Hi, I’m Dr. Jessica Donaldson from Children’s Care at Memorial Health! Today’s topic on nutrition and feeding concerns is something I deal with on a regular basis because I take care of hundreds of children, and, in many ways, their parents also. So, here is my advice on infant nutrition.
(Disclaimer: these are general recommendations, and are derived from the American Academy of Pediatrics, however make sure to still discuss specific concerns for your child with the Pediatrician who knows your child, as these recommendations may not apply to every situation)
Breastfeeding has gained a lot of traction from a medical perspective in the last several decades, however it is really an age-old practice that has always stood the test of time. So, why so much publicity now? The medical community has discovered and proved there are so many benefits for both baby and mom! Just to name a few:
Breastfeeding lowers your baby’s risk of asthma and allergies, plus babies who are exclusively breastfed for 6 months have fewer ear infections, respiratory infections, and diarrhea illnesses!
If that doesn’t sell you- it also helps moms get back to their pre-pregnancy weight, by increasing your body’s metabolism through all that milk production.
Breastfeeding isn’t all easy and happy though- it can be quite difficult to get the hang of, and many moms get discouraged. The reasons I see moms stop breastfeeding are not “I don’t think it’s best for me or my baby” or “I don’t think it’s important.” The top 3 reasons I hear on a daily basis are: painful nipples, perceived or real lack of milk supply, or lack of support. These 3 reasons are usually able to be overcome with the right information.
Here’s my advice for breastfeeding problems:
Painful nipples are typically an indication that the baby’s latch isn’t quite right. It’s important your baby has a wide-open mouth to latch on comfortably. Other latch problems can be addressed by your Pediatrician or Lactation Consultant, either from the Newborn Nursery in the hospital, or at your Pediatrician’s office. The support is out there- just ask! Prolonged sucking more than 30 minutes can also cause pain. Babies should not need to feed on one breast for more than 30 minutes. If they are, either they are not really feeding, but may be using you as a pacifier, or perhaps, the latch is not correct and they’re having trouble sucking/getting milk. In general, fixing the latch and suck will help the pain resolve, although it may take 1-2 weeks for the nipples to fully heal. In the meantime, Lanolin cream can help. I can’t stress enough- reach out to your Pediatrician or Lactation Consultant for help- don’t be afraid or embarrassed, it is something we talk about every day at work, and a little support can go a long way!
Worried their baby isn’t getting enough milk? First, know that babies are not supposed to get a large volume of milk the first 2-3 days after birth. Your body makes Colostrum, a thick nutrient-rich version of milk, which gives babies a chance to take in less volume and still get nutrients while they’re learning to nurse. This gives your body a chance to ramp up the milk production as well. This is a normal process, and milk production is expected to come in more fully by 3-5 days after birth. So, be patient before you jump to formula to supplement! Secondly, if you’re not making much milk after the first 3-5 days, 90% of the poor milk supply in this time frame is due to inadequate milk removal from the breast. The more the baby nurses and removes milk, the more your body makes- a supply and demand process. If baby is having a hard time with latching or emptying the breast at first, try pumping to stimulate your body to make more milk in the meantime. Often moms, being concerned for their baby, may jump to supplementing formula (not that formula is bad, and we’ll talk about that next) but adding on formula means the baby may not nurse as long or as frequently, removing less milk from your breasts, causing even decreased milk production. This can be a tricky cycle, because you may be tempted to offer more formula to keep the baby full. Offering formula is not a bad thing, but if you want to keep breastfeeding also, you’ve got to keep eliminating milk from the breasts either by nursing frequently, or with a pump at least every 3-4 hours, just as if your baby was solely nursing. So, stop worrying about which supplements to take to increase your supply, and spend more time regularly pumping. As I said, this will fix 90% of the poor milk supply problem! And remember- the content of your milk is dependent on your diet and general health, so keep taking those Prenatal vitamins and maintain a healthy diet and good hydration to keep your breastmilk full of good nutrients!
Going back to work. Another reason moms may stop breastfeeding, is they may be planning to go back to work. Again, this is a lack of support issue. Moms, know your rights- there is a federal law that requires all companies (with at least 50 employees) to provide the time and space suitable for mothers to pump during the workday. Also, most insurance companies are required to cover a double electric breastpump free of charge for nursing mothers. Electric pumps are much faster and easier than manual ones :)
Here are some quick facts about breastmilk storage: At room temperature, clean (meaning baby hasn’t started to drink out of the bottle and contaminated the milk) expressed breastmilk can last 4-8hours, in the fridge- 4-8 days, frozen- 9-12 months, and thawed-24 hours.
What’s the scoop on formula?
Ok, but maybe, apart from the above reasons, breastfeeding is not right for you or your baby. What’s the scoop on formula? Why all the different versions? Be careful not to fall for all the ads- formula companies are like all companies, they want to make money. Here’s what to know about formula: All brands of formulas are required by the FDA to contain the recommended vitamins and nutrients for infants. They all are supplemented with iron (good for baby’s brain growth), and have 19-20 calories/ounce. So that means the generic brand formulas are nutritionally the same as other “name brand” formulas! This is a great place to save money! Apart from the recommended and standardized nutrient content, there is not a lot of research on other additives in formulas. So although different brands may advertise “for spitting up” or “helps gas,” these things are not necessarily proven by ‘gold-standard’ research. And while we’re talking spitup: 70% of babies will spitup, and the majority of those babies will continue to grow and develop normally and “grow out” of their reflux by 6-7 months of age. As my elder colleague in our practice always says, “Spitup is a laundry problem, not a medical problem!” (Obviously, there are certain situations when changing formulas or addressing spitups are important, so again, still talk with your Pediatrician about your baby’s situation!)
One last thing on infant nutrition- Vitamin D!
Every baby needs a vitamin D supplement. Breastmilk content of Vitamin D is variable, and babies who are formula fed do not get enough from the formula until they are taking 30oz/day. Being Vitamin D deficient puts your baby at risk for Rickets and bone growth problems- which are totally preventable with a daily Vitamin D supplement, which is recommended from birth until babies are taking more Vitamin D fortified solid foods or 30oz of formula /day (around 6-9months).
Stay tuned for Part 2 on Toddler nutrition!