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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