Saturday, February 16, 2019

The First Few Days of Bottle-feeding Your Baby


Life with a new baby can be daunting as well as exciting. Ideally, you would have someone (e.g., your husband or mother) to stay with you for the first two weeks or so, until you have got used to the responsibility of caring for your baby on your own. During this time you should:
  • rest as much as possible
  • keep visitors to a minimum
  • share the care of your baby - you don't have to do everything to be a good mother!

Plan ahead

Well before your baby is due, you should unpack all your feeding equipment, read the relevant instructions and make sure that both you and your husband know how it all works. Your baby may want to feed as soon as you get home from the hospital and you will quickly get stressed if he is crying for food and you don't know how to prepare his bottle. Ideally, your husband will get everything set up before he collects you from the hospital so that at least one bottle is available for immediate use. You may want to use cartons of ready-made formula for the first few feeds until you get fully organized.

When your baby is born

Most babies want to feed very shortly after the birth, and your midwife will advise you when he is ready. She will give you a bottle of ready-made formula (which does not need warming), and your baby will almost certainly know how to suck and take as much milk as he wants. He should then settle quickly to sleep. This is what to expect:
  • He will only drink small amounts at first - about 10-30 ml (less than 1 oz) - and will gradually increase his intake as he starts needing more. Let him decide how much he wants.
  • If he swallowed a lot of amniotic fluid during the birth, he may be a bit `mucusy' and vomit back some of the milk. This is normal, and he will stop doing this once he has cleared his stomach -usually within 24 hours.
  • He may not want to feed much within the first 24 hours, but after this, he should feed roughly every three to four hours.
  • You should offer him a new bottle at each feed - do not keep using the same bottle until he has finished it. This is unhygienic and potentially harmful as it allows bacteria to multiply.
  • If he is getting enough milk, he should settle well after feeds and have at least six wet nappies a day.

Note: If you give birth at home all of the above still applies, apart from the fact that you will have to provide your own bottles of formula.

Rest

Giving birth is tiring, and you need time to recover. Try to relax when you first get home rather than rushing around catching up on housework, cooking, etc. Allow others to help, and try to fit in a daytime nap.

Visitors

It's very exciting having a new baby to show off, but don't overdo it! Having lots of visitors will not only make you very tired but might also unsettle your baby if he is forever being cuddled (or photographed) when he should be feeding or sleeping. A baby that is overtired or made to wait too long for feeds will soon become unsettled, and you may set the trend for disruptive days and nights.

Of course, you will want family and close friends to come and see your baby, but it is a good idea to agree with your husband in advance how long you want them to stay. He can then be the one to ask them to leave if they are staying too long. Many visitors think that they should stay a long time to show sufficient interest in the new baby, so it is helpful for them (as well as you), to know how long the visit should last.

Midwives and health visitors

All mothers and babies must be seen regularly by a community midwife for the first ten days after the birth, after which time she hands over to a health visitor. The midwife should visit you within 24 hours of you coming home, agree when she will next come to see you and give you her contact details if you need to see or speak to her earlier than that. Her role is to check your health and make sure that your uterus is contracting back down after birth. She will also carry out routine tests on your baby, weigh him, and advise you if you are having feeding or any other problems. If she thinks it necessary, she may carry on visiting you beyond day 10.

Your health visitor will usually call on or around day 10. She will give you a booklet in which to keep records of your baby's development, weight, etc., and tell you where your nearest baby clinic is and how to get hold of her should you need to. She is the one who will give you more general advice on baby care, check that your baby is reaching his milestones, and tell you when he needs his injections, hearing tests, etc.

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Friday, February 15, 2019

Bottle-feeding Your Baby


When your baby wakes for his feed, you should change his nappy, warm his milk and then settle down to give him the bottle. If you are using the correct teat, your baby should feed calmly and steadily, and take roughly 10-20 minutes to finish his bottle. He then needs winding, swaddling and settling down to sleep.

Changing nappies

Changing nappies needs to be done at every feed time and whenever he has a dirty nappy. This will keep your baby comfortable and prevent nappy rash. Ideally, you would change the nappy before a feed (so that you can settle your baby after the feed without disturbing him), but it may be better to change his nappy in the middle or end of a feed if:
  • He is screaming with hunger and wants to be fed immediately.
  • He regularly opens his bowels during feeds - it is a waste of time and money to change his nappy twice.
  • He often falls asleep before he has had enough milk - changing his nappy is an effective way of waking him enough to finish his feed.

Warming the milk

Although some babies are perfectly happy to drink cold milk taken straight from the fridge, most babies feed better if you warm the milk. You can do this by:
  • Standing the bottle in a jug of recently boiled water--this will heat the bottle more quickly than using hot water from a tap.
  • Using a thermostatically controlled bottle-warmer available from most baby shops.
  • Using a microwave. This is perfectly safe providing you don’t overheat the milk (which may destroy some of the nutrients) or give it too hot (which may burn your baby). When using a microwave, you will need to experiment to see how many seconds it takes to warm the milk to the correct temperature - this will depend on the amount of milk that you are heating as well as the power of your microwave oven. It's best to heat the bottle with the lid off, and you should shake it well to disperse any hot spots.

All the above methods are fine, but you must check the milk’s temperature before giving it to your baby. You can do this by shaking a few drops onto the back of your hand - the milk should be warm, not hot. A baby's mouth is very sensitive and easily burnt so, if in doubt, give the milk slightly too cold rather than slightly too hot.

It's also well worth varying the temperature of the milk you give your baby as some babies can become very fussy and start refusing the milk if it is not always at precisely the temperature they are used to.

Note: If your baby's bedroom is a long way from the kitchen, and you don't have a bottle warmer, you can save time at night by taking a vacuum flask of hot water (to heat the bottle) upstairs with you when you go to bed. The milk can also be taken upstairs and kept cool in a cool bag.

Giving the formula feed

Choose a chair (or bed) that allows you to sit comfortably, so that both you and your baby can relax and enjoy the feed.
  • Hold your baby with his head tilted slightly back over your arm -if he is too scrunched up you will find it harder to put the teat in his mouth and he will find it harder to swallow.
  • You should hold your baby in a slightly more upright position than you would if you were breastfeeding - this ensures that he won't choke on the milk (if it flows too fast) and also helps the wind to come up as he feeds.
  • The teat should go straight into his mouth (i.e., not at an angle) - if it goes in crookedly, it will be harder for his mouth to form a seal around the teat, and he may swallow more air as he feeds.
  • Hold the bottle so that the teat is always filled with milk - you will need to tilt your baby slightly further back as the bottle empties so he doesn't swallow air instead of milk.
  • When the baby stops sucking, you should wind him and then offer him more milk.
  • When he rejects the bottle, he is probably full.

Bottle-feeding is easy when a baby feeds well and only stops sucking when he has had enough milk. Unfortunately, this doesn't always happen! It may take several feeds or even several days to discover whether your baby is giving you the right signals, but it is relatively simple: if he settles well and gains weight he is getting it right. If he is slow to settle and is not gaining enough weight, he probably needs more milk. It may help to know that:
  • A small baby with a weak suck can get tired and fall asleep before he has drunk all the milk he needs.
  • Although most babies who are still hungry open their mouths every time the bottle touches their lips, some don't.
  • Babies don't always need the same amount of milk at every feed, so it can be hard to judge when your baby has had enough.
  • If you are using too slow a teat (so the feed takes too long), your baby may lose his appetite before he has had enough milk. Or the reverse can happen - if he feeds too quickly, he may take in so much air that he is difficult to wind and too uncomfortable to finish the feed.
  • You may need to experiment to find out which teat and which milk flow works best for your baby.
  • If your baby doesn't last as long between feeds whenever he has taken significantly less milk than usual, you could try to get him to take a little bit more milk.
  • The best way to judge whether your baby is getting the right amount of milk is to weigh him regularly - if he is putting on too much or too little weight you should adjust the amount of milk that you offer him.

Note: If you have a starving baby who is not satisfied for long between feeds, you could offer him formula milk designed for the hungrier baby to see whether this helps.

How long should each feed take?

It should take your baby about 10-20 minutes to drink his bottle, regardless of how old he is and how much milk is in the bottle. This is because the strength of a baby's suck is generally in proportion to his size - a big baby will finish a large feed in roughly the same time that a small baby will complete a small feed.

However, two babies of a similar age and weight may vary hugely in how efficiently they feed; one may suck strongly and continuously until he has finished the bottle, while the other may have a much weaker suck and keep falling asleep throughout the feed. It doesn't matter if your baby feeds very quickly (less than 10 minutes) or very slowly (more than 20 minutes) providing he enjoys the feed (i.e., he is not choking and taking in too much air) and is getting enough milk.

How many feeds a day?

A healthy normal baby needs to feed roughly three- to four-hourly for the first six weeks or so - this means he will have between six and nine feeds every 24 hours. As he gets older and starts sleeping longer at night (hopefully at around six weeks), he will gradually reduce this to between five and six feeds a day. Once he is sleeping right through the night, he may only need four or five feeds a day. You must feed your baby often than this (i.e., at least three-hourly) if he is premature, very small, jaundiced or suffering from a problem such as reflux.

Winding

When a baby feeds, he will usually swallow some air, which then starts accumulating in his tummy as wind. The more air he takes in, the more uncomfortable he will feel and the more frequently he will need winding. A very small proportion of babies do not suffer from wind at all, but the vast majority do need winding once or twice both during and after a feed. Your baby will typically let you know when he needs to be winded (by stopping feeding and crying), so you can generally allow him to carry on sucking for as long as he wants and only wind him when he stops feeding or seems to be uncomfortable.

You should always wind a baby at the end of a feed and also at any point during a feed when he seems uncomfortable. You need to do this for the following reasons:
  • A baby with too much wind in his tummy can become too uncomfortable to carry on feeding.
  • Air in his stomach can sometimes make him feel full and stop him feeding before he has had enough milk.
  • Winding a baby firmly will usually wake him up if he has fallen asleep before he has had enough milk - a baby will often doze off when his tummy is only half-full.
  • If your baby does wake up when you wind him, you should offer him the bottle again to see whether he wants more milk.
  • Winding a baby at the end of each feed is essential because a baby will rarely settle for long if he still has wind in his tummy. Even a baby who appears to be sound asleep will tend to wake and start crying within minutes if you lie him down without first winding him.

Note: If your baby brings up a lot of milk when you only wind him at the end of the feed, try winding him earlier to see whether you can avoid this happening. It doesn't matter if he brings up a lot of milk, but if he brings up too much you may then need to replace some of it by feeding him a bit more, and this can become rather time-consuming.

How to wind your baby

The air bubbles trapped in a baby's tummy will only be able to come up quickly if his back is straight. The three main ways to wind a baby are:
  1. Hold his body firmly against your chest with one hand and use the other hand to push gently into the small of his back to make sure it is completely straight. His back will usually feel stiff when he does have wind and relaxed and flexible when he doesn't. This is my favorite method.
  2. Put the baby on your lap and lean him slightly forward, supporting his head with your hand while you pat his back. This works perfectly well, but you must make sure that he doesn't sit in a crumpled heap with his back bent - it will take much longer to wind him if his back isn't straight.
  3. Lay him over your shoulder while you pat or rub his back. This works well (as it does ensure that his back is straight), but it can be a bit messy if your baby picks up a lot of milk onto your clothes! Although it is very common and normal for a baby to bring up a small amount of milk when he burps (this is called “possetting”), he is more likely to bring up milk when there is pressure on his tummy.

Winding in the middle of a feed is not essential, so don't insist on doing this if your baby gets agitated and wants to get on with feeding. Once the feed is over, you should spend a maximum of ten (but normally only two to three) minutes winding your baby - if he hasn't brought up wind within this time, it's probably not worth carrying on.

How will I know whether I have got all the wind up?

The short answer is - you won't! It is indeed a question of trial and error at first because you cannot assume that once a baby has done one burp, there are no more to come. However, as you get to know your baby, you will discover for yourself whether he never needs winding, whether he is fully winded after only one burp or whether it takes several burps before all his wind is up. Remember: if his back is floppy and relaxed he is unlikely to have wind.

Hiccups

It is very common for a baby to have hiccups. Most babies are entirely untroubled by them and will happily carry on with whatever they are doing - feeding, sleeping, etc. But if your baby is unsettled with hiccups, you could try offering him some cool boiled water (either from a bottle or from a spoon) to see if this helps.

Settling your baby after a feed

Some babies are very easy to settle; others are not. However, a baby will typically sleep longer and better when swaddled, so ask a midwife, relative or friend to show you how to do this. Most babies feel secure with their whole body firmly swaddled, but if your baby hates having his arms confined and he wants to suck his thumb, you can wrap him up leaving his arms free.

Don't risk overheating your baby (use a cotton sheet and fewer clothes and blankets in hot weather) and always put him down to sleep on his back or his side but not on his tummy (because of the risk of cot death, see page 43).
  • Your baby may fall asleep immediately, or he may gaze around for a bit before dozing off. Either is fine!
  • If he starts grizzling or crying gently, leave him for a while to see whether he settles - it's not unkind to do this as many babies will only fall asleep if they are left to cry. If you keep picking up a crying baby, you may end up making him thoroughly overtired and even more incapable of going to sleep.
  • If he is still awake after about 10 minutes, but his crying is at the same level or diminishing, you can leave him for a little bit longer. You could also offer him a dummy (see overleaf), rock his crib and gently pat his back.
  • If his crying escalates and he is becoming more unsettled, you should pick him up to wind him again and calm him down.
  • If absolutely nothing (i.e., winding, rocking or dummy) settles him, you need to go back to square one and offer him more milk.

Once all his needs have been met, a baby will normally fall asleep quite quickly and stay asleep till the next bottle feeding is due.

Note: For the first few weeks most babies fall sound asleep after a feed and then demand to be fed as soon as they wake up. After about four to six weeks, babies start becoming more alert, need less sleep and spend more time awake and playing. At this point, they will either still go straight to sleep after a feed but not need to be fed when they first wake up; or remain happily awake after a feed for quite some time before going to sleep, but then want to be fed the instant they wake up.

Dummies

Opinion is divided on the use of dummies. In general they are frowned upon as prolonged and excessive use is thought to have an adverse effect on a child's speech and intelligence, but conversely, more recent research suggests that using a dummy reduces cot deaths.
Personally, I loathe them, but none the less I do think that a dummy can be an invaluable aid when it comes to settling some babies and I will happily suggest using one when necessary.

I recommend that you:

  • Do not use a dummy on a baby who can't go to sleep because he is still hungry.
  • Only use a dummy if you cannot settle your baby without one. Don't automatically put it in his mouth every time you put him down to sleep - wait and see if he can settle without it.
  • Don't use it to stop your baby crying (e.g., when you are changing his nappy).
  • Don't use a dummy when you are walking your baby in a pram or buggy, as the movement should be enough to rock him to sleep.

If you follow these guidelines, your baby is unlikely to become addicted to the dummy and will usually stop using it of his own accord once he no longer needs it. This normally happens at about three months when a baby either stops needing something to suck on before going to sleep, or he discovers his thumb and uses that instead.

Note: Dummies need to be washed and sterilized frequently. Putting the dummy in your mouth and sucking on it does not make it germ-free and safe to go back in your baby's mouth - this particularly applies if you have a cold or any other infection, which may then be transmitted to your baby.

Formula feeding the twins

Bottle-feeding twins is potentially harder than breastfeeding twins because it is more difficult to feed them simultaneously when using bottles rather than breasts. On the other hand, bottle-feeding has the advantage of a limitless supply of milk, and others can help you with the feeds. If possible, arrange to have someone to assist you in the early weeks as it can be very tiring and stressful trying to feed, wind and settle two babies on your own. Although some mothers manage amazingly well right from the word go, they are the exception, so don't feel demoralized if you can't cope on your own.

What to expect:

  • Most twins are delivered earlier than their due date and are likely to be smaller (and possibly slightly weaker) than a full-term single baby. Very small twins may need to be admitted to the neonatal intensive care unit initially - your midwives will explain everything to you if this happens.
  • Don't worry if your babies need to stay a few extra days in the hospital to get feeding established, check for jaundice, etc. It is better to know that the babies are feeding well and taking enough milk before you leave hospital than to start worrying about it at home.
  • You may initially be given strict guidelines as to how much and how frequently the babies need to be fed. These guidelines will become more relaxed once everyone is sure that babies are gaining the right amount of weight.

Once you are in your house, it is helpful to synchronize feeds so that the twins feed and sleep at the same time. This way you will have time in between feeds to look after yourself - sleeping, eating and resting are very important for your health and well-being. This is much easier to achieve if you have help (husband, mother or maternity nurse). If you are on your own, I think you should plan to feed the babies one after the other so that each baby has your full attention and is cuddled as he feeds. Your babies will enjoy this far more than being bottle-fed propped up by cushions.

The aim is to give each baby enough milk to last until the next feed, which ideally would be three to four hours later. The timing of the next feed is then dictated by the baby who wakes the first; if he needs to feed after three hours, it would be wrong to make him wait for his brother to be hungry. Instead, you should wake the sleeping twin and try to feed them both together - most babies are happy to be fed earlier rather than later, so this normally works very well. But if this always upsets the sleeping twin, who then feeds poorly and is slow to settle again, you may need to allow them to feed at separate times. It is usually possible to get the babies synchronized at some stage, so don't worry if you can't manage it in the early weeks.

Hygiene

It is important to be meticulous about hygiene as it is easy to spread germs between two babies. You need not wash your hands in between handling one baby and the other during feed times, but you should wash your hands after nappy changes, before preparing bottles, etc., just like when you only have one baby.
  • The babies should not suck from the same bottle or share a dummy. Using different-colored rings on the bottles will help avoid confusion.
  • If one baby has an infection (e.g., thrush in his mouth), you must wash and sterilize everything very thoroughly, and you should also wash your hands carefully after you handle that baby.
  • If either baby develops an infection or a minor illness such as a cold, you should keep them apart until the ill one is better.

Most twins like to be physically close to each other and will usually settle better if they are put to sleep in the same cot. But if one twin keeps being disturbed and woken by the other, it is better to separate them than to have two wakeful babies!

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Thursday, February 14, 2019

Sterilizing Bottles and Making Up Bottle-Feeds


Most mothers are aware of the importance of sterilizing feeding equipment, though few fully appreciate why it needs to be done. Once it is all explained, a mother will become much more confident about her ability to decide what needs sterilizing, how often, and when she can stop sterilizing altogether.

You need to sterilize because:
  • young babies are very susceptible to germs
  • milk is a perfect medium in which germs can multiply
  • sterilizing is the best way to ensure that germs are destroyed

Although mothers are told that they must sterilize all feeding equipment for a minimum of six months, it is, in fact, safe to use something that has not been sterilized providing you have washed it properly (see page 16). After all, a mother does not pop her breast into a sterilizer before it goes into her baby's mouth!

These are the basic principles of hygiene and sterilizing:

  • You should wash your hands before allowing your baby to suck on your finger but, having washed your hands once; you do not need to wash them again unless you do something that might contaminate them, such as a nappy change.
  • You do not need to be fanatical about washing every time you touch something, but you should wash your hands very carefully after handling raw meat, going to the loo, etc.
  • A dummy that falls out of your baby's mouth into his cot can be put straight back into his mouth, but if it falls onto a dirty street it should not be used again until it has been sterilized (or washed very thoroughly if you don't have a spare one to hand). Putting the dummy in your mouth and sucking on it does not make it germ-free and safe to go back in the baby's mouth.
  • You need to completely clean the baby bottle to avoid giving your baby a tummy upset because of the bacteria that may contain in the bottle. A minor tummy upset is unlikely to do much harm, but if there's a particularly nasty bug in the bottle, your baby could suffer severe gastroenteritis and might need to be admitted to hospital.
  • If you need a baby bottle in a rush (and don't have time to sterilize), it should be safe to wash the bottle thoroughly, fill it with milk and use it immediately. Any bacteria that might be left inside would not have a chance to multiply to a dangerous level in such a short time.

Washing before sterilizing

Sterilizing is not a substitute for washing, so everything must be cleaned thoroughly before you sterilize it. Bottles, teats, etc., should be rinsed in cold water immediately after use and then left soaking until all of them are ready to wash in one go - this makes cleaning quicker and easier.

  • A sink must be filled with hot soapy water and use a bottle brush to wash each bottle thoroughly, inside and out, making sure that you brush around the ridges of the bottle and its screw-top.
  • Teats can be cleaned by squirting a bit of neat washing-up liquid into them and then giving them a good squidge around (both inside and out) using your fingers. You can also use a small brush specially designed for washing teats.
  • Rinse with clean water and put all items straight into the sterilizer - you do not need to dry them first.
  • The bottle brush does not need to be sterilized but should be kept in a clean place, e.g., in a jam jar (which you should also wash regularly).

Everything you wash (but are not planning to sterilize) should be left to drip-dry on a clean rack or paper towel - or you can shake the water off and use it immediately. If you use a dirty drying-up cloth or put items to drain on a dirty work surface, you will directly contaminate them and make them unsafe to use.

Note: In the U.S., many mothers put all their baby-feeding equipment in the dishwasher and do not sterilize any of it. This is less safe to do here because dishwashers in the UK wash at a lower temperature than they do in the U.S.

Sterilizing methods

You can use an electric or microwave steam sterilizer, or sterilize in cold water using liquid or tablets following the manufacturer's instructions.

You can also sterilize items by boiling them in a saucepan. The bottles should be immersed in cold water (making sure there are no air bubbles left inside the bottles) and then boiled for at least 10 minutes. The teats can be added for the last three minutes but be aware that they will perish quickly if you boil them too often.

Note: Pouring boiling water over a teat, dummy, etc., does not sterilize it.

How long will equipment remain sterile?

Most manufacturers say that the contents need re-sterilizing every time you open the sterilizer to get something out. This is being overly cautious! If you wash your hands carefully before removing items from the sterilizer, everything left will remain safe to use for about 24 hours. But if your hands are dirty and you sneeze into the sterilizer before replacing the lid, you will need to wash and sterilize again! Bottles that are removed from the sterilizer and kept fully assembled with their lids on will remain sterile for about 24 hours, even when left at room temperature in the kitchen or out and about with you and the baby. These bottles can be left empty or filled with cooled boiled water, but if you put milk into them, they should be kept cool in the fridge.

Making up bottle-feeds

Current advice is that bottles should be made up immediately before a feed, rather than being prepared in advance and kept stored in the fridge. This is another example of manufacturers being overly cautious! Mothers are advised to make up one feed at a time to make allowances for those who fail to sterilize and store the feeds correctly - the milk does not start deteriorating once the powder is added.

You can, therefore, decide which suits you the best; preparing 24 hours' worth of feeds in advance or waiting until your baby is hungry before mixing the milk.

These are the pros and cons:

Method one: preparing in advance

  • I think it is quicker and more efficient to get into the habit of preparing all the bottle feeds at the same time each day rather than doing each bottle as and when you need it.
  • Your crying, hungry baby doesn't have to wait while you prepare his bottle.
  • Bottles of milk must be kept cool, which means taking a cool bag when you are out for the day, traveling etc.
  • The milk has to be warmed before you give it - easy and quick if you microwave it, but slower if you don't.

Method two: making individual bottles

  • Can be stressful if your baby is screaming for his feed. Anyone can get a bottle out of the fridge for you, but not everyone (e.g., a visiting friend) will know how to find and add the powder in a hurry.
  • When out and about, you have to take bottles and powder with you in separate containers.
  • You can keep the bottle filled with water at room temperature -no need for cool bags and possibly no need to heat the bottle either. (See page 24, "Warming the milk.")
  • Safer if you are not meticulous with hygiene and sterilizing.
  • No chance of your baby being given old milk that has been left at the back of the fridge for a week (or longer).

When making up the feeds, you should:

  • Rinse out the kettle, fill it with water (taken from the cold water tap) and bring it to the boil.
  • Allow the water to cool for about 10 minutes (so that the water is still hot, but not boiling).
  • Wash your hands, take the bottles out of the sterilizer and stand them on a clean work surface.
  • Baby bottler must be filled with the exact amount of water, i.e., 180 ml (6 oz) of water if you want to make up 180 ml (6 oz) of milk.
  • Add the milk powder to the water, first checking the tin for instructions as to how much powder to add. It is usually one level scoop of powder per 30 ml (1 oz) of water.
  • Dissolve the powder by putting the tops back on the bottles and giving them a really good shake.
  • Put bottles straight into the fridge, even though they will be quite hot. (The sooner you cool the milk down, the sooner you will stop germs multiplying if you have failed to sterilize the bottles correctly.)
  • You can leave the bottles out of the fridge if you are not adding a powder to the water.

Do not:

  • Use mineral water, as this is designed for adults, not babies (unless the label explicitly states that it is suitable for babies).
  • Use water that has been softened (i.e., water softener in your home).
  • Boil the water more than once as this concentrates the chemicals in the water.
  • Add more than what is the prescribed amount of milk powder.
  • Use milk that is more than 24 hours old - all old milk must be thrown away.
  • Put a half-finished bottle of milk in the fridge to be used again later in the day. (This is unhygienic and can allow harmful bacteria to multiply.)

Note: It is only necessary to use bottled (rather than tap) water in countries where there is no safe water to drink. In this case, you should always boil the water, regardless of whether you are using tap or bottled water.

How much milk to offer

As a rough guide, most babies under the age of four months will need approximately 150 ml (5o z) of milk per kg of body weight (or 2%2-3 oz per lb) every 24 hours. To work out how much your baby will need at each feed, you divide the total amount of milk he needs by the number of feeds he is having.

Metric

For a 3 kg baby on six feeds a day, you would multiply 3 kg by 150 ml = 450 ml. Divided by six feeds = 75 ml per feed.

Imperial

For a 7 lb baby on seven feeds a day, you should multiply 7 lb by 3 oz = 21 oz. Divided by seven feeds = 3 oz per feed.

As this is only a rough guide (because I have multiplied by 3 oz, rather than by 2% oz), you should not worry if your baby takes slightly more or less than this.
  • Always make up a bit more than you think your baby needs so that if he is particularly hungry at one feed, he can have more.
  • A small amount of milk should always be left in the bottle at the end of each feed, so you can be fairly sure that the baby has finished bottle-feeding because he has had enough milk, rather than because there was no more milk available to him.
  • A bottle-fed baby tends to take pretty much the same amount of milk at each feed, but his appetite will vary a little. Don't force him to drink more when he has had enough, as this is likely to make him gain too much weight.


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Wednesday, February 13, 2019

Which Formula Milk?


For the first year, formula milk (and breast milk) must be provided to an infant as this milk comprises more balanced nutrients and are easier to be processed and absorbed in the body than cows' milk. Cows' milk should not be prescribed as the main drink if the baby is less than one year old.

There is such a wide choice of formula milk on offer that it can be hard to know which to choose. In addition to the regular milk, there is a specialist formula milk for babies who have milk allergies or intolerance, reflux, as well as for pre-term babies and hungrier babies, etc.

But first things first:


  • Pediatricians tell me that they do not recommend any particular brand. They all contain similar ingredients, and it is only good marketing that persuades a mother she is giving her baby 'the best' formula milk. Nor do they recommend organic over non-organic.
  • It is, however, best to choose a brand that contains added prebiotics (which are a natural component of breast milk), as these will increase the friendly bacteria in the baby's gut and help develop his immune system.
  • If the formula you choose doesn't appear to agree with your baby (i.e., he brings quite a lot of it up, becomes “mucusy” or won't drink much), it's worth swapping to another brand to see whether it suits him better.
  • If this doesn't help, don't continue to try other brands as there might be another cause (such as reflux or milk allergy) for his symptoms. See your doctor and take his advice.
  • If there is a history of hypersensitivities in the family, it might be best to use a hypo-allergenic formula right from the outset, but you should also discuss this with your doctor first. It's not a good idea to label your baby as 'allergic' without first getting a medical opinion.
  • Consult your GP or pediatrician before using any specialist milk —this is because many doctors think that some milk (e.g., soya) can cause worse problems than the standard cows' milk formulas.
  • Ready-made milk (in cartons and small bottles) are nutritionally the same as making up your own with powder, but are a lot more expensive!

Regardless of which brand of formula you choose, make sure that it is suitable for the age of your baby, and only graduate to milk for the older or 'hungrier' baby once it becomes appropriate.

Each tin of formula milk will have full instructions on making up the feeds and storage, and will also include feeding guidelines as to roughly how much milk your baby will need according to his age and weight. As long as the baby's weight gain is good, it doesn't matter if he is drinking more or less than the chart recommends.

First infant milk

This should be your first choice of milk for a normal healthy baby and is suitable from birth. It will be whey dominant, meaning it is easy to digest and as close to breast milk as possible.

Milk for the 'hungrier' baby

This can also be utilized from delivery, but casein is (rather than whey) dominant. Casein is harder to digest than whey, which means the milk stays in a baby's stomach for longer and leaves him feeling more satisfied and better able to feed slightly less frequently. It is not more fattening than other milk and is ideal to use for a hungry baby who is frequently feeding and gaining too much weight. You should only switch to this milk if your baby needs it, because a very young baby might find it too hard to digest, and this will make him uncomfortable and unsettled.

Follow-on milk

You should switch to this milk at six months. In addition to all the previous ingredients, follow-on milk contains extra iron, calcium and Vitamin D, all of which are beneficial for older babies. In addition to solid food, this will meet all his nutritional needs until he can start drinking ordinary cows' milk at the age of one year.

Specialist formula milk

These are designed for babies with special dietary needs (e.g., pre-term or low-birth-weight babies, and babies with milk allergies, etc.), or those with feeding problems (such as reflux) who need to use a specialist rather regular formula milk. Many of these are available on prescription only, but others can be bought over the counter. None the less, I do recommend that you consult a doctor before using any of these milk (including soya and goats' milk) to be sure that: 


  • your baby is genuinely unable to drink cows' milk formula
  • a proper diagnosis is made (e.g. of milk allergy) so the right milk is prescribed, and follow-up appointments are made to review your baby's progress


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Tuesday, February 12, 2019

Choosing Your Bottle-feeding Equipment


There is such a bewildering choice of bottles, teats, sterilizers and other paraphernalia available in the shops that most mothers don't know where to begin. Besides, not all shop assistants are well informed about the merits of the different types of bottles, teats, etc., and therefore may not give you all the information you need to make an informed choice. This article should cover pretty much everything you could ever want or need to know about bottle-feeding equipment and will help you make decisions about what to buy. Bottle-feeding is not just a question of throwing any formula into any old bottle and then expecting your baby to feed perfectly.

Equipment

Although some equipment is essential (like bottles), you don’t have to buy everything that s an offer – for example. You don’t need a bottle warmer.

The main advantage in buying all the correct kit is that it will make the sterilization and preparation of bottles easier, but the downside of buying more than you need is that it will clutter up your kitchen and will then have to be stored until the next baby.

I suggest that you start by only getting in the essentials and then buy more things as and when you need them. Ideally, you will decide which brand of products you like the best, then stick to buying within that particular range, as the products will be designed to interact with each other. For example, the Avent bottles will fit onto the Avent breast pump and will also pack perfectly into the Avent steam sterilizer, but will not fit onto other pumps and vice versa.

You will need:
• six 260 ml (9 oz) bottles
• six teats
• a bottle brush
• a steam sterilizer or sterilizing solution or tablets

Note: You will not need six bottles if you are making up feeds individually and you begin bottle-feeding when your baby is having fewer than six feeds a day.

Bottles

There are many different types of baby bottles on the market, and they all work, However, each manufacturer will give reasons as to why theirs is the best, so it is quite difficult to choose which one to buy. Despite all the claims, I have not found that any one bottle “works” substantially better than another, but these are my tips:

• Wide-neck bottles are easier to make up feeds in than the narrow-neck bottles.
• Narrow-neck bottles will fit onto some breast pumps (e.g., Medela), so might be a better purchase if you are using these pumps.
• It is more beneficial to start off using small 150 ml (5 oz) bottles but this is unnecessary and a waste of money. The 260 ml (9 oz) bottles work just as well, and you will need this size eventually anyway.
• A baby that is feeding badly or “messily” may feed better from a different type of bottle and teat — you will need to experiment to see what suits him best.
• Some anti-colic bottles are very fiddly to clean and assemble; I would not opt for these if you establish that your baby cannot feed well from a more basic bottle.
• Disposable bottles, or bottles with disposable liners, are useful if you are traveling and can't easily sterilize. The Playtex bottle is excellent and is very economical, as you only throw away the liner rather than the whole bottle.

Note: I do not think that breastfed babies need to be given special bottle and teats to avoid causing “nipple/teat confusion.” But if you are breastfeeding (and giving some bottles), you should avoid using a fast-flow teat that makes it much easier for your baby to feed on the bottle than your breast. If this happens, your baby might prefer the more comfortable option and start rejecting your breast in favor of the bottle.

Teats

Teats come in all shapes and sizes, with variable flow rates and a choice of silicone or latex. Most babies will feed well from a standard teat, but as with bottles, some teats will suit one baby better than another.

• Most wide-neck bottles can only be used with their brand teats (e.g., you can't put a Nuk teat on an Avent bottle).
• Narrow-neck bottles are more versatile and will take any teat that is designed for narrow bottles.
• Silicone teats are more expensive than latex teats but are mores durable and need replacing less often.
•Latex teats are often (but not always) softer than silicone and make feeding easier for babies with a weak suck (e.g., very premature babies).
• You can also enlarge the hole in a latex teat (using a glowing hot needle), which is useful if your baby needs a very fast flow of milk. You can't do this with silicone teats.
• Choose a teat that is the right size for the age of your baby (this will be clearly labeled) and then experiment to see whether he likes a slow-, medium- or fast-flow teat — the medium-flow is usually a good one to start with.
• It should take your baby roughly 10-20 minutes/to empty the bottle. If he takes much longer than this, he needs a faster teat, and he needs a slower teat if he is feeding too fast.
•Vari-flow teats are designed to release the milk at a rate which varies according to how strongly the baby sucks. This allows the baby to feed quickly when he is very hungry and to feed more slowly at other times. This teat can also be useful when you are trying to persuade a “lazy” baby to suck more strongly.

Sterilizers

Electric steam sterilizers will sterilize anything you put into them (breast pumps, dummies, etc.) but it's helpful to pick one that accommodates the type of bottles you are using. You will still be able to sterilize other bottles, but they may not pack in as efficiently. Steam sterilizers are very easy to use, take between five and eight minutes to sterilize the contents, and come with clear instructions.

Microwave sterilizers work in much the same way, apart from the fact that you must own a microwave oven to operate them. They are smaller, lighter, cheaper and more portable than electric sterilizers, but will be less versatile if you regularly visit family or friends who do not have a microwave oven. They will sterilize bottles in as little as two minutes.

Sterilizing fluid or tablets are useful to take away with you on holiday or when you visit friends and family to save you packing a lot of bulky sterilizing equipment. You can buy a particular sterilizing unit or use any non-metallic container (e.g., a plastic jug, ice-cream container or Pyrex bowl), which you fill with ordinary tap water and a measure of sterilizing solution or tablets. All items to be sterilized must be fully submerged in the water (you may need to use a saucer to weigh them down) and then left to soak for 15-30 minutes. The main disadvantage of this method is that the solution needs to be changed every 24 hours and the chemicals are fairly tough on your hands, which can become dry and chapped. You are also advised to rinse all items with cooled boiled water before you use them, Sterilising fluid and tablets can be bought from any chemist and come with full instructions.

Bottle-warmers

These are not essential, as you can easily heat bottles in a jug of hot water or a microwave oven (providing you don't overheat the milk). A bottle-warmer will often take slightly longer to heat the milk and will clutter a small kitchen - but they are useful at night if the baby's bedroom is a long way from the kitchen.

Note: A study has shown that standard feeding bottles leak a small amount of the chemical Bisphenol A (BPA) when heated. There is insignificant proof to show that this is harmful to babies, but it is possible for anxious parents to buy plastic bottles that are free from BPA. Glass feeding bottles are also available.

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Sunday, February 10, 2019

How Much Should A Newborn Eat


One very practical question that many mothers ask is how much should a newborn eat when she brings her home from the hospital. Two particular ideas that exist as to the means of determining the time that should elapse between breastfeedings. At one extreme is the school that feels babies should be breastfed by the clock, that is, at carefully regulated intervals. Mothers who are insecure in their new role may like clock feedings because rigid guidelines are provided and they are not required to make decisions.

The second school that of demand feeding recommends breastfeeding whenever the infant wakens and demands to be fed. This latter philosophy, on the surface, might appear to be the more logical way of determining when to breastfeed the baby. To all inexperienced mother, however, this method may prove to be a little more complicated in practice than it sounds in theory, for she may be confused as to what a particular cry means. Does it mean that the baby is hungry and needs to eat, or does it merely indicate that the baby is uncomfortable and needs some assistance and reassurance?

Newborn breastfeeding schedule

how much should a newborn eatFor the average baby and mother, the simplest way of establishing how much breastmilk does a newborn need at each feeding would be to integrate the two schools of thought, using the demand feeding system combined with the clock technique. That is, encouraging the baby toward a somewhat systematic breastfeeding schedule, but allowing some variation according to the particular needs indicated by the crying of the baby. It certainly seems foolish to awaken a sleeping child when the clock says it is time for a meal, but on the other hand, it also is a bit ludicrous to breastfeed a baby who has just finished a meal an hour earlier. Therefore, a mother probably will be most comfortable with a baby if she encourages him toward a breastfeeding schedule of approximately four-hour intervals between feedings. However, premature or tiny babies will need to eat as often as every two or three hours for a few days.

In many instances, the baby will already be established on a time interval of four hours between feedings since this is the approximate breastfeeding schedule of most hospitals. Some babies, however, may need to be gradually encouraged in this direction. Most mothers of first babies find some comfort in an approximate newborn feeding schedule such as this, rather than using demand feeding entirely.

Establishment of a newborn feeding schedule is most easily accomplished by being certain that the baby has had an adequate meal at each feeding. This may mean, for some sleepyheads, that the mother might need to rouse the baby rather than putting him back in bed when he drowses off after consuming only an ounce or two of milk.

In general, it is unwise to get in the practice of giving more food soon after the baby finishes a meal. If a well-fed baby rouses after approximately one hour, it is much more likely to be a gas pain upsetting him than a hunger pain. Therefore breastfeeding is not appropriate at such a time and, after relief of a gas pain by burping, the baby probably will go back to sleep until close to the time for the next breastfeeding.

It is extremely wearing on both mother and baby if frequent breastfeedings become the pattern. Should this situation develop, mothers can gradually extend the time between feedings so that they begin to work back toward the desired breastfeeding schedule. A four-hour newborn feeding schedule (six feedings per day for the young infant) seems to work well for both breast- or bottle-fed babies. It permits the baby time to rest before it is time to commence the next feeding, and it also gives the mother time to do other jobs. Small infants probably will not be able to achieve a four-hour breastfeeding schedule until a weight of approximately eight pounds is reached.

As the baby matures, it will gradually be possible to eliminate the middle of the night feeding. This, from the parental viewpoint, is extremely desirable. One can work toward the routine on how much should a newborn eat by having good breastfeeding at approximately ten o'clock at night and then encouraging the baby at the usual middle of the night feeding to gradually wait just a little longer. With the average size baby, sleeping through_ the night will occur at three to six weeks of age. The baby that is smaller at birth will require a somewhat longer time to reach a weight that will enable him to go through the night without the usual two o'clock feeding.

Is my baby getting enough breast milk?

how much breastmilk should a baby need
Some babies never lose an ounce from the day they're born and put on weight with the greatest of ease. Most newborns drop some pounds during the first week but get back to birth weight by about three weeks of age. In rare instances, perfectly healthy babies take as long as six weeks to recoup their birth weight.

Is my newborn getting enough breast milk? The newborn baby is probably getting enough to eat if the baby nurses every two or three hours.

Checking the number of wet diapers is an easy way to determine whether your baby is getting enough breastmilk. If the baby has six to eight wet diapers a day, he is doing fine. (For this purpose, keep the baby in cloth diapers. It's easier to judge wetness with cloth, rather than disposable, diapers.)

From time to time, you and your doctor will weigh the baby as a way of measuring his physical progress. A pound (453 grams) a month, or four to seven ounces a week is an acceptable gain, although some babies add a pound or more a week. Remember—healthy, happy babies come in all shapes and sizes. Both the quite fat and the very slim baby can be normal and healthy. Neither bigness nor smallness is a reason for concern as long as the baby's food is breast milk and nursing care according to his needs. If you feed your baby in a way that is naturally intended for the human infant, his weight gain will be what is natural for your particular child.

Concerning baby's size and appetite, mothers who give birth to large babies and mothers who give birth to small babies have at least one thing in common: they can expect to have their ability to breastfeed the baby questioned.

How to determine if my baby is getting any breastmilk when nursing?

First be sure that your baby's mouth is positioned correctly over your nipple and areola. Her lips should be turned out on the breast, not in over her gums. She should have your nipple and most, if not all, of the areola in her mouth.

Next, watch the pattern of sucking. At first, the jaw moves very quickly, almost frantically for a few seconds, while she positions the nipple against the roof of her mouth. Then the sucking becomes rhythmical, and you will see and hear a suck, swallow, breathe sequence. This is "nutritive" sucking. Five to ten minutes of this type of sucking will give your baby all the milk needed at a feeding. Toward the end of a nursing, the sucking sequence changes to three or more jaw movements or sucks before swallowing. Some babies' mouths seem to quiver. This is sucking for satisfaction or contentment. It is okay to let baby do this if you do not have any nipple discomfort.

How do I get my baby to let go when he is finished nursing?

To break the suction that your baby has created on your breast, slip your finger into the corner of baby's mouth and between the gums. When the suction is released, or your baby starts sucking on your finger, you can gently withdraw your breast.

When should I baby nurse for the first time?

This will often have a lot to do with your hospital or birthing center's policy. Ideally, you should baby nurse as soon after delivery as possible. Your baby's sucking reflex is most vigorous immediately after delivery, and then it slows down for the next day or two. Nursing soon after birth can be helpful to stimulate milk flow. If that isn't possible, don't worry. Most new mothers baby nurse their newborn for the first time sometime within twenty-four hours after the birth.

How long should my baby nurse at a feeding?

A baby can empty a breast in five to ten minutes, but you should not let the clock decide the length of a feeding. Let baby decide when the meal is over. Sucking is his most pleasurable experience. Sometimes he will be starving and eager to eat and finish quickly. Other times he will be lazy and slow, taking far longer to baby nurse. Still other times, he may enjoy the sucking sensation so much that he will linger after sucking vigorously for a while. All of these patterns are normal, and all babies vary to some degree nursing to nursing. Once you have baby nursed for a short while, you'll be alert to these changing patterns in your baby.

Limiting of Nursing Times

A common precaution given to new mothers is to limit nursing in the first few days to three or five minutes on each side at each feeding and to work up to about ten minutes on the third or fourth day. More than one person may tell you not to let the baby nurse too long or too often for fear of getting sore nipples. Such advice does not take into account the fact that it may take two or three minutes for the milk to let down in any quantity, especially in the early days. Nursing for less than five minutes could mean that the feeding would end almost before it started. And once the milk is flowing, the slight soreness that may be felt subsides when the baby begins to nurse. Keep in mind that, in the beginning, nursing frequently—every two hours or so—is more comfortable on the nipples and at the same time stimulates the production of milk, a primary concern.

Such advice about the drastic limiting of nursing times should be put into perspective. Many nursing moms are never worried about sore nipples at all, no matter how often or how long the breastfeeding takes.  Soreness may never be a problem for you, particularly if you have followed the suggestions for nipple care during pregnancy.

If you do develop tender nipples, there are some tried and true remedies to prevent them from becoming worse and to ease the discomfort. Nipple soreness, like muscle soreness after a workout, is temporary. With continued exercise (or continued breastfeeding) it goes away. Limiting nursing may only prolong the conditioning period and the length of time that the nipples remain sore. It also depresses the milk supply. What an empty accomplishment it would be if a program of restricted nursing kept a mother's nipples from getting sore, but she was then left with insufficient milk for her baby.

Should I use both breasts every time I baby nurse at each feeding?

how much to feed a newborn
You should alternate the breast at which you begin each feeding. To keep track of the breast used first at the last feeding, some mothers put a small safety pin on that side of their bra. If you alternate the first breast used at each feeding, it doesn't matter if the baby nurses from both breasts. Let the newborn baby nurse at least five minutes on the 1st breast.

You can then slide her over to the other breast and let baby nurses as long as she likes. She will get the bulk of her nourishment from the first breast and contentment and extra sucking from the second. If you are nursing for the first time and your nipples are a little tender, using both breasts can help to keep one from getting too sore due to prolonged nursing. Using both breasts in the beginning also helps stimulate milk flow.

Why should you offer both breasts to the newborn baby?

While breastfeeding is being established, we recommend that you offer both breasts to the baby at each feeding. Nursing on one breast only could mean a four- to six-hour lapse before a breast is again baby nursed—too long a period in the beginning. The added stimulation of suckling baby on both breasts is a way of keeping pace with his increasing interest in nursing and his need for more milk. Besides, the breasts will not become painfully overfull, a condition that can develop quickly in the early days.

At each feeding, alternate starting sides. For instance, if at one feeding you start nursing on the right and then switch to the left, reverse the order for the next feeding. You'll be using the last used side first and the first, last. To help remember the starting order, mothers have come up with all kinds of ideas from fastening a small safety pin on the bra on the side used last to transferring a small ring from hand to hand. You'll soon figure out your method. If you do forget, your baby and your full breast will probably soon let you know—oops!—you've offered the "wrong" side. No harm is done if this happens from time to time; there's no need for you to worry about it.

How often should my baby be nursed in a day?

It is a fact that when a baby's tummy is filled often enough, and the mother's breasts are emptied regularly enough, most breastfeeding problems are avoided. But no timetable can tell you how often you should baby nurse. All babies are different, and each has his timetable for eating. Because breast milk is easily digested, most newborns need to be fed every two hours in the beginning. It may stretch out to three hours apart as the baby gets a little larger and his stomach can hold more, and you produce more milk. During the first few months, most babies nurse seven to ten times a day. Some baby nurses more while others get hungry less often. Such an increased need is an indication that the baby is lively and growing and is not a cause for worry. "Ad-lib nursing" can be very relaxing. You should not worry about putting the baby to the breast "too often."

Milk and Milk Composition

Breast milk is a continually changing food that adjusts to the age and needs of your baby. The composition of your breast milk is never constant. The amount of protein, fat, sugar (lactose), and other components changes. The milk you produce if your baby is delivered prematurely is different from milk you would produce after nine months of pregnancy. And that milk is different from the milk you will produce after a few months. Mothers make milk that is suited to the needs of their babies.

The first milk being produced by new mothers is the colostrum, which looks yellowish and creamy. Only a small amount of it is produced, but it is exactly what is needed, and you should not need to supplement with anything else. Colostrum is high in protein and helps your baby resist infection. It also acts as a laxative, helping babies pass the thick, green/ black meconium (the first stool). This is important in avoiding the development of jaundice.

In the first two or three clays, your milk will gradually change from colostrum to mature breast milk. This milk is thinner and sometimes slightly bluish, rather than the yellow color of colostrum. Some women become anxious that their milk is not thick enough now to satisfy their babies. But in fact, it is all your baby needs for the next six months; usually, no artificial formula, water, or juice is needed.

Your body does all of this work for you, and you do not have to think about it or decide what your baby needs. But it is essential to understand that how you feed your baby can affect the composition of the milk that your baby takes.

Getting the Balance Right

Milk composition also changes throughout every breastfeed. The milk your baby takes at the end of a feed is different from the milk at the beginning of a feed. As you start, she will get a lot of milk quickly. This milk (called the foremilk) is high in volume, low in fat. So although your baby gets a lot quickly, this milk is low in calories but high in protein and other good things to help her grow and resist infection.

As your baby feeds, the composition of your milk gradually changes. After the first few minutes, the amount of milk she gets slows down. You will see that her sucking also slows down, with longer pauses between periods of sucking.

As she sucks less frequently, she starts to get milk that is low in quantity and higher in calories; it is called the hindmilk. This is a progressive change that occurs throughout the feed. It is not related to the timing of the letdown.

It is essential that your baby get a good balance of both the foremilk and the hindmilk because this is the only way that the baby will be able to take in enough milk and enough calories.

Your baby is the only person who knows that she has had the right balance of foremilk and hindmilk.

Your baby understands her appetite, and she knows when she is full. To ensure that she gets a good balance, therefore, all you need to do is let her feed when she is hungry and let her stay on each breast until she has had enough and came off herself.

Allow your baby to take the first breast first, then offer her the second side.

When she comes off the first side, sit her up. Let her burp if she needs to. (This is usually easy for breastfed babies.) Then offer her the second side. She will often take the second breast, but sometimes she will have had enough with one.

Problems that might occur in getting the balance right:

• Not positioning your baby well at your breast will result in her often not feeding long enough to get to the hindmilk.

• Limiting feeding time could cause problems for babies. Stopping her from feeding as often as she needs, or taking her off the breast after a set period might result in her not getting enough milk or enough calories.

Don't Impose Rules


how often do newborns eat
There are no rules about the amount of time babies need to stay at the breast.

Some babies take all they need in four or five minutes; others need forty to fifty minutes. This changes over time with each baby too; they may take longer when very young than when they are older. And there are times when they increase their feeding time over a day or two to boost milk production. Like adults, who sometimes eat a small meal and sometimes a three-course dinner, your baby will sometimes feed for a short time, sometimes longer. Don't look at the clock to decide if she has had enough; look at your baby. Women breastfed long before clocks were invented.

Don't worry about trying to balance the foremilk and the hindmilk yourself. Your newborn will let you know what you need to know. The important thing is that you do not interfere with the balance by limiting the frequency or length of breastfeeds.

A tip: Sometimes you will need to interrupt a feed before your baby is finished. For example, you may need to answer the phone or get to the shops before they close. This is okay to do as long as you do not do it regularly. Every now and then is fine. It is essential to keep your life normal.

Here is a summary of what is important about milk and milk composition:

• Let your baby take a good balance of quantity and quality (foremilk and hindmilk). To do this, do not limit the number of times you feed or the length of each feed.

• Offer your newborn the second side if your baby finished taking the first breast. This is to see if she wants to take more.
Things to avoid are as follows:

• Do not give a fixed, small number of feeds in a day.

• Do not take your baby off either the first or second breast before she is finished.

• Do not let your baby feed if she is not well positioned.

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