General Newborn and Infant Feeding Recommendations:
Newborns and young infants nutritionally need only milk in the first several months of their life – either breast milk or formula designed to closely approximate breast milk. Breast-feeding is preferred for nutritional reasons and also to provide better resistance to infection, to decrease the symptoms of colic, to decrease the chance of having an overweight baby and possibly to decrease the risk of development of food allergies and other sensitivities. Another strong reason to breast-feed is that this experience is found to be enjoyable, helpful for the mother’s postpartum healing, and rewarding to both baby and mother. Breast-feeding also promotes good attachment or development of relationship between mother and baby. Breast-feeding is the recommendation of our practice if a mother’s situation allows this option.

Bottle fed babies grow, thrive and feel loved and a mother should not feel guilty or selfish if she chooses to bottle-feed for reasons the mother feels important such as work, family commitments or her personal preference. A baby lovingly held while being fed a bottle will receive good nutrition and feel loved and secure.

Techniques and resources for breast-feeding ares not included here but a list of good resources – both text and trained consultants – are available on request.

Similac and Enfamil product lines are the best formulas in their approximation to breast milk. The Academy of Pediatrics and nutritional experts find insufficient evidence to recommend the newly developed and more expensive Enfamil Lipil or Similac Advance formulas.

After the first few days of adjustment, your baby should take about 3-4 ounces of milk every 3-4 hours. As they grow, a good rule of thumb is to divide the baby’s weight in pounds in half to find the amount of milk in ounces that should not be exceeded for each feeding. For example, a 10 pound baby divided by 2 equals 5 ounces for the baby’s approximate maximum intake per feeding. Use of this formula to establish a volume would generally require 3-4 hours between feedings. For the breast-fed baby this amount will generally be taken by the baby in 10-15 minutes on each breast or 20-30 minutes total of active nursing. The baby gets 85% of the milk from each breast in the first 3 ½ to 5 minutes of nursing and then receives a gradual flow that satisfies the desire to suck over the next interval as you finish the feeding on each side. Spacing of approximately every 3 hours allows digestion and some quiet time for the infant as well as for the mother. Feedings spaced through the day will vary but should average every 3-4 hours for bottle-fed babies and about every 3 hours for breast-fed babies. A child who acts hungry before this time should be pacified or settled another way to avoid overfeeding, spitting up, or gaining of weight too fast. If your non-premature baby sleeps through the night (approximately 7-8 hours) and they have already begun gaining weight consistently, you need not waken them for a feeding. Slow growing or premature infants should be fed at least every 4 hours through the night to allow enough feedings until growth is well-established. Until 6 months of age, your baby does not need solids, juice or water. (Although there is no nutritional need for these types of feedings, there are certain situations you may desire or we might recommend their use for other reasons.)

WATER – Although newborns and infants generally do not need additional water if they are taking adequate amounts of formula, they can be given a few ounces of water if you desire. If you believe the environment is particularly warm and sweat or other body fluid losses might be high, then giving a little water might be useful.

SOLIDS – Although solids are not needed for nutrition, they can be given and are tolerated well in the following circumstances:
• Many parents feel that their babies sleep better through the night when given rice cereal with the bedtime feedings. Often this occurs around the 2 months age. If you find that your baby might fit into this circumstance, it is acceptable to give 1-2 tablespoons of rice cereal in the bottle mixed with formula or fed with a spoon at 4 months of age or so when the baby’s tongue thrust motion has made spoon-feeding more practical.
• Many parents find it enjoyable to allow their child to experience many tastes and textures. If you choose to start solids, we recommend limiting feedings to once per day if 2 months of age, twice per day at 4 months of age, and 3 times per day at about 6 months. Each feeding should be limited to 2 tablespoons at 2 months of age and 2-3 tablespoons at 4 and 6 months of age. Early solid feeding should not be allowed to interfere with the necessary intake of 28-30 ounces of formula or continued full regimen of breast-feeding during this timeframe. From 6 months to 1 year of age allow solids to make up for the growing desire for food that your child manifests as you limit formula to 30-32 ounces per day. Prior to 6 months of age, introduction of solids is not necessary for nutrition but is useful in promoting development of eating skills, teaching your child to accept new and different tastes, and helping to prevent overeating of formula after 6 months of age. The usual progression of food choices begins first with cereal, often using rice cereal as the initial offering. This is followed with vegetables and later with fruits, and then meats. You can make your own baby fruits and vegetables by blenderizing canned (poor off the water) or cooked fresh foods and then freezing in an ice cube tray. These cubes can be stored in zip lock bags and one cube or so can be defrosted for each meal. Keep the rest frozen so that these foods do not spoil.

Avoid using formula, juice, the bottle (even the breast) as a pacifier. Feedings should be intermittent and even where mothers want to feed “on demand” time at bottle or breast should be limited to prevent habits that will be later hard to break. Additionally, frequent intake of juice and milk increases the risk of dental caries.

SAFETY CONSIDERATIONS:
Do not prop your baby’s bottle. If they cannot fully hold it themselves, you should hold it for them. If they hold their own bottle, they should be sitting propped up 45 degrees in a car seat, infant seat or held and supervised by an adult while they are feeding. Feeding while lying flat increases the chance of choking and increases the risk of ear infections.

When introducing solids, start only one new food at a time and offer it 1-2 days before adding another new food. It is okay to continue foods you know your child tolerates but if more than one new food is given and the baby seems ill or gassy, etc., then you will not know which food causes the problem. Raw honey – particularly non-pasteurized honey – can rarely cause serious disease (botulism) in infants. We discourage using honey to sweeten feedings in infants and prefer that store-bought pasteurized honey be used when this does occur at a later age.

Because your baby is likely to swallow without chewing, even after they begin to get teeth, never offer a young child spoonfuls of peanut butter, large pieces of raw carrot, nuts, grapes, popcorn, peanuts, uncooked peas, hard candies or other hard round foods. Choking can also happen with hot-dogs and meat sticks if a baby breaks off a large piece that gets lodged in the back of the throat. Danger from this can be avoided by cutting such items lengthwise and then crosscut into smaller pieces before being given to a child of this toddler age. Foods given to babies under a year of age should be generally such that can be mashed into a applesauce or mashed potato consistency.

Certain foods are potentially higher risk for allergic reactions. These may include seafood, eggs (particularly egg whites), nuts and berries. Therefore, we recommend that you avoid feeding these items until the child is one year of age. When they are given, start with smaller amounts and observe closely for rashes or evidence of breathing difficulty.

COMMON SENSE ADVICE:
Avoid acidic foods like full strength orange juice or tomatoes since they often cause problematic diaper rash from undigested acid. Corn, raisins, and some fibrous vegetables will pass through the baby’s digestive system undigested but are not harmful. It seems reasonable to also limit spicy foods. Avoid adding salts, butter and fats to your baby’s or toddler’s food – particularly if made from table foods you are processing for the child. Sharing food from your plate or utensils or drinking from your glass exposes the infant to germs and viruses. When feasible, keep exposure like this to a minimum. Licking your child’s pacifier to wet or clean it is also exposing them to potential infection.

Reading all the instructions above, as well as other baby books and hearing advice from physicians, nurses and family, keep in mind that if you are thoughtful and observant, there is no single correct way to feed your child. REMEMBER, YOU CANNOT DO THIS FEEDING THING WRONG (IF DONE SAFELY). The information we are giving above hopefully leads you to have plenty of flexibility and enjoyment in working with your child.

When your toddler age child is eating, please have them sit to avoid choking. Choking is more likely if walking or even stumbling while eating.

Changing to Whole Milk:
At one year of age, for formula fed babies, it is recommended that you change your child over to whole or 2% milk. Prior to the 12 month age, special additions of vitamins, amino acids and special building blocks are added to your child’s formula and are thought to be important for their growth and development. At 12 months of age these seem to be unnecessary and the additional expense of formula is not justified. Breast-feeding mothers at about this time begin considering diminishing or stopping breast-feeding. Certainly, breast-feeding can be continued many months further. The general rule of thumb is that if either the mother or the baby prefers to stop feeding at the breast, breast-feeding is discontinued. Certainly, it is commonplace and very appropriate to breast-feed to 15 or more months of age, although many mothers decrease the number of feedings per day at breast. Although the Academy of Pediatrics recommends whole milk after one year of age, we believe that 2% milk is also very acceptable because of the general fat intake received from other parts of the infant’s or toddler’s diet. Skim and 1% milk are not adequate in their fat content.

Vitamin Supplements:
Iron is needed by babies for healthy blood development and therefore formulas labeled as low iron should be avoided. The amount of iron in formula is the baby’s daily dietary need and is not a treatment level dose.

Fluoride is needed by babies for healthy tooth development, starting at 6 months of age. If your water source is from a well or city water that does not contain fluoride, your doctor or nurse practitioner will give you a prescription for fluoride vitamins to be given once a day.

We recommend that babies being breast-fed be offered ADC vitamins such as Ply-Vi-Sol 0.5 ml or ½ dropper daily (which can be obtained over the counter) to ensure good intake of vitamin D from breast milk. Breast milk has adequate and very usable iron for your baby.