Breast feeding vs formula feeding
Breast feeding
The American Academy of Pediatrics encourages breast feeding as the first choice for nutrition for newborns. Babies that are breastfed have fewer infections and allergies during their first year of life than babies that are fed formula. Breast milk is also easier to digest and helps in minimizing gassiness and colic symptoms. There are also some very practical reasons to breast feed your baby. Human milk is relatively low in cost, it needs no special preparation, and it is instantly available.
If though for medical reasons, work issues or personal preferences you decide not to breast feed, infant formulas are a safe alternative. We will help you select the appropriate formula for your baby according to your baby's need. We recommend that you talk to us before making any formula switches because we may be able to better guide you through the process.
How often do I breastfeed?
The first feed should take place in the delivery room, if mother and baby are stable. The second feeding should take place again in the next 3-4 hours. Many babies will be rather sleepy for the first 24 hrs and may not eat as vigorously. Try to feed your baby every 2-3 hrs during the day and every 3-4 hrs at night. Do not let then baby sleep more than 4 hrs during the day so that she can sleep a little longer at night. Also try not to feed less than 2 hrs apart because then we create the pattern of "grazing" that leads to constant feeding.
How long per feed?
We recommend nursing for about 10-15 minutes per side. The goal is to complete a nursing in about 30 minutes. Place baby first on one breast, burp after the first 15 minutes and then proceed to place on the other side. Remember to alternate which side you use first, in order to avoid engorgement. Once the milk supple is well established the feeding may become shorter because of more efficient feeds. Most babies will get about 90% of what they need in the first 10 minutes of a feed.
How do I know my baby is getting enough milk?
The main indicator of good intake is the number of diapers. Breastfed babies should have at least 3-4 stools per day and at least 4-5 voids per day. Babies also should seem satisfied after a feed and for the most part fall asleep after a feed. We will also be keeping close track of the weight gain. Baby's first visit will be at 1 week of life. The main reason for that visit is to check the weight gain. By two weeks of life most babies have reached their birth weight. Once your milk supply is established your baby should gain about 1/2oz to 1 oz a day for the first 3 months of life.
What about bottles?
It is best for he babies to exclusively nurse for the first two weeks of life. Once milk supply is well established it is ok to introduce a bottle. You can express breast milk either manually or via breast pump. Once expressed milk can stay in the refrigerator for up to 48 hrs. If you know ahead of time you will not be using it in the next 48 hrs it is best to freeze it immediately. Breast milk can stay in your freezer safely for about one month. If you have a separate deep freeze it can stay in the freezer for up to 3 months. When it comes time to use the milk it is best to warm it up to room temperature. Best way to warm it is to place the bag or bottle in a container with warm water and to rotate it frequently. Do not heat bottle in the microwave! That can create hot spots that may scald your baby's mouth. Thawed milk should be used within 24 hrs. Do not refreeze the milk.
Possible nursing problems
Sore and cracked nipples
The best way to avoid cracked and painful nipples is to insure proper latching. If your nipples or other parts of your breasts are sore during nursing please consult the nursing consultants at the hospital. After nursing wash your breasts with plain water. Let your breasts air dry for a few minutes. Then apply Lanolin cream or a small amount of breastmilk on your nipples. Avoid plastic nipple shields or plastic lined nursing pads.
Engorgement
Try to keep the feeds frequent in order to avoid engorgement. Also make sure baby nurses out of both breasts. If not then express the milk out of the non used breast with a pump or manually. You may also want to try some warm compresses right before nursing and during nursing. For severe engorgement it may be better to use cold compresses in order not to increase the blood flow.
Mastitis
Mastitis is an infection of the breast tissue caused by bacteria. It may present with redness, tenderness and pain with nursing. You also may get a fever, chills, nausea and fatigue. Contact your doctor because you may need to go on an antibiotic. You may still nurse with mastitis. The milk itself is not infected. Breast feeding will help the mastitis because you need to keep the breasts empty.
Bottle feeding
Infant formulas are a safe alternative to breast milk. We will be recommending a formula for you when we see your baby in the hospital if you decide to bottle feed. The FDA has strict restrictions on all commercially prepared formulas so they all have very equivalent nutritional value and supplements.
You baby will be on formula for the first year of life. Most infant formulas are available in ready to feed, powder or concentrates. Follow the directions on the containers. Make sure the bottle and nipples you use are clean. It is ok to wash you bottles with hot water and soap and then rinse with hot water. You may prepare the formula ahead of time but make sure it is refrigerated. Formula that is refrigerated has to be used within 24 hrs. If you have not used it then discard it. It is best to warm refrigerated formula to room temperature. You may do so by emerging the bottle in warm water for a few minutes. Do not microwave the formula! It can create hot spots that can scald your baby's mouth. Once formula is at room temperature it is only good for about 2 hours. If you have not used it in that time frame it is best to discard it.
How much do I feed?
Most babies will take 1-2 oz of formula per feeding and will eat every three to four hours for the first 1-2 weeks. Give the baby about 20 minutes to eat. If the baby is eating two ounses in less than 15 minutes then you may consider increasing the amount you give for the next feed. Most babies will eat about 4 oz at a time by the time they are one month old. Keep in mind though that every baby has its own pace. Do not force feed your baby in order to finish the bottle.
Common feeding concerns
Burping
Most babies will swallow air during feedings. At times this extra air may make them fussy. Try to burp frequently during the feeds in order to eliminate the extra air and to avoid any discomfort.
Hiccups
Hiccups are a very normal reaction. They may occur more often after eating. They are not harmful to the baby. One way to help eliminate them is to keep the baby upright immediately after a feed.
Spitting Up
Spitting up is also very common in infancy. Most babies will spit up at one time or another. It is the frequency and the amount they spit up that we want to monitor. If your baby is having projectile vomiting or is very irritable you need to contact us immediately. A few things that help with spit up are: Keeping the baby upright during the feeds Place the baby in an upright position following a feed Avoid vigorous play or moving after a feed Make sure the flow on the bottle is not too fast or too slow. If the hole on the bottle is the proper size a few drops should come out of the bottle when you invert it, and then it should stop.