Dr. Stuppy, mother and pediatrician, shares her personal reflections on various topics related to pediatrics and keeping kids healthy. Writings and ideas do not constitute medical advice. Please see your doctor for specific medical advice. @pediatricskc
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Tuesday, April 2, 2013
Feeding Your Newborn
I wrote today's blog as a new web page for our office website, but it works well for here too...
Determining what to feed your baby is a big decision when you become a parent. Regardless of whether babies get breastmilk, formula, or a combination of both, the most important thing to remember is that they need to be hydrated and get the nutrition needed to grow. Many parents are guilted into choosing one feeding over another based on friend's or family's opinions. Some parents have a feeding plan that simply doesn't work. You must choose what works best for you and your baby! Remain flexible if needs change.
Breastfeeding is the ideal way for many babies to be fed. Just a few reasons breast is best: it protects against illness, helps prevent allergies, is inexpensive, and even helps the mother in many ways! The American Academy of Pediatrics recommends breastfeeding for as long as mother and baby mutually desire. We think it is ideal to use exclusive breastmilk for 4-6 months, then add foods with breastmilk until at least 1 year of age.
Ideal does not mean this is the only option. Despite being natural, it is not always easy (or even possible) for mothers to breastfeed. We recognize this and support all parents in feeding their infants a nutritionally sound milk - whether it is formula or breastmilk.
Some babies are born with a short frenulum under the tongue. Many people refer to this condition as "tongue-tied" (medically called ankyloglossia). Sometimes affected children may have trouble feeding or later talking. If it is a problem feeding in the newborn period, one of our physicians can clip the frenulum (the part that "ties" the tongue down) and release the tongue so it can move better. We will be happy to discuss and evaluate if you feel your child will benefit from this procedure.
We also have a Nurse Practitioner and nurse available in our office who have additional breastfeeding education (not IBLCE certified) and can coordinate a lactation consultant (IBLCE certified) to visit with you in our office or at your home. Just ask!
Formula has come a long way over the years to becoming more tolerable and nutritious. There are as many reasons parents use formua as there are brands available. There are even several varieties within each brand, making which formula to use a difficult choice for some. We support partially hydrolyzed formula as an initial formula for most babies who will take formula to reduce risks of milk protein sensitization. Soy formulas and lactose free formulas are not generally recommended unless there are specific medical needs. Discussion of why we have these recommendations is found on How to Choose What to Feed. There may also be benefit to whey formulas over casein products. Discuss any formula changes with your provider. We don't want babies to be on a new formula every other day... they don't tend to tolerate that well and it is difficult to determine their response to changes if they are made too frequently.
How much to feed? This common question varies by age and size of your baby. In general the first few feedings are measured in milliliters, regardless if breast or bottle feeding. Too much too soon tends to come back up!
Breastfed babies usually do well on colostrum alone until milk comes in (around day 3-4). They typically feed immediately after birth, but then are sleepy until about 24 hours of age, so might need encouragement to eat. We expect them to lose up to 10% of their birth weight during the first week. We want them to feed at least 8 times per 24 hours, which averages to about every 3 hours. They should wet at least 1 diaper the first day, 2 wet diapers the 2nd day, and 3 diapers the 3rd day. By day 4, milk should be in and they should have wet diapers about every time they eat. Some urine might hide in stool, so if they are feeding well, stooling, and not losing excessive weight, don't worry if they don't seem to be making urine. Most mothers will work with a lactation consultant and their nursery nurse while in the hospital. We watch their weight carefully until weight gain is established. Term babies should be back to birth weight by 2 weeks of age.
Formula fed infants typically take 10-15 ml with the initial feed. They eat about every 3 hours (range 2-4 hours), and slowly increase the amount of formula to about 30ml (one ounce) per feed over the first days. When they show hunger sooner than their schedule, it means they are ready to increase the volume per feed. Like breastfed babies, we expect them to lose weight the first week, although typically less is lost compared to a breastfed baby. By the end of the first week they take about 60ml (2 ounces) every 3 hours. They should be back to birth weight by their 2nd week birthday. By the end of the first month they take about 24 ounces per 24 hours (average 3 oz every 3 hours).