Baby Care & Child Health Problems

Part I
BABY CARE

III
Feeding the Baby

Breast milk is the best food for your baby, more so, in the first six months of his/her life. Studies have proved beyond doubt that babies, who have been breastfed for the first six months of their lives, stay healthier throughout their lives. It is very important that you feed the baby the first milk your breast produces, known as colostrum. This is rich in antibodies and other substances that protect the baby from infections and illnesses. Breast-feeding is extremely healthy for your baby as it prevents many health conditions like chest infections, ear infections and diarrhoea. Protection from some diseases last long even after you have stopped breast-feeding. Feeding the baby breast milk will provide the best protection against infections.

Even mothers benefit from breast-feeding their babies. The cases of breast cancer, ovarian cancer and osteoporosis, at a later stage in life are much less among women who have breastfed their babies. A combination of breast milk and formula milk will decrease the risk of infection to a large extent. If you have a family history of diabetes, asthma, eczema, etc, formula milk can increase the risk of such diseases in the baby. In case you decide to combine breast-feeding with bottle-feeding, then the bottle-feeding should be introduced only after the baby gets used to breast-feeding. This will ensure that you have sufficient supply of breast milk. If you are unsure about whether to breast-feed or bottle-feed, it is better to start breast-feeding. Once you start bottle-feeding, it is difficult to switch to breast-feeding.

1. Breast-feeding Information

As a mother, it is your duty to take best care of your child. For the first six months, when the child is completely dependent upon breast milk, the mothers develop an emotional bond with him/her. Breast-feeding is probably the most motherly thing to do, which brings the child and the mother close to each other. So, you must cherish these moments and try to be a doting mother throughout this phase. Though initially, especially if it is your first time, breast-feeding is a little confusing and complex thing to do, with time you understand your child's habit and necessity.

The Phenomenon

Before you begin breast-feeding, you must understand how the entire phenomenon does take place. It is a very simple phenomenon, the breasts are divided into lobes and this is where the milk is produced. Individual lobes comprise 15 to 25 ducts that carry milk to the nipples and get collected at the areola before being expressed. It is when a child cries, the breasts grow hot and the blood hurries to the breasts, carrying with it sugars to the milk glands.

Getting Started

It is not easy to breast-feed as it seems. You have to take care of lots of things, so that your baby does not remain hungry. The best way to breast-feed a baby is to hold him/her close to your breast and hold your breast in a “C-hold” position, with your thumb on top and fingers beneath. You must make sure that your baby's mouth is open wide and covers your entire nipple. In case there is suction, break it by your fingers. Keep on checking for it in between. You should offer your baby both your breasts at the time of feeding.

Importance of Breast-feeding

Breast-feeding is very important for the normal mental and physical development of a newborn. The mother's milk is a complete source of all the nutrients as well as antibodies to the newborn. A breastfed baby is likely to be more strong, healthy and immune. Breast milk is easily digestible by the baby and is always available at right temperature. It also develops a sense of attachment between the mother and the baby. Apart from this, it also guards the mother against breast and ovarian cancer.

Mother feeding her baby

Myths about Breast-feeding

Here are some common myths about breast-feeding.

 You should not breast-feed for 24 hours after the baby receives vaccinations.

 Stop feeding completely if your nipples are cracked.

 You need not wash your nipples every time you feed.

 Those who smoke should not breast-feed at all.

 You should not breast-feed after exercising.

 Do not breast-feed if the baby has diarrhoea.

2. Breast-feeding Positions

When you are a new mother, there are a number of things that you have to learn and teach your baby. One of them is breastfeeding. Mother's milk is the only food for the newborn till the first few months. Therefore, it is important that your child learns the right breast-feeding technique as early as possible, so that he/she doesn't feel hungry after being fed, as some infants do. The mother may have to explore certain breast-feeding positions to determine the one that best suits the child. Below given are a number of positions for breastfeeding the baby.

Traditional Position1

Keep a few pillows on your lap; place the baby on them, so that he/she is on the same level as your breasts. Support his/her head with your forearm in such a way that the rest of his/her body is across your stomach. You can help by cupping the baby's head in your hand (use your right hand for left breast and vice versa).

Traditional Position

Underarm Position

Arrange a few cushions at your side and place the baby on it in such a way that his/her legs are pointing behind you. Hold your baby in such a way with your right hand that you cradle his/her head, while he/she feeds from your right breast. Women with Caesarean section use this position to avoid pressure on the scar. Twins can be breastfed together using this position.

Lying Down Position

Lie on the bed with your head resting on a pillow and place the baby close to you. The bed will give them the support they need. With your free hand bring them to your breast and support them. Keep pillows behind your back to prevent a backache.

Find a position that is comfortable for both you and your baby, so that breast-feeding is easy.

Underarm Position Lyingdown Position

Beware of Things While Breast-feeding

 Baby should be tucked close to your body.

 The chin should be against your breast and stretched upward and not tucked in.

 Mouth should be open wide and their bottom lip should curl outwards.

 There should be movement of the face and jaw.

 Lower lip should take in more of the areola that the upper lip.

 The cheeks of the baby should not be sucked in.

 Lip action as if the baby is sucking a straw is a sign of wrong breast-feeding.

Beware of Sounds While Breast-feeding

 Slow and quick sounds of milk being swallowed signals that the suction is right.

 The baby should not make clicking noise.

 The baby should not smack lips.

The Feel

 You should be able to feel firmly gripped while breast-feeding.

 Letdown reflex, a tingling feeling in the breasts, usually when feeding begins as the milk flows to the baby.

 Slight pain may be felt when the baby begins to suck in the initial weeks. The pain should not last longer than the initial momentary pain.

3. Breast-feeding Problems

Both mother and baby will have to learn to master the art of breast-feeding. This will take time and what works for one pair need not necessarily work for another pair. However, breast-feeding may also pose some problems for the mother. There are some common problems associated with breast-feeding that one out of every two mothers face. While some problems disappear in due course of time, there are some that need professional help. Given below are the causes and solutions to some of the common breast-feeding problems.

Insufficient Milk Supply

The baby may want to keep feeding all the time if he/she is not positioned properly or if there is insufficient supply of milk. In the initial days, the baby may insist on feeding continuously, simply because he/she enjoys it and breast-feeding is very comforting for him/her. It could also happen if the baby is trying to increase the supply of milk. If this activity is a change from his/her normal feeding pattern, it may return to normal in a day or two. Make sure that you position the baby properly and let him/her feed on demand.

Bleeding/Sore/Cracked/Nipples

This happens because the baby is sucking your nipple and not the breast as a result of bad positioning. Dislodge the baby by inserting your finger gently into his/her mouth to break the grip. Reposition your breast, so that the breast and not just the nipple go inside the baby's mouth. Try different positions. Express milk manually and rub it on the nipples as this will help in healing. Use the less sore side to feed the baby.

Thrush that Doesn't Heal

White marks or sore nipples that don't seem to heal are known as thrush. It can appear when either you or the baby have taken a course of antibiotics or may appear without any particular reason. Both of you may have to take oral medication or use anti-fungal cream.

Flat Nipples/Lumpy, Hard and Full Breasts

Primary engorgement takes place when milk first ‘fills in’ on the third or fourth day. Secondary engorgement takes place when the baby reduces the number of feeds he/she takes, maybe because he/she has started sleeping for longer hours at night. If this is the case, your body will reduce the amount of milk it is producing. Feed the baby more often to reduce engorgement. If baby is unable to latch on properly, express some milk to help him/her do so. Wear warm flannel clothing to ensure milk flow or have a warm shower before feeding to ensure the same. Using chilled cabbage leaves inside your bra can reduce the swelling.

Lumps in the Breast

Free movement of milk is stopped because of a block in some duct of the breast. This can happen because you have slept in a wrong position, sat for a few hours with the seat belt across your breast or a tight bra. Massaging the area or using warm compress on the area will help the lump to dissolve. If possible, position the baby in such a way that his/her jaw is near the lump, so that he/she can feed and help in dissolving the lump. Feed from the sore side, if it doesn't work, express milk from the breast.

Inflamed, Red Areas on the Breast

Inflamed, red areas on the breast along with flu symptoms like temperature, aches with sore breast that is full; this condition is known as Mastitis. It is an inflammation of the breast when milk leaks into the breast tissue. Rest as much as possible, but continue to feed the baby. Use of warm and cold compress will reduce the swelling. If there is no improvement, go to your doctor, who will probably prescribe painkillers or a course of antibiotics.

Baby Refuses to be Fed from the Breast

There could be a number of reasons for this:

 A change in the taste of milk because of a change in diet or medication.

 You are using nipple cream.

 You have stopped using nipple shields.

 You are undergoing dental treatment or your periods are starting.

Breast-feeding Twins

When you have twins, the task of breast-feeding becomes a little more difficult and there is the often-asked question of about whether to feed them together or one at a time. Feeding one baby at a time improves bonding between the mother and child. However, this can be time consuming. Letting them feed together will improve your milk supply and it will be easy to remember who has had how much. If you decide to feed them together, placing one baby under each arm is the best position to use. You can also criss-cross them on your lap and feed them together. Swapping the babies between the breasts ensures equal production of milk. However, using one breast exclusively to feed one baby will customise the supply for that baby and ensure that he/she gets sufficient milk.

4. Expressing Breast Milk

There are times when you may want to express breast milk. If your breast seems too full and hurts, it would be a good idea to express the milk and store it for later use. You may want to go out and would like the person taking care of your baby to feed him/her this breast milk, instead of formula milk. Additionally, you may have to rely on milk expression techniques when you are carrying the baby out, so that you have breast milk in store for the baby. You can express milk with your hand or with a breast pump.

Hand Expression

 Take a sterile wide rimmed container to collect milk.

 Wash your hands before you begin expressing the milk.

 Close the door before you begin the process in order to avoid embarrassment for you and the intruder.

 Massage your breast gently to increase milk flow or use flannel to warm your breasts.

 Hold your breast with one hand and with the fingertips of the other, move all around the breast stroking it gently. You can use the back of your knuckles, massaging from the outer edge of the breast to the nipple.

 Once you have completely relaxed, place your hand behind the areola and start squeezing gently. You should be applying pressure on the milk sacs that are under the skin, at the edge of the areola. These sacs will feel like peas under your fingertips.

 As you squeeze in, milk will first drip out and then spurt. Move your hand all over the breast to remove milk from all the ducts.

Using Breast Pumps

There are a variety of breast pumps available today. You will have to very carefully select the pump that is best for you. If you choose the wrong one, you may harm your breast tissues. It is best to consult your doctor before buying a pump. There are two types of breast pumps:

 Battery-operated Pumps
These are easy to use, but may not be very durable. These make less noise than electric pumps. Use a pump that has been designed to release suction at regular intervals to prevent excessive pressure.

 Electric Pumps
There are different kinds of electric pumps available in the market. Some come with a double pumping system, which is convenient for expressing milk from both breasts at the same time. Small and light pumps are available, which can be easily carried to work and when you travel. These pumps can be recharged in your car, as they come along with adapters.

Different types of breast pumps

Storing Breast Milk

There are bags that are specially made to store expressed breast milk. You can use small disposable bottle bags or small glass or plastic bottles as well. Depending on how soon you want to use the expressed milk, you can either refrigerate or freeze it.

Tips to Store Breast Milk

 Fresh expressed milk can be stored for ten hours at room temperature. Milk brought to room temperature after refrigerating or freezing must be used within half an hour.

 Fresh expressed milk can be refrigerated for anything between five to seven days. Taste the milk to find out whether it is fresh, before giving it to your baby.

 You can store freshly expressed milk for up to six months in an average freezer, depending on the efficiency of the freezer. Make sure you store in the coldest part of the freezer and away from the door.

 Pumped milk that has been refrigerated for less than 48 hours can be frozen. If refrigerated for more than 48 hours, it should not be frozen.

 Freezing causes breast milk to expand. While filling bottles or bags, leave about one inch space from the top, so that there is place to accommodate this expansion. If you are using a disposable bag, fold the top and fasten it with a rubber band.

 Milk containers should be labelled with the time and date on which it was expressed.

 If you can express large quantities of milk, do not store it in a big bottle or bag. Use small bags or bottles. The baby will need only small quantities at a time and you can defreeze one small bag or bottle each time. Thus, wastage will be minimised.

 If you want to transport stored breast milk to use away from home, keep it cold till you use it. Use a cooler with ice or frozen packs to keep the milk cold, while transporting it.

 The oldest milk should be used first.

Defrosting Expressed Breast Milk

 To thaw breast milk, use a hot bowl of tap water or do it at room temperature. Defrost using minimum amount of heat.

 Do not microwave to defrost, as it destroys the essential vitamins and enzymes in the milk.

 Feed the baby defrosted milk, only when it has thawed completely.

 If the milk smells or tastes sour, do not use it.

 Milk that has been thawed should be kept in the refrigerator and used within 24 hours.

5. Introducing Bottle to Baby

There is no doubt about the fact that breast-feeding is better than feeding the baby formula milk. Many mothers would like to bottle-feed their babies some time later. Some babies, who have been breastfed, may take to bottle-feeding as soon as it is introduced. Babies may prefer it; especially if they are having trouble having being breastfed. But many breastfed babies refuse the bottle, when the change is introduced. Practical experience shows that this is especially true with children, when they are breastfed till an older age However, you will be introducing bottle to the baby sooner or later.

Introducing Bottle to Breastfed Baby

 You could try using different kinds of nipples. Making the teat soft by boiling it or using different types of nipples may help. Often the babies who refuse the bottle are the ones who have been breastfed for a long time.

 You should hold the baby in the same position while bottle-feeding him/her, as you do while breastfeeding him.

 You should encourage your partner or babysitter to bottle-feed the baby, as he/she will not expect to be breastfed by them and may take to bottle-feeding more easily.

Different types of bottles and nipples

 Try changing the formula you use, as there is a chance that the baby dislikes its taste.

 Research has shown that if the bottle is introduced early, when the baby is about six weeks old, even for just one or two feeds a week, the baby is more likely to accept being bottle-fed on a regular basis.

Caution

It has been found that newborn babies, who are bottle-fed regularly, often forget how to suck milk from the breast. They may even need to relearn being breastfed. Experts are still trying to find an explanation for this behaviour. Therefore, it is best to introduce bottle-feeding only after breast-feeding is well established. If you want to avoid using a bottle, you could try spoon-feeding your baby or use cups specially made for babies. It has been found that babies, who use these cups, comfortably take to breast-feeding later on. However, it is important to learn the correct technique of using this cup from a trained person. Mothers are often concerned and wonder whether bottle-feeding will affect the health of the child. However, bottle-fed babies grow up to be just as healthy as the breastfed babies.

Breast-feeding vs Bottle-feeding

Breast-feeding does not ensure that your child will never fall ill. Although studies show that they are more resistant to common ailments as compared to formula-fed babies. Colic in babies, in both cases is more or less the same. Where sleep is concerned, it is true that formula-fed babies, sleep better and longer at night. One possible explanation is that, formula milk takes longer to digest than breast milk. Therefore, babies who are bottle-fed sleep longer between feeds. Therefore, mothers may use formula milk to ensure that babies sleep through the night. On the other hand, breast-feeding the infant during the night may be slightly inconvenient for the mother, but she doesn't need to get up and prepare bottle-milk in case the baby needs it during the night. Ultimately, it is for the mother to decide what the best option for her and her baby is.

6. Bottle-Feeding Tips

Deciding to bottle-feed your breast-feeding baby is a conscious step taken by mothers, when they want to return to their original routines. Either they want some time off from their babies, or have to return to work. It is better to think carefully about bottle-feeding because many children learn to use a cup for drinking without even going through the bottle phase. Timing plays an important role in making your baby learn to bottle-feed. If bottle-feeding is introduced too soon, then the baby may give up breast-feeding. If introduced too late, the baby may not take up the bottle and refuse to give up breast-feeding. However, not all babies need to be taught to bottle-feed, a number of them take to it without much fuss.

Bottle-Feeding an Infant

 Either use expressed breast milk or artificial milk, also called formula for bottle-feeding the infant.

 Most babies enjoy bottle-milk slightly warm. Before feeding the baby, shake the bottle and place a few drops on your inner wrist to check the temperature. Run warm tap water over the bottle, if required.

 To reduce the swallowing of air by the baby, tilt the bottle to let the milk fill the nipple and air to rise to the bottom of the bottle.

 Keep the head of the baby straight when he/she is feeding. If the head is turned sideways or backwards, the baby will not be able to swallow the milk easily.

 Switch arms while feeding the baby from the bottle. This will reduce arm fatigue and also present different views to the baby.

 Take care not to force the nipple into your baby's mouth. You should rather stimulate the baby to accept the nipple by touching his/her lips gently to the nipple.

 Look for signs indicating that the nipple hole is too large or too small. If the milk flows, instead of dripping, when the bottle is turned upside down, discard the nipple as the hole is too large. Similarly, if the baby tires during sucking and his/her cheeks cave in due to strong suction, the nipple hole may be too small and needs replacement.

Bottle-feeding a baby

 Always clean and sterilise the bottles by washing them properly an boiling in water, or keeping them in hot water for a while.

FAQs

Q-l. Is breast milk sufficient for the baby?

Ans. There is a way of knowing whether the milk is sufficient or not except to check the growth chart of the baby. You may be rest assured that your milk supply is sufficient if your baby seems satisfied after feeding for a reasonable period of time. Also if the baby is gaining weight adequately and if the baby passes urine five to six times a day, then it is an indication that your breast milk is sufficient for the baby.

Q-2. Should I boil the stored breast milk before use?

Ans. The breast milk is sterile and needs no boiling. Boiling leads to breast milk losing its natural nutrients. The bottle of breast milk may be warmed by gradually placing it in a bowl of hot water just before feeding the baby.

Q-3. For bottle feeding which milk is better – cow's milk or formula milk?

Ans. Cow's milk may be easily available and low on cost but there is high chance of it getting spoilt if kept for longer duration. Secondly heating and reheating of cow's milk may lead to it losing its nutritional contents considerably. Formula milk may be costly, but there is less chance of contamination if it is stored properly. Also the formula milk is fortified with many essential nutrients in such a way that it comes closest to mother's milk in terms of digestibility and nutritional value. So it is always advisable to use formula milk for the first year if you can afford it. However, if you have to use the cow's milk then always ensure that it is fresh milk and not the packaged one.

Q-4. How much milk should be given to the baby?

Ans. The quantity of milk to be given to the baby may vary. However on a general note, give around 5 to 6 ounces (1 ounce is equal to 30 ml) per kg body weight per day. If a two-month old baby weighs 5 kg then the baby requires 30 to 36 ounces of milk in a day. The baby may be fed 6 to 7 times in a day.

Q-5. Why do some bottle-fed babies get recurring ear infection?

Ans. The problem of ear infection is more with the bottle because when the nipple hole is too big and the baby gulps down the milk, some of it goes up into the ear via a tube connecting the ear to the area behind the nose. To stop it from recurring is by changing the nipple with a normal sized hole.

Q-6. Why do some babies bring up milk after each feed?

Ans. Most babies bring up some milk after their feeds. This milk may be small in quantity but seems quite a lot because it is mixed with saliva. This problem is more in the babies who are bottle-fed than those who are breastfed. This problem may arise due to any one of these reasons:

 Baby is swallowing air along with the milk. So hold the bottle properly and make sure that the nipple is always full of milk.

 After a full feed, the back of the baby is rubbed very hard. Do it gently to burp the baby.

 Baby is being pushed to take extra milk in order to finish the entire contents of the bottle. This should not be the practice. Let the baby drink as much milk as he/she can easily take.