby is allergic to cow's milk, you'll need to choose a soy formula. Fresh cow's milk should not be given to babies under 9 months to 1 year old.

If you want to make your own formula, here's one recipe (from the American Academy of Pediatrics) you might try:

·      One 13-ounce can of evaporated milk (not condensed milk)

·      2 tablespoons (6 teaspoons) sugar (sucrose)

·      IS to 19 ounces of sterilized water (bot­tled or boiled)

Wash your hands and the top of the evap­orated milk can with warm, soapy water. Open the can with a can opener that has been scalded with boiling water. Empty the can of evaporated milk into a sterilized (boiled) 1-quart jar with a screw-on top or airtight lid. Add the sugar. Fill the jar with sterilized water, which has been allowed to cool at room temperature (lukewarm if you're going to feed your baby right away). Close the jar tightly and shake it until the ingredients are thoroughl^y mixed together. Pour into baby bottles, and seal them with lids. Sterilize the bottles of formula by placing them upright in a pot of water and boiling the water for 25 minutes. Allow the formula in the bottles to cool before feeding your baby! Refrigerate any of the formula you don't use immediate­ly. Use or throw out all of the formula within 24 hours.

If you make your own formula, follow the instruction exactly. Also, be sure that your doctor knows that you're using homemade formula, so that the necessary vitamin and mineral supplements (such as vitamin C and iron) can be given. Proper nutrition is needed for normal growth and development.

WHAT EQUIPMENT WILL I NEED?

If you decide to use traditional baby bot­tles, you'll need bottles and nipples, plus equipment to sterilize them. Alternatively, there are disposable bottle liners, so that you don't have to sterilize the bottles. You'll see a lot to choose from on the market, but the nipples that look and feel most like the breast are probably the best. The other thing to look out for is the size of the holes in the nipple. They should not be too small, because the baby could grow tired of suck­ing and swallow a lot of air. If the holes are too big, the baby will drink too fast and may have problems digesting. When you hold the bottle upside down, a steady stream of drops of formula should come out.

WHEN AND HOW MUCH SHOULD I FEED THE BABY?

Today, most people believe it's best to feed the baby when he or she shows signs of hunger. (See Feeding "on demand," on pages 23 to 24, for more information.) Every baby is different, but in the beginning it's usually 5 to 10 feedings in 24 hours. Some babies stop wanting to feed at night early on. Others keep wanting it for a long time. Some babies eat a lot, while others seem to need less. Calories provide energy. In general, until the baby is 5 months old, he or she will need 55 calories a day for each pound of body weight. About 3 ounces of formula, per pound, per day contains that amount of calo­ries. Remember, babies vary — yours may need more than this or less.

BREAST PUMPS

Some mothers think they have to bottle-feed with formula because they're return­ing to work. This isn't necessarily true. You can breast-feed all through your maternity leave if you work outside the home, even if it's just for a few weeks. With careful plan­ning, you can use a breast pump to express  your own milk, which you then store in the freezer. Or, if you are not able to do this, you can have your baby on formula during the day and breast-feed before and after. Remember, though: The baby needs to suck  or you need to express — breast milk at least once a day to keep producing it. Many women keep breast-feeding once or twice a day all throu^gh the first year, which will provide your baby with essential nutrients as well as formin^g a special bond. Ask your doctor, midwife, childbirth educator, or breast-feeding advisor for information about breast pumps.