Pearls of Wisdom: Infant Nutrition

Infant FeedingWhen it comes to infants and children, basic nutrition choices have a lifetime impact on overall health and are key for satisfactory growth and avoidance of deficiency states. Adequate nutrition helps in the prevention of acute and chronic illnesses; maximizes physical and mental potential and provides reserves for stress. During infancy, it’s all about milk, whether breast milk, formula or a combination of the two. Breast milk and formulas contain enough nutrients needed by babies in the first year of life. Around 4 -6 months of age, most babies can start consuming solid foods like iron-fortified cereal, mashed fruits and vegetables, and pureed meats. As you introduce more foods, keep in mind that a healthy amount of fat is important for the babies’ brain and nerve developments – unless advised by your doctor for particular health reasons, low-fat options can be avoided.

The feeling of ease between infant and mother is essential to successful infant feeding. When mom can establish a comfortable, satisfying feeding practice, the result is usually emotional well-being of both the mother and infant. Remember that mom’s feelings are readily transmitted to the baby and greatly influence the emotional setting in which feeding takes place. Hence, a tense, anxious, and emotionally labile mother is more likely to develop a difficult feeding relationship with her baby. It’s helpful if she receives appropriate guidance and support from an empathetic family member, friend or physician.

Infant FeedingImmediately after birth, the infant can safely tolerate feedings to ensure a smooth transition from fetal to extrauterine life, to promote maternal- infant bonding and prevent hypoglycemia and electrolyte imbalances. It is critical that your infant receives enough fluids so he will not develop dehydration. Moms who wish to initiate breastfeeding in the delivery room are definitely encouraged to do so. Subsequent feedings either by breastfeeding or bottle feeding are given every 3-4 hours a day and at night. That’s a lot of eating! This is based on the time it takes for the infant’s stomach to empty and varies from 1-4 hours. Do not expect your baby’s feeding schedule to be consistent immediately after birth.  However, by the end of the first month, 90% of babies will establish a more regular feeding schedule. Majority of healthy formula-fed infants will want 6-9 feedings per day by the end of the first week of life. Some babies are satisfied with every four hour feedings, while others who have a faster gastric emptying time will want to eat every 2-3 hours. Interestingly, most breast-fed babies get hungry quicker and require more frequent feedings with shorter intervals. This just reinforces the fact that individual feeding needs vary and one infants’ feeding would not be expected to fit the pattern of another. The best parameter of successful infant feeding is weight gain by the time the baby reaches the second week of life.

Infants cry for various reasons and babies do not need to be fed every time they cry. Usually, sick babies are not interested in feeding and if an infant refuses food, this should act as a red flag to see your pediatrician. If your baby is constantly waking up every 1-2 hours, he may not be receiving enough milk at each feeding or be suffering from infantile colic. This can be addressed during your doctor’s visit and may involve discussions about formula choice and feeding practices. It is important to know that babies cry for reasons other than hunger. Some may just need to be picked up and held, others may continue to cry even after feeding so it’s important to carefully evaluate your infant’s health and behavior for other potential causes of distress. Try to discourage the habit of frequent small feedings, holding and feeding to pacify crying as he may become too reliant on you to calm him.

Infant FeedingThe post-partum period is oftentimes a period of much anxiety and insecurity for first-time parents who may be overwhelmed by the responsibilities that comes with having a new baby. The questions are endless: Am I feeding her enough?  Is she having diarrhea? Should I switch formulas? The list goes on and on. This is why anticipatory guidance sessions should be scheduled between you and your pediatrician. During each office visit, your doctor is already tracking your baby’s weight gain and monitoring whether her weight is steadily increasing. Normally, babies in the first four months of life gain 1 ½ lbs-2 lbs per month and grow 1-1 ½ inches. By the time he is a year old, he would have tripled his birth weight.  Breastfed babies also tend to be chubbier than formula-fed babies in the early months of life however they become leaner by nine months to one year of age.

Parents need to understand the goal of infant’s “self- regulation.” Once the infant establishes a regular feeding schedule, other family members are able to resume their normal daily routine with minimal disruptions. It doesn’t take long to achieve the confidence and calm of an experienced parent. Your baby will give you enough signals and clues as to how she likes to be treated, talked to, held and comforted.  This very special bond, once established will guide you through this challenging stage and the next.

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

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Dr. Pearl

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Pearls of Wisdom: Dr. Pearl’s Bookshelf

With warmer weather springing up in most states around the country, it’s a good time to stroll to your local library and introduce your children to new stories and/or picture books. My patients’ waiting room often echoes with children repeating their parents’ recitals of “One Fish, Two Fish, Red Fish, Blue Fish…”  This brings back memories of reading aloud with my own two children, now ages 15 and 12, so I thought I’d share with you BabyLeggers some of our favorite children’s books.

Parents also frequently ask for recommendations of clinical books that offer developmental, practical and medical information.  Such basic reference guides are well worth keeping on hand and I bet you will find yourself consulting them again and again as your children grow. So today, I present to you the first installment of “Dr. Pearl’s Bookshelf.”

Happy reading!

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Children’s Books:

Children

Charlotte’s Web, Goodnight Moon, The Very Hungry Caterpillar, The Cat in the Hat, The Lion, the Witch and the Wardrobe, The Secret Garden, Madeline, Chicka Chicka Boom Boom, The Tale of Peter Rabbit, Are You My Mother, Little Bear and A Wrinkle in Time

Clinical Books for Parents:

Most of the clinical books are available on the American Academy of Pediatrics’ website — www.aap.org — in their bookstore.

Parents

Building Resilience in Children and Teens, Patient Education for Children, Teens and Parents, Managing Infectious Diseases in Child Care and Schools, Caring for Our Children, Nutrition: What Every Parent Needs to Know, Home Strength Training for Young Athletes and Nelson Textbook of Pediatrics.

Please go to the BabyLegs Facebook post about books for parents and children and tell everyone what books you and your children love!

 

All information contained in this blog and on our web site(s) should be independently verified by you by a medical professional of your own choosing and you should always conduct your own research and due diligence before making any decision related to the subject matter of this blog or our web site. 

———–

Dr. Pearl

 

Dr. Pearl Cenon

A pediatrician in private practice in New Jersey for over 15 years, Dr. Cenon (we like to call her Dr. Pearl) also has two children of her own. Dr. Pearl’s husband, Kevin McDonough is also a pediatrician and they work together. She writes basic posts about topics that interest many parents, from skin care and nutrition to seasonal issues, such as allergies and colds. Her kind, approachable tone in each blog post will have you looking forward to the next one.

Breastfeeding — How hard can it be?

That is what I thought after an expectant friend said she was worried about breastfeeding. “It’s how we were designed, what’s to worry about,” I thought. With that (vastly incorrect) outlook, I entered motherhood without considering breastfeeding except that it was “best,” “natural,” and I would do it. Oh, what I have learned!

  • Babies do not always “latch on” and eat – in fact, some, like my son, refuse to latch on but instead scream or, when they finally do latch on, fall asleep.
  • Babies don’t always wake to eat. After my son did not wake to eat his first night at home and into the morning, I called the nurse, who advised bringing him in. Not only had he developed jaundice in the 17 hours since we left the hospital, he had not eaten. Thus, based on the advice of the lactation consultant, I pumped milk, supplemented with formula, and worked on nursing will also finger-feeding him (use a thin tube attached to a feeding syringe filled with formula or breast milk and tape that tube to the finger, which the baby then sucks on to remove milk from the syringe).
  • Finger-feeding to avoid nipple confusion is not a guaranteed success. For the first few weeks, we woke our son every two hours to eat, requiring that we finger-feed him because he would not nurse or wake to eat and we were told giving him a bottle would cause nipple confusion. We now joke that instead of nipple confusion, he got “finger confusion.” For the first couple months, he wanted to suck on someone’s finger instead of a pacifier or bottle – fingers were more comforting/familiar to him.
  • Pumping milk for a baby who won’t nurse is not always possible because the pump does not always stimulate enough milk production.
  • Working with a lactation consultant is helpful and can work, but doesn’t always. The lactation consult gave us great advice, but it just did not work for our son.
  • Sometimes breastfeeding does not work, not for lack of trying or desire – some babies just will not breastfeed and some moms are just unable to do so and that is OKAY.
  • Not nursing when you so badly want to is a tough decision and can cause guilt. I was disappointed, felt guilty for giving up and being unprepared, and often wished I had tried longer. But, after a few weeks of waking my son every two hours, spending twenty minutes unsuccessfully trying to get him to nurse, then finger feeding him, then pumping what (very little) milk I could get so that I could feed him that, with formula, at the next feeding, then starting all over again thirty-forty minutes later plus fitting in trips to the lactation consultant and doctor, I reached my breaking point and, sobbingly, told my husband I could not do this anymore and wanted to just formula feed. He was supportive and we still had to wake our son regularly to eat for a short time, but he had a bottle and life was easier for all of us.
  • Just because one baby won’t nurse, does not mean others won’t. I talked to other moms who had a child who would not nurse and then had other children who nursed just fine. So, when I was pregnant with Baby #2, I decided I wanted to try nursing again after. I prepared myself better this time, but didn’t need to – she latched on twenty minutes after birth, nursed great, and is still nursing twice a day at twenty months. I was also able to return to work and pump three times a day while away from her until she was one, providing her with plenty of milk despite having been unable to pump more than a ½ ounce at a time with my son. Friends, colleagues and even family eye me suspiciously when I say she is still nursing or ask, “When are you going to wean her?” But, I am in no hurry to wean her yet. She seems to nurse less and less each day though and will, I think, wean herself before long.
  • Overall, breastfeeding is a wonderful experience and I would encourage anyone who wants to do so and can to breastfeed – but, it is not always easy and it does not always work and that is okay.

On a side note: our son, who would not wake to eat and when awake, often refused to eat, is now five and still does not like to eat – never has. Meals are always a battle and he would choose to go all day without eating if we let him. He is healthy and in the 75th percentile on the charts, he just does not like food (except fruit snacks and suckers). I maintain that this was the problem from day one – it wasn’t that he couldn’t nurse – he just didn’t like to eat.

 

Shawna’s beautiful daughter and son!

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About the Blogger:

Hi! I’m Shawna. I am a married, working mom of two — one boy, one girl, who I love more than I could have every imagined. Parenting has not always been easy for me and my children throw plenty of unexpected surprises, but I wouldn’t trade that for anything.