Starting solid foods

During your baby’s first year, his most important source of nutrients and energy will be breast milk or iron-fortified infant formula. Parents look forward to feeding their baby solid foods. They see it as an accomplishment, an important developmental step. But your baby must be physically and developmentally ready for solid foods. Most babies are physically ready at four to six months of age. The American Academy of Pediatrics recommends that no solid foods be given before four to six months of age. In fact, the earlier any food is introduced, the greater the chances are that the baby will have problems with it.

After the first 6 months, when babies start showing signs of development like sitting with support and gaining head control, complementary feeding can begin. This is the stage when babies are fed solid foods in addition to breast milk.

This stage is very important because:

• It promotes the physical and mental development of the child.
• It allows the development of healthy habits and the child learns how to eat.
• The child begins to connect with different foods. You must let them touch, smell, explore and play with what they eat, even if they get dirty. It is part of the learning curve.

It is recommended to:

• Adapt the portions and have utensils suitable for the child.
• Respect when babies no longer want to eat. The hints are turning their heads, closing their mouths, pushing the spoons away, or spitting out the food.
• Avoid combining too many different foods at the same time so the babies get to know the smell of each food.
• Be careful about the texture and temperature of babies’ food. The first foods should have extra-soft textures. Then, the food should be mashed or chopped into thin parts so they can integrate bigger pieces little by little.
• Avoid adding salt, sugar, or other condiments to the baby’s foods so they know the natural smells and develop taste.
• Offer each new food individually for 3 straight days to evaluate tolerance and food allergies.
• Make sure babies eat foods that contain iron, such as meat, liver, baby cereal, spinach, or beans.

  

  
  

Vomiting, Spitting up and Diarrhea

Vomiting

Vomiting is not the same thing as spitting up. Vomiting is the forceful throwing up of stomach contents. Spitting up is when your baby’s stomach contents low easily out of her mouth, often with a burp.

If your baby has forceful, persistent vomiting any time during the first six months, let your pediatrician know. If your baby’s vomiting continues, and he has fever or abdominal pain, your pediatrician will need to see him right away. Also, if your baby bumps his head hard, falls headfirst or is struck in the head and later starts vomiting, call your pediatrician.

Another important thing to watch for with vomiting is dehydration. The first signs of dehydration are a dry mouth and a decrease in the number of wet diapers. To prevent dehydration, you will need to make sure your child drinks plenty of fluids so he can replace what’s been lost through vomiting. Call your pediatrician’s office right away if you think your baby is becoming dehydrated.

Spitting up

Many babies spit up. It usually means that the baby has eaten more than his stomach can hold. So he spits up while burping or drooling. Some babies spit up more than others, but most stop spitting up by the time they’re able to sit.

You may be able to help your baby spit up less often and in smaller amounts by:

• Making each feeding calm and quiet.

• Burping your bottle-fed baby for three to five minutes during feedings.

• Making sure the hole in the bottle’s nipple isn’t too big—because formula can low too fast—or too small— because your baby will gulp air. The hole is just the right size when you turn the bottle upside down and a few drops come out, then stop.

• Not feeding your baby while he’s lying down.

• Placing your baby in an upright position—like in an infant seat—immediately after you feed her.

• Feeding your baby before he’s overly hungry and upset.

Diarrhea

Your baby has diarrhea if he produces loose, watery stools more than six to eight times a day. It’s often caused by a virus. Diarrhea isn’t a medical emergency, but it can lead to dehydration. Don’t wait for your baby to become dehydrated.

Call your pediatrician’s office if your baby’s stools are very loose and occurring more often than after each feeding (six to eight per day). An oral electrolyte solution made for babies may be used. These products give your baby the right balance of minerals, salts and carbohydrates to replace those lost in fluids. These solutions can be found in most drug stores and grocery stores. Never give your baby over-the-counter antidiarrheal medications.

Call your pediatrician’s office if your baby has any of these symptoms:

• Mild diarrhea that lasts more than 24 hours

• Severe diarrhea

• Fever above 100.4°F

• Vomiting two to three times in a two-to-three-hour period

• Blood in the stool

• Infrequently wet diapers (further apart than every two to three hours)

• Deeply coloured urine

• Lethargy or excessive sleepiness

• Any time you think your baby is acting very sick

The most important part of treating diarrhea is to keep your child from becoming dehydrated. Follow these steps to prevent dehydration caused by diarrhea:

• Keep an oral electrolyte maintenance solution at home so you can give it to your child as soon as diarrhea starts.

• If your baby is less than one year old, call your pediatrician for dosing instructions. A toddler who’s one year of age or older should be given as much oral electrolyte as he’ll drink every three to four hours.

• Don’t hesitate to give your baby more oral electrolyte solution if he vomits or spits up. It may be necessary to give smaller amounts (by the teaspoon) more frequently.

• If you’re breastfeeding and your baby gets diarrhea, continue to breastfeed your baby between feedings of the oral electrolyte solution.

• Continue feeding regular foods or formula. Your child is growing fast and needs a constant supply of good nutrition, especially when he’s sick.

How to tell if your baby is sick

Many babies get sick at one time or another. It’s a good idea to know a few warning signs of sickness. Just because your child has one or more of these signs doesn’t mean she has a severe illness. But contact your pediatrican’s office if your child has any of these warning signs that might indicate he’s sick:

• Temperature of 100.4°F or higher

• Vomiting—not just spitting up

• Refusal to take feedings

• No energy—lethargic

• Diarrhea, especially if there’s mucus, blood or an unusually bad smell

• Hard crying with no obvious cause

• Inability to see or hear normally

• Unusual rash

Fever

If your baby develops a fever—a temperature of 100.4°F or higher—call your pediatrician. Fever is a sign of infection somewhere in the body. The best way to measure your baby’s fever is to take a rectal temperature. Follow these steps to take a rectal temperature:

• Use a digital thermometer. Lubricate the bulb of the thermometer with a small amount of petroleum jelly.

• Place your baby on his tummy. With your thumb and index finger, spread the baby’s buttocks.

• With your other hand, insert the lubricated thermometer 1/2 to 1 inch into the anal opening. Hold the thermometer in place for about one minute, until you hear a beep.

• If the digital reading is over 100.4°F, your child may have a fever.

To lower your baby’s temperature, you can give him acetaminophen (Tylenol®). Call your pediatrician for important dosage instructions. If the fever is very high, call your pediatrician. A suggestion: you sponge your baby off with water that’s at room temperature (about 78º F). Or you can give him a bath in water of this temperature for 20 to 30 minutes. The water shouldn’t be too cold. Don’t use plain rubbing alcohol because it can chill your baby. Ice baths should not be used.

Colds

Your baby will probably have more colds than any other illness. Colds are caused by viruses and can be easily spread by not washing hands. Most go away by themselves. Usually, colds involve just a runny or stopped-up nose or a mild cough and can be handled at home. If your baby has vomiting or a high fever, please your pediatrician.

During the first month or two of life, most babies have some nasal mucus that can cause sneezing and noisy breathing. To help your baby feel better and breathe easier, try clearing his nose with the nasal bulb you were given at the hospital.

You can also try a cool mist vaporizer in your baby’s room. Call if he develops a fever, persistent coughing, refuses feedings, or is irritable or unusually sleepy.

Understanding your baby’s cries

Crying is one of the ways your baby communicates with you.

He can let you know if he’s hungry, tired or needs a diaper change. The trick is learning when your baby is crying from hunger, pain or another reason. You’ll soon be able to tell what your baby needs just by his cries. Sometimes your baby may be crying for no reason—he’s just had a meal, a nap and a fresh diaper. Some babies just have fussy periods now and then. This kind of crying seems to help babies get rid of extra energy so they can become more relaxed and content.

The best way to handle your baby’s crying is to go to him right away when he cries, especially during the first few months.

You can’t spoil your baby by giving him attention. In fact, if you answer his calls for help, you may find that he’ll cry less overall.

Comforting your crying baby

If your baby’s been fed, changed, rested and he’s still crying, try some of these tips for comforting him:

• Give your baby something to suck, such as a pacifier.

• Swaddle your baby—wrapping him snugly— in a receiving blanket.

• Give your baby more physical contact and movement. Try walking or rocking him.

• Gently stroke his head or pat his back or chest.

• Take your baby for a stroller ride or car ride.

• Try burping your baby to see if he has any trapped gas bubbles.

• Play soft music or try rhythmic noise or vibration.

If nothing seems to work, you may want to just leave your baby alone. Many babies can’t fall asleep without crying. Your baby won’t cry for long if he’s really tired.

Of course, if your baby just can’t be comforted no matter what, you may want to check his temperature to be sure he’s not sick.

If you’re frustrated because you can’t comfort your baby, try to stay calm. Anyone will tell you that listening to a baby cry for hours can test the patience of even the most relaxed person. No matter how angry or impatient you become with your baby’s crying, do not shake your baby. SHAKING AN INFANT HARD CAN CAUSE BLINDNESS, BRAIN DAMAGE OR DEATH. Have a family member or friend give you some relief. Remember, all babies cry, and sometimes for no reason at all. It’s not because you’re a bad parent or because your baby doesn’t like you. Newborn babies cry from one to four hours a day as they adjust to life outside of the womb. Don’t expect to be able to console your baby every time he cries. Just do your best, and be sure to enjoy him when he’s in one of his happier moods!

Bowel Movements and Diaper Rash

Bowel movements

Just as every baby has his own feeding habits, he has his own bowel habits, too. You may notice changes in your baby’s stool. Occasional changes in the colour and consistency of stools are normal. A breastfed baby’s stool is usually yellow, mustard-colored, and is a thick or pasty liquid in his diaper.

A formula-fed baby usually has yellowish-tan, brown or green stools.

As long as your baby seems happy, gains weight steadily and shows no signs of being sick, don’t worry about changes in his bowel movements. Babies may have several bowel movements a day after the first few weeks of life, or even go a day or two without a movement. While it may not seem pleasant for your baby, it’s normal.

If your baby’s stools are small and pebble-like, he may be constipated. Constipation has nothing to do with how often he has a bowel movement. Don’t give him an enema, laxative or suppository until you’ve talked to your pediatrician.

If your baby’s stool is green, runny and frequent, it may be a sign of diarrhea. Check with your pediatrician if you think your baby has diarrhea.

Diaper rash

Almost every baby gets diaper rash at one time or another. This is the rash or irritation in the area covered by your baby’s diaper—redness or small bumps on any part of your baby’s body that comes into direct contact with his wet or soiled diaper. Babies usually get diaper rash because a soiled diaper is left on too long: the moisture in a wet diaper can cause the skin to become chapped, and the digestive agents in a stool-soiled diaper can irritate the skin. Your baby will probably be uncomfortable and irritable when he has diaper rash. Be sure to keep him changed and dry—it can be even more irritating for him when he’s sitting in a wet or dirty diaper.

You can help prevent your baby from getting diaper rash by:

• Keeping his diaper changed and keeping his diaper area clean and dry.

• Letting your baby’s bottom “air out” whenever possible.

If you’re using plastic pants or disposable diapers that it tightly around your baby’s legs and tummy, be sure that air can get inside your baby’s diaper.

If your baby still develops diaper rash, talk with your pediatrician about which lotion or ointment is best to use. Normally, diaper rash improves within two to three days.

Teething

Most babies start to get teeth anywhere between four and seven months of age. The two bottom teeth usually appear first, and then the four upper teeth may appear about a month or two later. If your child doesn’t show any teeth until later, it’s nothing to worry about. Teeth come in at their own pace.

When your baby is teething, he may be irritable, drooling and even running a low-grade fever (not over 100º F). The gums around his teeth may be swollen and tender. You can massage his gums with your finger, or even give him a firm rubber teething ring to chew on.

If your baby seems miserable and has a fever over 100°F (37.8°C), it’s probably something other than teething. It’s a good idea to call your pediatrician’s office to discuss what’s going on with your baby.

You can clean your baby’s new teeth by brushing them with a child’s soft toothbrush, or wiping them with gauze each night at bedtime.

Best Sleeping Position for Baby

A couple of things may stand in the way of you and your baby getting a good night’s sleep. First, your baby doesn’t know the difference between day and night. And second, his stomach holds only enough to satisfy him for three or four hours, no matter what time it is. You can begin trying to teach him that nighttime is for sleeping. When you’re awakened by your baby at 3 a.m., keep the feeding as quiet as possible— no playing or bright lights. Put him right back in bed after feeding and changing him.

While most new babies sleep a lot, waking every two to four hours to eat, your baby will gradually go longer between feedings as he gets older and his stomach grows. You will be glad to know that most babies sleep through the night (six to eight hours) by three months. But that doesn’t mean that your baby will sleep through the night every night. Be prepared for different sleep stages. He may start to wake again during the night at five to seven months of age. Just comfort him and change him if needed. He’ll get back into his pattern of nighttime sleeping again soon.

The best sleeping position for your baby

The American Academy of Pediatrics recommends that healthy infants, when being put down to sleep, should be placed on their backs. This is the safest position for your baby, based on information about Sudden Infant Death Syndrome (SIDS). Be sure to place your baby on his back to sleep during the first year of life unless the pediatrician instructed you to place him in a different position for sleeping. Propping him on his side is also not recommended as he could roll over onto his tummy, and again be at risk for SIDS. (Rarely, medical conditions require other sleeping positions.)

 

Bathing Baby!

Your baby really doesn’t need much bathing if you clean his diaper area thoroughly during diaper changes. Giving your baby two or three baths a week during his first year is plenty. In fact, more bathing can dry out his skin. During his first week or so, until his umbilical cord stump falls off, your baby should have only sponge baths—just a gentle cleaning with a soft, damp, warm washcloth, with mild baby soap. Keep your baby wrapped in a towel, and expose only the parts of him that you’re washing at that time. Use the damp cloth to wash his face first—without soap—then wash the rest of his body, starting from the top of his head down to his toes, until finally washing the diaper area.

Once your baby’s umbilical cord is healed, you can bathe your baby directly in water. Most parents use a Bathinette™, sink or plastic tub lined with a clean towel. Use water that feels warm, but not hot, to your wrist or elbow. Again, wash your baby starting with his head and face, and wash the rest of his body from the top down. Have all of your baby soap, drying towels and other supplies nearby.

DO NOT LEAVE YOUR BABY ALONE IN THE BATH, EVEN FOR A SECOND!

If you’ve forgotten something, need to answer the phone or door, or have an older child who needs your attention, wrap your baby in his towel and bring him with you!

How much formula does your baby need?

In general, babies eat when they are hungry and stop when they are full. But formula-fed babies tend to be heavier than breastfed babies, appetites vary among babies, and each baby's nutritional needs change from day to day and month to month.

Your newborn may drink anywhere from 2-3 fluid ounces of formula about every three hours. In general, your baby will take in what he needs to meet his body’s demands. There is no need to be too concerned about fixed amounts. Instead, you should feed him when he is hungry. He will let you know when he is finished. If he drinks a bottle and still acts hungry, he probably is. You should offer him an extra ounce.

Most babies do fine with 3-4 fluid ounces per feeding during the first couple months. You should increase by about 1 ounce a month until he is drinking up to about 7-8 fluid ounces every four hours during the day at 6 months of age. The amount your baby drinks may change from feeding to feeding, based on his needs. So there is no need to worry about fixed amounts or a strict feeding schedule.

Daily care of your baby the first few months

You’re already learning so much about your new baby. You know how he likes to be held while he’s eating, or the best way to rock him to sleep. But if you’re like most new parents, you still have lots of questions about how to care for him during these first few weeks. These are some of the normal conditions that most babies experience during this time.

Once you understand more about what is happening with your baby, the more you will relax and enjoy him, knowing you’re making the right decisions about his care.

Umbilical cord

Keep the stump of your baby’s umbilical cord clean and dry until it shrivels and falls off, usually within a few weeks. To keep the cord dry, some doctors recommend using a cotton swab dipped in alcohol to clean away the wet, sticky material that sometimes is around the base of the stump. Keep your baby’s diaper folded down below the cord to keep urine from soaking it. If you see a spot of blood or a clear, moist fluid for a while after the cord drops off, don’t worry…this is normal.

But if the oozing continues, or you see other signs of infection, such as pus or red skin around the base of the cord, or if your baby cries when you touch the cord or skin next to it, contact your pediatrician right away.

 

Skin

Some babies have tiny white bumps or yellow spots across the tips of their noses or chins. These are called milia and go away after the first two or three weeks. One of the most common newborn rashes is newborn acne, which disappears in six to eight weeks. Just wash the area with a mild soap once or twice a day. Don’t apply oils, lotions or creams.

Feeding Techniques

Hold your baby close to you, in the nursing position. Support your baby’s head during feedings, keeping it slightly higher than her tummy. This aids in digestion and helps avoid ear infections.

• Touch your baby’s cheek or upper lip with the nipple. She may open her mouth and turn toward it.

• Hold the bottle at a 45º angle, and keep it steady so she can get the right suction.

• To keep your baby from swallowing air, the nipple should be full of formula, and your baby shouldn’t suck on an empty bottle or drain the bottle.

• Do not prop your baby’s bottle to let your baby feed on her own. Your baby loves her feedings, but she loves being in your arms, too. Propping the bottle could cause your baby to choke, or may lead to ear infections.

• Your baby will usually swallow a little air when she’s eating. Be sure to give your baby a chance to burp when she takes a break, or at the end of her feeding.

• Keeping your baby’s head slightly higher than her tummy may help prevent a common cause of ear infections. When your baby lies flat while taking her bottle, liquid in her mouth may drain into the ear canal and may result in an ear infection.

How to correctly prepare your baby’s bottle.

When making your baby’s bottle, it is very important to carefully follow the instructions on the package. Proper hygiene, preparation, dilution, use and storage are important when preparing infant formula. Powdered infant formulas are not sterile and should not be fed to premature infants or infants who might have immune problems unless directed your baby’s doctor.

Here are a few instructions for preparing your baby’s bottle of routine formula. A few formulas have special mixing instructions:

• Wash your hands thoroughly with soap and water before preparing formula. Make sure to re-wash after any interruptions.

• Discuss with your pediatrician the need to use cooled, boiled water for mixing and the need to boil clean utensils, bottles and nipples in water before use. Be sure to let your pediatrician know if you use well water. If it is not necessary to boil water to clean your equipment, you can simply use your dishwasher, or wash utensils in hot, soapy water with dish washing detergent, and then rinse them thoroughly in hot, clean water.

• Follow the mixing directions on the product label.

• For accurate measurements, use a standard household measuring cup rather than the marks on the side of a bottle. Formula cans usually comes with a scoop included.

• Prepare concentrated liquid or powder formula with cool water (35-75°F); it should feel cool on your wrist. If you prefer, you may mix with warm water but only if you feed or refrigerate the formula immediately. Warm water is about 100°F; it should feel neutral (neither warm nor cool) on your wrist.

 

Formula – feeding your baby

Breast is best! Experts agree on the numerous benefits of breast milk; however, there may be mothers who consider both breastfeeding and bottle feeding for various reasons such as mommy is going back out to work, she is on certain medication and may not be able to breastfeed for a particular period. Sometimes a combination of the two might be best. Either way, your baby will be healthy and happy with your decision. If you decide to formula feed your baby, an iron-fortified DHA enriched formula is the next best alternative. It is very important to mention that breast milk and / or infant formula should be the only forms of milk your baby gets during his first year of life. If you do choose to supplement with an infant formula, it is recommended to choose a formula that is best for all his nutritional needs. Also, you should express your breast milk to maintain your milk supply if the baby was offered a bottle. It is also important to express your breast milk if there is a missed breastfeeding with your baby to avoid your breasts from becoming engorged or to leak milk.

If you think you are ready to start supplementing, talk with your pediatrician to discuss the best option available for your baby!

Eat a balanced diet while breastfeeding

If you are breastfeeding your baby, you will be giving him all your nutrition.  You need to ensure that you are receiving all of the nutrition you need as well. Women who are breastfeeding need to add about 300 -400 calories per day to their normal diet to cover the energy that is needed to make breast milk. Breastfeeding also increases the amount of fluids your body needs so you should drink enough fluids to satisfy your thirst. You will know when you are getting fluids if your urine is nearly colourless or pale yellow. A suggestion to ensure that you are getting enough fluids is to sip on a glass of water, fruit juice or milk while nursing. Fruit juices and milk supplies other nutrients such as calcium and Vitamin C which you need in extra amounts for nursing.

Foods in breastfeeding mothers’ diets usually don’t bother their babies. It may happen however, with spicy or gassy foods. If your baby is fussy or gassy and you do not know why, you should review what you ate within the last 24 hours. You should try to eliminate any “problem” foods and see if it helps baby.

Nursing mothers should also look at other important nutrients such as DHA for their babies’ health, well-being and development. Expert nutrition groups recommend a diet containing at least 200 – 300mg of DHA per day for nursing mothers. DHA is a nutrient that promotes babies’ eye and brain development. Eating fish such as salmon and shellfish can help achieve the recommended levels of DHA. As the majority of mothers do not eat enough DHA enriched foods, nursing mothers should also consider using a dietary supplement to help meet the nutritional needs while breastfeeding.

Getting comfortable with your baby at feeding

Before each feeding, get comfortable with your baby.

Ensure that your baby is latched on correctly. This means that he should have a good grip on your areola, not just your nipple. When your baby is latched on properly, the breast milk will flow better, the milk supply will be stimulated and your baby is kept satisfied. If also helps to prevent your breasts from becoming engorged or overly full. After some practice, you will know when your baby is properly latched, it may feel like he is pulling or tugging as he draws in milk.

If your nipple becomes sore, try starting on the side that bothers you the least. If your breasts are too sore and you may need to skip feeding, you should express your milk by hand or with a breast pump at your baby’s regular feeding times so you will be able to maintain your milk supply. Talk to your pediatrician if your baby is latched on correctly yet you are still having pain while breastfeeding.

It usually takes about 2 to 3 weeks to fully establish your milk supply as it is based on a “supply and demand” system. The more your baby nurses, the more milk you will produce. There is no need to give supplemental formula, sugar water or a pacifier to satisfy his urge to suck as you try to establish breastfeeding; this may decrease you milk production.

Your baby will let you know when he is satisfied, he may let go of your breast or may fall asleep. If allowed, some babies may nurse constantly to satisfy their need to suck. If this is your baby, ensure he is getting enough milk or speak to your pediatrician about the use of a pacifier.

About 10 to 20 minutes on each breast provides about 90% of available milk. After that, you baby receives less and less milk per suck.

Breastfeeding your baby

According to the American Academy of Pediatrics, breast milk is considered the gold standard in infant nutrition as breast milk provides immunity factors and the proper balance of nutrients. It also helps create that special bond between you and your baby. The first few days will be a time of learning; both for you and for your baby! Be patient as you both become comfortable with breastfeeding, before you know it, breastfeeding will become second nature.

In the beginning, your breasts will produce colostrum which is a clear or yellowish fluid. This fluid is extra rich in essential nutrients. It may seem like a small amount but it is close to what your baby’s stomach can hold. Your baby will receive colostrum until your milk “comes in”. Your milk will change from colostrum to what looks more like skim milk by the third or fourth day of breastfeeding.

You may recognize your breasts have gone to being soft to feeling firm. Your breast milk will adjust to the needs of your baby for as long as you breastfeed. Breast milk changes its nutritional qualities to match the changing needs as your baby grows.

Your newborn baby may probably need to nurse every two to three hours. It is important that he feeds 8 to 12 times per day. You will need to wake up your newborn to feed him if he sleeps longer than 4 hours. As he gets older however, he will be able to go longer between feedings as his stomach can hold more and you’re producing more milk.

Feed your baby on demand, that is, whenever he’s hungry. Instead of watching the clock, you should look for signs that he is ready to eat, like nuzzling against your breast, rooting, sucking or putting his hand to his mouth, or crying.

You should let your baby nurse on the first breast for as long as he wants. If he stops for a while or falls off the breast, you should trying burping him. If your baby seems to be sleepy after nursing on the first breast, try playing with him or change his diapers then switch him to the next breast.

As your baby tend to suck more efficiently on the first breast he uses, it is advised that you alternate from feeding to feeding the one he uses first. A trick some mothers use to remember the side of the breast last used is pinning a safety pin to their bra on the side last used so they know where to start for the next feeding.

 If you are taking medication and breastfeeding, you need to consult with your pediatrician. While most medications pass into breast milk in concentrations that are not a threat to your baby's health, there may be some exceptions. Of course, recreational drugs are not safe for you or for your baby as they pass into breast milk.