1-6 Months

Health & Development

One Month Old:

  • Motor Skills:
    • Head control:
      • Lifts head for very briefly by the end of the first month when laid on their tummy.
      • Turn head to side.
  • Vision:
    • Stares at people
    • Starts following moving objects/people
    • Can see colors (especially black and white) but doesn’t differentiate similar color tones
  • Hearing: responds to sound
  • Expressions: (not common)
    • Smile, laugh
    • Coo/ah  sounds

 

Two Months Old:

  • Motor skills:
    • Head control: Hold head briefly when laid on back
  • Vision:  Start differentiating color tones/shades
  • Hearing: responds to sound, noise, music
  • Expressions:
    • Smile, laugh
    • Coo sounds

Three Months Old:

  • Motor skills::
    • Starts lifting legs and raising hands towards feet
    • Holds objects
    • Head control: Can hold head at a 45o when laid.
  • Vision:
    • Distinguishes color shades and shapes
    • Recognizes mother’s face
  • Hearing: starts distinguish mother’s voice
  • Expressions: Frequent laughs, smiles, coos and start babbling

Four Months Old:

  • Motor skills:
    • Starts lifting legs and raising upper body and hands towards feet
    • Starts reaching out for objects and grab them with both hands (beginning of sight-hand coordination)
    • Head control: Supports head
  • Vision: Can see far objects
  • Hearing: distinguish and react to mother’s voice
  • Language: Starts uttering sounds
  • Drools

Five Months Old:

  • Motor skills:
    • Playing with their own feet
    • May pull feet and put into mouth
    • Puts objects in mouth
    • Rolls over
    • May start sit with support
    • Head control: Holds head steadily
  • Vision:  Shows curiosity towards objects
  • Vision/Hearing: Examines mother’s lips as she talk
  • Hearing: May start recognizing their own name
  • Speech: More uttering sounds (ba, ma), trying to imitate mother’s words
  • Social:
    • starts recognizing strangers
    • start showing anger/discomfort when taking objects away

Six Months Old:

  • Motor skills:
    • Rolls over
    • Pulls feet into mouth
    • Reach for objects
    • Hold their bottle
    • May start sitting without support
    • Adjust body to see an object
    • Can bear most weight on standing position
  • Head control: Holds head steadily without lagging
  • Vision: Recognizing objects from far
  • Hearing: Turns towards sound
  • Speech:
    • Continue to imitate sounds and words
    • Make one syllable sound (ma, ba, da)

nfants come in different sizes and heights, and so they grow differently. But their growth is somewhat predictable. Generally speaking, a baby may grow about 1.5 to 2.5 centimeters a month and gain about 140 to 200 grams a week in the first six months of life. When babies reach their 5th month, they are expected to double their birth weight.

Remember that your baby’s weight gain depends on how well feeding goes.

Read more:
Breastfeeding [Hyperlink]
Formula feeding [Hyperlink]
Nutrition [Hyperlink – Nutrition 1-6]

Nutrition

0-4 Months:

  • Breast milk (best choice) and/or:
  • Iron-fortified infant formula

 

4-6 Months:

Introduce the following between 4 and 6 months of age, when your baby is ready:

  • Iron-fortified infant cereals
  • Pureed meats, beans, and legumes

Once cereals and meat are accepted, add:

  • Cooked pureed Vegetables and fruits
  • Single-ingredient commercial baby foods

Introduce every food alone and monitor your baby over 3 to 5 days before introducing another new food, to make sure your baby doesn’t have an unhealthy reaction to a food.

  • 0-4 Months:
    • 12 feedings/day of breast milk or infant formula (2-4 oz.)
  • 4-6 months:
    • 4-6 feedings/day of breast milk or infant formula (6-8 oz)
    • 1-2 feedings/day of infant cereal (1-2 Tbsp)

The following foods are not recommended for infants:

  • Hard, raw fruits or vegetables such as apples, green beans
  • Hard biscuit
  • Raisins, whole grapes
  • Hot dog pieces
  • Popcorn
  • Peanuts
  • Sticky foods such as peanut butter, which can get stuck in the back of mouth
  • You may introduce fresh juice (6 months onwards) using a cup, not a bottle, and must be limited to 4 ounces per day.
  • Sugar-containing foods and drinks and foods with added salt are not recommended for infants.
  • Avoid foods that the infant cannot chew. Un-chewed food can block the airway.
  • Non-formula milk — such as cow's, goat, rice, or soy milk—are not appropriate before 1 year of age.
  • Honey should not be given for infants (under 1 year) because of the risk of botulism spores (a serious fatal illness caused by a toxin produced by the bacteria found in Honey).

Fats:

Because of the fast rate of growth, babies need a much greater amount of energy compared to body weight than adults.

Fats supply half of the energy content of breast milk and also provide prostaglandins and fat soluble vitamins A, D, E, & K.

Breast milk also provides docosahexaenoic, arachidonic acid, omega 3 and omega 6 fatty acids that are needed for brain and neural development.

 

Carbohydrates

Carbohydrates supplies 40% of the energy provided by breast milk. Mainly provided by lactose, but breast milk also includes other carbohydrates like monosaccharides and oligosaccharides – the latter helping develop probiotic intestinal flora like bifidobacteria that act as a defense against harmful bacteria.

 

Protein

Babies need protein for developing and maintaining tissue and for making enzymes.

There are two types.

  1. Casein: It makes up 40% of the protein in breast milk and makes a fine curd in the stomach that takes longer time to digest than whey.
  2. Whey: It makes up the other 60% of breast milk. It contains lactoferrin and lysozyme, both of which inhibit bacteria. It also includes immunoglobulins (antibodies) and alpha-lactalbumin that help balance essential amino acids.

Vitamins

Breast milk in a well-nourished mother provide the following vitamins:

  • Vitamin A aids in growth, healthy skin, vision and immune system.
  • Vitamin B helps metabolize energy.
  • Vitamin C help absorb iron and to form collagen for making skin, scar tissue, blood vessels, tendons and ligaments.
  • Vitamin E is important in metabolism.

Breast milk does not provide adequate amounts of the following vitamins:

  • Vitamin D: which is needed for calcium absorption. There is a risk of poor bone growth and rickets without it. It can be synthesized by exposure to sunlight but this is not appropriate for infants. Pregnant and breastfeeding women are recommended to take 10 mg supplements of vitamin D daily.
  • Vitamin K: plays an important role in blood clotting and is synthesized in the gut. Intramuscular or oral supplements can be provided by the midwife during baby’s first few weeks.

 

Minerals:

  • Calcium: needed for bone growth, blood clotting, nerve transmission and muscle contraction.
  • Phosphorus: needed for bone growth.
  • Zinc: essential for growth and the immune function
  • Iron: has many roles including helping transport oxygen. By 4-6 months, the baby’s stores of iron that was provided in the womb by mother, begins to deplete and needs to be re-supplied through diet.

For the growing baby, adequate supplies of vitamins and minerals are important. But two in particular need highlighting to parents. Without vitamin D, baby’s teeth and bones cannot develop correctly and without enough iron, health, behavior and brain development are affected.

Iron

For the first 3 years of life, babies have high requirements for iron. They are born with a store that will run out after 4-6 months so need to replenish that from their diet. Iron is present in all the cells of the body and important in hemoglobin – the carrier of oxygen to the tissues.

The most common nutritional deficiency in infants is that of iron. This can be caused by medical conditions like celiac disease but this is rare. It is much more likely that the cause is a deficiency in diet.

Vitamin D

Vitamin D is vital to help the body absorb calcium for bones and teeth. There may be enough calcium in the diet but without vitamin D it will not be absorbed properly. Vitamin D deficiency can lead to rickets, where insufficient calcium is available for growth and bones soften and bend. Bowed legs are one of the consequences.

Vitamin D can be made by the action of sunlight on the skin but mothers that have covered up in the sun or have darker skin may have low levels of vitamin D. If this is the case then their babies will also have low vitamin D stores and levels in mothers’ breast milk will probably also be low. Babies on vegetarian or vegan diets subsequent to weaning may also have low levels.

Spending time outdoors in the sun helps but will not provide a baby with the levels it needs and babies should not be exposed to too much sun.

Pregnant and breast feeding women should take 10mg of vitamin D each day.

Breastfeeding

The benefits of breastfeeding extend well beyond basic nutrition. In addition to containing all the vitamins and nutrients your baby needs, breast milk is packed with disease-fighting substances that protect your baby from illness.
Exclusive breastfeeding is recommended in the first six months (although any amount of breastfeeding is beneficial).
Scientific studies have shown that breastfeeding is good for your health, tooBenefits to Infants:

  • Boosts immunity
  • Improves cognitive & mental development
  • Protect against allergies
  • Protect against illness
  • Decreases respiratory infection
  • Reduces risk of becoming overweight or obese as a teen or adult
  • Decreases kids chances of developing stomach viruses, lower respiratory illnesses, ear infections, and meningitis
  • Decrease chance of deaths for babies aging 1 month – 12 months by 20%
  • Cuts risk of sudden infant deaths syndrome (SIDS) by half
  • Reduces risk of developing childhood cancers
  • Help avoid illnesses later in life like: type 1 and type 2 diabetes, high cholesterol, inflammatory bowel disease and high blood pressure.
     

Benefits to Mothers:

  • Reduce your stress level and your risk of postpartum depression
  • Reduce your risk of breast and ovarian cancer
  • Lower your risk of osteoporosis
  • Gives you natural birth control, breastfeeding may stop menstruation
  • Easier and saves time, no need to sterilize bottles or heat water
  • Burns calories, help lose pregnancy weight [Hyperlink – Is it True that BF Help in Losing Weight]
  • Helps uterus return to its original size
  • Reduces uterine bleeding after birth

 

Breastfeeding Benefits (In-depth):

(Source: Roneca Website)

Breast milk has long been recognized as giving babies the best start in life and research over many years has shown that it provides a number of advantages1-5. The World Health Organization recommends exclusive breastfeeding for the first 6 months of life.

With over 80 specific components, breast milk has the right balance of nutrients in a form that baby’s immature digestive system can absorb easily6 and contains enzymes like amylase to break down starches and lipase to help break down fats7,8. It also has lower levels of sodium and chloride than cow’s milk so puts less strain on immature kidneys in excreting excess electrolytes and by-products of protein metabolism9-12.

Breast milk helps prevent infection in the infant13-18. Particularly, mothers’ first milk (colostrum) is rich in substances that help destroy disease-causing microorganisms like bacteria and viruses, as it contains lymphocytes, macrophages and neutrophils from mothers’ own immune system13,16,17.

It also contains other protective elements such as the immunoglobulin Secretory IgA which protects against harmful viruses and bacteria in the intestine13,14,18 and Bifidus factor that promotes the growth of protective intestinal bacteria19, 20. Lactoferrin is an iron-binding protein that inhibits harmful intestinal bacteria by denying them iron and Lysozyme helps kill them13,14. It is also believed that Nucleotides encourage the growth of protective intestinal bacteria21, 22 and that some of the lipid (fat) molecules in breast milk help combat harmful viruses23.

It has been suggested that breastfed babies may have lower risks of developing diseases like Type 1 diabetes, lymphoma and Crohn’s disease later in life24-26. Experts have also observed a lower incidence of gastrointestinal infections in infants who are breastfed compared to those who are not and have suggested this may be due to protective factors in mother’s milk2, 13.

Not to be underestimated is the role of close physical contact in the establishing of a strong mother-baby relationship2 or the fact that breastfeeding is convenient – no preparation needed.

Breast feeding benefits mother in a number of ways – including increasing self-esteem23. It is also thought to reduce the risk of post-partum hemorrhage and help bring the uterus back to its original size23,24 as well as reducing the risk of ovarian and pre-menopausal breast cancers23.

Also known as Kangaroo care, Skin-to-Skin care has benefits for both mother and baby. It promotes bonding25 as well as stimulating milk production26 and may help extend breastfeeding duration26. It may also trigger mammary antibody production to help protect the infant but this is not yet proven27.

Initially, babies are likely to feed inconsistently and mothers should feed ‘on demand’ for as long and as often as baby wants.

During the second month, the baby may start feeding less frequently (7-9 times a day) but feedings might go back as before during rapid growth phases. By 6-9 weeks, babies will often settle into a pattern. Parents should be encouraged to keep a feeding diary, recording when and how long baby feeds. This will help to spot a pattern and establish a routine.

Starting the third month, babies tend to get hang of breastfeeding. They take less time at each feed 9on average each feed will take 10 – 20 minutes only).

Breast milk is a miracle food that changes depending on the needs of the infant and is recognized as the best way to feed babies in the first 6 months of life.

It contains the correct balance of proteins, fat, carbohydrate, vitamins and minerals for optimal growth and development in a form that is easily absorbed. Breast milk also provides elements that support the immune system and help protect against infection.

Protein

Whey and casein are the two types of protein present in breast milk. In mature milk they are found in the proportions 60/40.

Whey is more easily digested than casein with the main protein being alpha-lactalbumin. This is 27% of breast milk protein and is rich in essential amino acids like tryptophan and cysteine.
 

Fats

Due to their rapid rate of growth, infants have much greater energy needs relative to bodyweight than adults. The fat in breast milk helps provide this, accounting for half its energy content.

Palmitic acid makes up 20-25% of the fatty acids in breast milk. Other essential fats include linoleic acid, alpha-linoleic acid, docosahexanoic acid and arachidonic acid – needed for brain and neural tissues.
 

Carbohydrates
 

Most of the other half (40%) of energy in breast milk is provided by carbohydrates. These are mainly monosaccharides and oligosaccharides, the latter promoting the growth of intestinal flora and supporting gut health. The main carbohydrate in breast milk is lactose which helps the absorption of calcium to promote optimum bone growth. Lactose splits into glucose and galactose during digestion.

Pregnant women start to produce breast milk at around six months into the pregnancy and some women find that they occasionally ‘leak’ a liquid called colostrum [Hyperlink]. There is no need to worry as this is quite normal. It may be practical for them to keep some breast pads handy (What to buy? [Hyperlink]).

Colostrum [Hyperlink] is a thin and watery liquid that is replaced by breast milk a few days after birth. It is rich in protein and antibodies and helps baby pass meconium [Hyperlink – Stool], a greenish, sticky mixture that precedes proper stools.

At each feed, mother will first produce ‘foremilk’ which is watery, rich in lactose (sugar) and is designed to satisfy baby’s thirst. This will then change to ‘hindmilk’, which is rich in fat and is designed to satisfy baby’s hunger. The change between foremilk and hind milk is very gradual i.e. fat levels gradually increase during the feed. When this gradual change happens, milk flow starts to decrease.

Mothers are advised to feed their babies for as long as they want in order to make sure baby is satisfying both hunger and thirst.

Why is Foremilk Different from Hind Milk?

When milk is produced, fat globules in milk tend to stick to each other and to milk ducts. During the feed or ‘let down’, milk ducts dilate to release watery part of milk that is low in fat (foremilk). Fat globules start to dislodge and gets released in milk; this increases fat content in milk (hind milk).

Foremilk/Hind milk Imbalance:

Also called ‘oversupply’. It’s when milk production is high, making I difficult for baby to digest the lactose rich foremilk.

Only the volume of milk is correlated with weight gain of exclusively breastfed infants, and not fat content.

  • Breast milk composition may differ during the day
    • Late night: lower fat content
    • Early morning: higher fat content
  • Composition of breast milk may be affected by:
    • Breastfeeding routine: affects fat content.
      • Mothers who breast feed on demand during day and nurse during night have high breast milk fat concentration in early morning.
    • Volume of milk produced:
      • Fuller breasts tend to have lower fat content than emptier breasts.
    • Time interval between feedings: frequent feeding increases fat content
  • Protein concentration is only slightly affected during day and night and foremilk and hind milk.
  • Calcium levels are not affected during day or night, foremilk or hind milk.
  • Age of baby:
    • First few days: Colostrum [Hyperlink]. Colostrum is high in nutrients but low in volume.
    • Milk composition and volume change continuously to meet the needs of baby at every age.
  • Single breast feedings: second feeding from the same breast may have higher fat content. It is important to switch between breasts when feeding [Hyperlink – Switching Between Breasts]

Mother’s diet during breastfeeding [Hyperlink- Healthy eating during breastfeeding] may affect type of fat and not composition.

  • In the following health issues, a mother should consult the doctor before breastfeeding:
    • Related to mother:
      • Mothers infected with HIV
      • Mothers infected with tuberculosis
      • Mother has cancer and is under chemotherapy
    • Related to baby:
      • Metabolic disorder such as galactosemia (in ability to metabolize the sugar galactose)
      • Birth defect making breastfeeding impossible
  • Other (non-health related) factors that can affect exclusive breastfeeding:
    • Maternity leave is over
    • Mother died
    • Insufficient breast milk [Hyperlink – How to increase my milk supply?
    • Nipple fissure
    • Inverted nipple

A healthy diet is as important for a breastfeeding mum as it is for pregnant women. Healthy eating help keep up energy levels. In addition, nutrients obtained from diet will pass to baby through breast milk. It is important, therefore for a breastfeeding mother to consume a varied and balanced diet.

Eating meals regularly should be a priority. If mums are finding it difficult to find the time to eat properly, suggest that they keep meals simple (meals that take less preparation) and eat smaller meals more frequently.

A Breastfeeding Mother’s Diet Should Include the Following:

  • Fruits & Vegetables:
    Preferably 5 portions a day. This can be fresh, frozen, tinned, dried or juiced.
  • Starchy Foods:
    Starch provide the extra energy needed by a breastfeeding mother.
    This includes bread, pasta, rice and potatoes.
  • Fibers:
    After childbirth, some mothers suffer from painful constipation but a good intake of fiber can help prevent this.
    Wholegrain bread and cereal, pasta, rice, pulses (beans & lentils), fruit and vegetables are all good sources.
  • Protein:

Best found in lean meat, chicken, fish, eggs and pulses.

  • Fish:
    Should be eaten at least twice a week.
    Oily fish like trout, salmon, sardines, mackerel and fresh, not canned and tuna, should be limited to two portions a week.
    No more than one portion of shark, swordfish or marlin should be eaten per week due to the high levels of mercury found in them.
  • Dairy Food
    These are good sources of calcium and include milk, cheese and yoghurt.
  • Vitamins
    Breastfeeding mothers should take 10mg (micrograms) of Vitamin D supplements each day. Other vitamins should come from a varied diet, unless prescribed by the doctor.
  • Fluids/Drinks:
    Water, milk and unsweetened fruit juices are the healthiest choices. Small amounts of whatever mother drinks will be passed to baby in breast milk.
    Strong tea, coffee and coke can cause problems. Mothers have reported babies being unsettled, irritable or constipated as a consequence of such drinks.

If parents think their baby is being affected by the food that mother is eating, they should seek advice from a healthcare professional

If baby empties one breast, they should be offered the other. Some babies may not want both in one feed. When baby has had enough they will either let go of the breast or just fall asleep.

Mothers should begin the next feed with the unfinished breast during the last feed. It is a good idea to wind/burp the baby when switching breasts [Hyperlink – Burping].

If a mother switch breasts before emptying current breast, the baby will only get foremilk [Hyperlink- Breast milk composition differs during a feed]. Foremilk is the initial part of milk that is watery and low in fat. Researches showed that offering foremilk only to babies might cause gas and cramps.

The rule is ‘baby knows best’. They will feed when they are hungry and stop when that hunger is satisfied. Despite that, many breast feeding mothers will worry their child is not getting enough milk. They may need reassurance.

What are the Indications that My Baby is Feeding Well?

Weight Gain:

Most babies loose a little weight during the first couple of days. If your baby has regained their birth weight by the time they are two weeks old then you can be pretty sure that feeding is effective.

Wet Nappies/Diapers:

Plenty of wet nappies are also a good indicator although some are so absorbent that it is difficult to tell. Placing a ball of cotton wool in the nappy and checking it when changing is a good way of making sure.

Dirty Diapers/Regular Bowel Movements:

Regular bowel movements are another good way of checking. By the end of the first week, baby should be passing 2-3 substantial yellow stools per day. Persistent green stools are an indicator that baby is not getting enough milk.
This does not apply in the very early days. In the first day your baby will have only one dirty diaper, the stool will be greenish black and sticky [Hyperlink – Stool].

Keep I mind that color, consistency and frequency of stool different in breastfed and formula fed babies. [Hyperlink – Stool: color, consistency and frequency of stool in formula & breastfed babies]

Jaundice

Jaundice is another sign that baby is not getting enough milk. ‘Breast milk jaundice’ can occur when mother’s milk has not yet ‘come in’ as the limited contents of the milk may affect the baby’s liver. Some of the enzymes in breast milk are also thought to contribute to ‘breast milk jaundice’.

Other Signs

Baby settling for a while after feeding is a good sign, as are being awake and alert for some of the time and waking regularly for feeds.

If your baby is getting enough milk [Hyperlink – Is my baby getting enough milk?] there is no need to worry about milk supply.
The following tips may help increase your milk supply:

  • Frequent feeding: The suckling action of baby’s mouth stimulate the production of prolactin hormone which is responsible for milk production.
  • Efficient nursing: Emptying the breasts during feeding is an important factor in increasing milk production. If your baby did not empty the breast, then you should express milk [Hyperlink – Expressing/Pumping Milk] between feeds so as to maintain adequate milk supply. You can store the expressed milk [Hyperlink – Storing Expressed Milk] and offer it later. Your baby won’t nurse efficiently if breastfeeding position [Hyperlinks – Breastfeeding Positions] and latching were improper. Also avoid nipple shields, you will only produce sufficient amount of milk when nipples are stimulated with direct sucking action.
  • Switch between breasts [Hyperlink]: Make sure your baby is offered both breasts every nursing session. Or, offer the next breast in the following session.
  • Exclusive breastfeeding: The more you nurse, the more milk you produce. Try not to offer formula milk.
  • Respond to demand and pick up early hunger signals: Nurse as much as your baby wants and as long as needed.
  • Be available to nurse all the time: going back to work or being away from your baby will decrease stimulation and hence supply.
  • Sucking action is stronger than pumps: delay bottles in the first weeks, to let baby learn to suck and to empty breasts.
  • Avoid alcohol, heavy smoking [Hyperlink - Breastfeeding & Smoking] and some medicines [Hyperlink – taking medicines while breastfeeding]: birth control pills, decongestants and some other medicines may reduce milk supply. Consult your doctor before taking any medications.
  • Stay hydrated: Drink fluids when thirsty especially water, and eat foods that are rich in water like fruits and vegetables.
  • Eat a balanced diet: Do not go into diet while breastfeeding, nursing mothers need 500 extra calories than regular female adults. Make sure you are eating healthy and nutritious foods.
  • Rest, sleep, stay away from stress and ask for support.
     

Are there natural foods that increase milk supply?

There are foods and supplements that are believed to increase milk supply. But are not necessary proven scientifically (ask your doctor before taking any supplements):

  • Fenugreek
  • Fennel seeds
  • Black sesame seeds
  • Dill leaves seeds
  • Barley
  • Oatmeal
  • Cumin
  • Thistle supplements
  • Nuts
  • Dried fruits
  • Salmon
  • Garlic
  • Carrots
  • Green leafy vegetables e.g. spinach
  • Fruits like apricots and papayas

Why is Positioning Important?

It is important to properly master breastfeeding positions for multiple reasons:

  • Stimulation: proper positioning help stimulate milk production
  • Sufficient nursing: proper positioning aids in providing enough milk to baby.
  • Eliminate sore nipples
  • Comfort: proper positioning provides comfort for both mother and baby
     

Breastfeeding Positions Basics & Tips:

  • Find a comfortable spot, use pillows to support back and arm.
  • Baby’s face and body should face you.
  • Baby’s ear, shoulder and hip should be aligned (straight lined).
  • Keep baby’s body close to your nipple to avoid nipple pulling.
  • Bring baby to your breast, not the other way round.
  • Baby’s head should be higher than rest of body
  • Hold breast with your fingers in a ‘U’ or ‘C’ shaped manner, so as to remove breast weight from baby’s chin and avoid nose blocking.
     

Positions:

Apply all basic tips (mentioned above) in all positions.

Cradle Hold:

This is the most common hold.

  • Support baby using the arm of the same nursing side
  • Rest baby’s head on crook of your elbow
  • Support baby’s body with your inner arm and palm.
  • Hold breast using opposite hand
     

Cross-cradle Hold:

  • Support baby on a pillow on your lap to lift baby up
  • Hold breast using hand of same side of breast
  • Support baby’s head using opposite hand. Your palm should be placed at the back of neck with index and thumb right behind ears.
     

Football Hold:

This is advised for mothers who underwent C-section as it keeps baby away from away from incision site.

  • Lay baby on your side (same side of feeding breast) and under your arm.
  • Hold the baby’s head using the hand on the same side of feeding breast, with arm supporting head, neck, shoulder and back.
  • Support baby on a pillow on your lap to lift baby up
  • Hold breast with the other hand.

 

Side-laying Hold:

This position is also comfortable for mothers who had C-section.

  • You and your baby lay down facing each other.
  • Support your back and baby’s back using pillows or support baby with your forearm of the lower arm (the arm on the same side of feeding breast)
  • Nurse baby on the lower breast
  • Hold breast with opposite arm
     

Laid-back breastfeeding (biological nurturing):

  • Position yourself in a reclined manner (either on a recliner or on a bed with pillows supporting your back) supporting your head, back and shoulders.
  • Lay baby vertically on your body facing the breast, with baby’s front touching your front. 
  • Allow one of your baby’s cheeks to rest on the breast (next to nipple)
  • Baby will naturally start sucking
  • You may or may not hold breast.
     

Football Twins Hold:

This position allows you to nurse twins at the same time.

  • Put a pillow on your lap.
  • Place each baby at one side, with elbows bent
  • Support each baby with an arm (forearm)

What is Latching & Why is it Important?

Latching is baby’s mouth grip on nipple. Proper latching stimulates milk production and enables child to get sufficient milk. Milk production is dependent on demand, the more the demand, the more milk will be supplied. Sufficient and efficient breastfeeding will help initiate and maintain a demand and supply cycle.

If you have sore cracked nipples [Hyperlink - sore nipples] or your breast are engorged [Hyperlink – breast engorgement], your baby will have difficulty to latch on.

Read more:

Breastfeeding tips [Hyperlink]
Breastfeeding in the first days [Hyperlink]
Breast feeding challenges [Hyperlink]
How to increase milk supply? [Hyperlink]
Breastfeeding positions [Hyperlink]
 

Latching Steps and Tips:

  • Make sure that you are holding your baby correctly [Hyperlink – Breast Positions]
  • Support/hold your breasts in one of the following holds, the aim is to remove weight of breasts off baby’s chin and to avoid nose blockage:
    • ‘C’ hold:
      Thumb on top of areola and rest of fingers on the bottom of areola.
      Or, index on top and middle finger under areola.
    • ‘U’ hold:
      Thumb and index finger vertically and placed on the sides of nipple in a parallel manner.
  • While holding your breast, apply slight pressure.
  • Make sure your baby’s mouth is wide open is if he or she was yawning. If the baby’s mouth was not open, tickle the check or let your nipple touch the bottom lip.
  • Bring the baby closer to your breast while aiming nipple into upper palate.
  • As the baby’s mouth closes, all the nipple and part of areola (the pink to brown area around nipple) should be placed in. The chin should gently touch breast, and nose should be barely touching breast, with lips being flanged.
     

Hints that the Latch is Poor Include:

  • Nipple pain.
  • Baby is sucking and not swallowing.
  • Baby is making clapping like noise while sucking.

If you notice any of these, unlatch by inserting finger in the inner corner of baby’s lips and re-latch.

The answer is yes! Breastfeeding uses up a lot of the calories that the body stored up during pregnancy and most women are going to lose half a kilogram (1lb) a month while they are breastfeeding.

Breastfeeding help get mothers back to their pre-pregnancy weight, if they consume daily 500 extra calories from that recommended for female adults.

Gentle exercise will help. New mums should try to walk every day with baby. The fresh air should be beneficial for both of them.

Always tell your doctor or pharmacist that you are breastfeeding before taking any medicine.
Most medications may pass in different degrees into breast milk and may affect milk supply. This includes prescription, over-the-counter, complementary and alternative medications.
Some medicines may even harm your baby.
Complementary and alternative medications are not well researched, therefore they are not recommended for breastfeeding mothers.

Most breastfeeding mothers can drink caffeine in moderation

  • Caffeine does cross into breast milk.
  • Best time to drink coffee is half an hour before breastfeeding (the level of caffeine is highest one hour after drinking).
  • Infants under 6 months, may be more sensitive to caffeine.
  • Newborns have a much harder time metabolizing caffeine than older infants.
  • Preterm or ill infants might also have more problems with mom’s caffeine intake.
  • Babies whose mothers avoided caffeine completely during pregnancy seem to react more to caffeine in mom’s diet.
  • Too much caffeine (more than 750 mL per day) can cause babies to become fussy. This can result in a baby who shows signs of caffeine stimulation (wide-eyed, active, alert baby who doesn’t sleep for long).
  • Cut caffeine for 2-3 weeks by decrease caffeine intake gradually, abruptly stopping caffeine can result in headaches or other symptoms. It takes 3-7 days for caffeine to be eliminated and baby to become less fussy.
  • One study has indicated that chronic coffee drinking might decrease iron content of breast milk.
  • There is no evidence that caffeine decreases milk supply.

Some studies indicates that caffeine can stimulate milk production. Yet a baby who is fussy from caffeine stimulation may not nurse well which could lead to a decreased milk supply over time.

Breastfeeding and Smoking:

 

Should I Continue Breastfeeding if I Can’t Quit Smoking?

The answer is yes. Breastfeeding is the best nutritional source that can be given to babies. But, that does not mean you shouldn’t quit smoking! Cigarettes contain nicotine and other harmful chemicals that pass into breast milk when you smoke. If you were unable to quit, try to smoke less right after nursing session. The more cigarettes you smoke, the higher the risks to your baby is. You should also never smoke or allow others to smoke around your baby, because he/she might inhale those chemicals.

How Does Smoking Affect Breast Milk?

Smoking negatively affects quantity and quality of milk.

  • Smoking may decrease milk supply. Nicotine reduces prolactin hormone that is responsible for milk production. That may explain why smoking moms are more likely to wean their babies early.
  • Low levels of iodine and possibly some other vitamins and minerals.

 

How Does Smoking Affect My Baby?

  • Increase risk of respiratory infection (including, pneumonia, bronchitis, asthma)
  • Increased risk of eye irritation
  • Increased risk of gastrointestinal discomfort (including, colic, vomiting, nausea, diarrhea)
  • Increased risk of allergy
  • Increased risk of developmental brain issues due to decrease of iodine transportation into breast milk that is caused by smoking
  • Increase risk of sudden infant death syndrome (SIDS)
  • Increase risk of cancer
  • Due to decreased milk supply, baby may not gain weight normally.

Breast feeding is regarded as the most complete kind of nutrition for all infants. However, there are some cases where it is not advisable. Physicians need to consider each case on its merits to decide whether there are factors that warrant either interruption or preclusion of breast feeding.

Breast feeding is not advisable for women where any of the following conditions apply:

  • Treatment involving drugs that are secreted in breast milk – narcotics, barbiturates, steroids, anticoagulants or anticonvulsants
  • Taking antiretroviral medication
  • Dependency on illegal drugs
  • Taking cancer chemotherapy agents
  • Undergoing radiation therapy (temporarily)
  • Suffering from untreated, active tuberculosis
  • Infection with human T-cell lymphotropic virus type I or II
  • HIV positive patients

Formula feeding

Brief Description:

Formula milk is generally made of treated cow’s milk. Cow milk is processed to suit babies from birth up to 12 months of age.

Ronesca recognizes World Health Organisation recommendations and encourages mothers to breastfeed for the first 6 months (26 weeks) of life. There are many occasions, however, when breastfeeding is not possible and for babies under the age of 1 year, infant formula is the only alternative.

Based on cow’s milk, many infant formulas have been developed to mimic the content of breast milk. Some infant formulas like Ronalac have gone further in order to mimic the biological effects and benefits of breast milk. Their enriched formulas will typically have revised proportions of prebiotcs, probiotics and long-chain polyunsaturated fatty acids.

Composition

Most formulas contain:

  • Protein: casein and whey
  • Fat: blend of vegetable oils
  • Carbohydrate: lactose
  • Vitamins
  • Minerals
  • Other
     

Different Formulas for Different Age Groups

There are different types of milk for different age groups to suit the increased needs of growing babies. They are generally divided into 3 categories:

Stage 1 Infant Formula:

Suits babies from birth up to 6 months. If you decide not to breastfeed, it is recommended that you use this formula exclusively without introducing solid food.

Every mother should know that breastfeeding is the best nutrition that could possibly be offered to their babies. Read more about breastfeeding benefits [Hyperlink]

 

Ronalac 1 [Hyperlink] is Ronesca’s stage 1 milk.
 

Stage 2 (Follow-on Formula):

Stage 2 milk is designed for babies from 6 months to 12 months of age.

Ronalac 2 [Hyperlink] is Ronesca’s stage 2 milk.

Stage3

Stage 3 milk is designed for babies starting from 1 year.

Ronagrow [Hyperlink] is Ronesca’s stage 3 milk.

Special Formulas

There are also other special formulas for special cases:

  • Diarrhea [Hyperlink]: Ronalac AD [Hyperlink]
  • Constipation [Hyperlink]: Ronalac AC [Hyperlink]
  • Regurgitation [Hyperlink]: Ronalac AR [Hyperlink]
  • Milk protein allergy (soy being the protein source): Ronalac HA [Hyperlink]
  • Lactose free (for lactose intolerant babies): Ronalac LF [Hyperlink]
  • Colic [Hyperlink] (hydrolyzed protein): Ronalac Gentle [Hyperlink]
  • Low birth weight (premature – Hyperlink - Preterm): Ronalac Premature [Hyperlink]

The World Health Organization (WHO) recommends exclusive breastfeeding during the first 6 months and continued breastfeeding for as long as possible; this is because babies grow at different paces and hence, health professionals should advise the mother on the appropriate time when her baby should start receiving complementary foods. Therefore, Ronesca believes that breast feeding is the best and optimum method for healthy growth and development of your baby, which is why we encourage mother's to exclusively feed for the first six months of the babies life.

Formula milk is recommended if milk supply decreases, stops or you suffer from health condition that forbids you from breastfeeding.

Read more:
Breast feeding benefits [Hyperlink]
Combination Feeding [Hyperlink]
How to increase milk supply [Hyperlink]
Breastfeeding Restrictions [Hyperlink]

Mothers, particularly new ones, sometimes need help to understand how much and how often to feed their baby.

Not all formulas are the same – it is important to carefully read the instructions on the packaging. Neither are all babies the same. Some have bigger appetites than others and that can vary from day to day and also as they grow. The best guide is baby and how hungry they are.

Tips:

  • As a general rule, babies know best. They should never be forced to finish a feed. If they are hungry, they will feed and if they are not they won’t.
  • Babies self-regulate their intakes from day to day.
  • When baby has had enough, they will usually let go of the teat and will often fall asleep.
  • Babies who are still awake and interested in the bottle even after it is empty are likely still to be hungry.
  • Parents who are unsure or confused about the amount of milk to give to their baby should be encouraged to talk to a healthcare professional.
  • Every brand of infant formula provides its own guidelines for how much formula to give, depending on age. The recommended amounts of Ronalac 1 [Hyperlink] are shown below but these are for guidance only and do not apply to premature or low birth weight babies.

 

Age of Infant

Previously Boiled Water (mL)    

Levelled Scoops

No. of Feeds per Day

1st & 2nd Week

90

3

6

3rd & 4th Week

120

4

6

2nd Month

150

5

5

3rd & 4th Month

180

6

5

 

  • Newborn babies may take small volumes to start with. By the end of the first week most babies will demand for approximately 150–200ml per kg per day until they are six months old (this will vary from baby to baby).
  • You should feed your baby as often as he asks, provided he is not regurgitating. If your baby is regurgitating significant amounts give smaller but more frequent feeds than suggested amount mentioned on the formula milk guideline.
  • Initially, feed your baby on demand. As your baby grows, he/she will develop their own timetable.

Formula fed babies feed less often than breastfed babies. This is because breast milk is easier to digest than formula milk.

Bottles of infant formula are best prepared only when they are needed as this helps to reduce the risk of infection. But there are occasions such as feeding whilst traveling, when parents will need to make up feeds in advance. They should be advised on the best way to store made up formula.

 

Risk of Bacterial Infection

Stored made up formula is prone to infection from bacteria. Bacteria like Cronobacter sakazakii and Salmonella will multiply even at low temperatures and the longer the made up feed is left in the refrigerator, the more the bacteria will multiply.

 

Storing

Made up formula should not be stored for longer than 24 hours. The formula should be made up as instructed on the product packaging and then stored in the main compartment of the refrigerator. Bacteria can grow rapidly in formula milk kept at room temperature and can grow slowly in the fridge. Store milk at a temperature below 5°C and should not be kept in the door of the refrigerator as this may not be cool enough.

 

Warming Stored Formula

Never use a microwave to warm stored formula. This should be done using a bottle warmer or in a container of warm water. The bottle should then be shaken to ensure the contents have an even temperature throughout. Temperature should then be tested by shaking a few drops of feed onto the inside of the wrist. Made up feed should be used immediately and any remaining discarded after one hour.

 

Making Up Formula on the Move

Parents who are out and about with their babies may need to make up formula whilst away from home. The following items will be needed:

  • A clean vacuum flask containing freshly boiled water. The flask should not have been used for any other purpose.
  • A sterile container with the correct amount of infant formula powder
  • Sterilized bottles

The water in the vacuum flask can be used to make a fresh feed when needed. Before offering the bottle to baby, it should be cooled by running it under cold water and the temperature tested by shaking a few drops onto the inside of the wrist.

Combination Feeding

It should be done gradually, replacing one feed of breast milk at a time, rather than substituting several in a single day. Mothers should are advised to be consistent from day to day about which feeds are breast fed and which bottle fed.

Mothers may find it easiest to introduce their baby to bottle feeding by initially using expressed breast milk. When introducing infant formula, first infant milk should be used if baby is less than 6 months old.

Combination feeding will reduce the supply of breast milk. The more you breastfeed, the more milk you make. Expressing or pumping milk may help in maintain good milk supply. It is advisable for working mothers to exclusively breastfeed following working hours and during weekends to maintain good milk supply.

Read more:
How to increase my milk supply? [Hyperlink]

Breast/Formula Milk Feeding Problems & Common Mistakes

What is Regurgitation/Reflux?

Regurgitation is the backward movement of stomach contents up the esophagus into the mouth. The contents may be released/spit outside the mouth and sometimes the nose.

Gastro-esophageal reflux is also known as possetting, regurgitation and ‘spitting up’. It is, not surprisingly, very common – babies are taking large amounts of milk into small stomachs to fuel rapid growth and the contents of the stomach are sometimes moved back into the gullet (esophagus) or mouth.

What are the Causes & When Will My Baby Stop Spitting Up?

It can be caused by how the baby is fed and the size of feed. Incorrectly made infant formula or feeding too quickly can both contribute. Reflux should not usually be a cause for concern and usually disappears by the time the baby is 12-15 months of age.

In some cases, excessive parental anxiety is thought to make esophageal reflux worse.

Symptoms:

Symptoms include frequent vomiting and excessive crying as well as insufficient growth, poor sleep and refusing to feed. Ear, chest and sinus infections and constant coughing may also be signs.

When Should I Seek Medical Help?

  • If regurgitation persists beyond 18 months – 2 years it may need treatment. Stomach contents contain acid and whilst this tends not to be a problem in the stomach it can damage the delicate lining of the esophagus. There is also a danger that the feed may go into the lungs and cause infections.
  • Problems gaining weight
  • Excessive crying
  • Feeding problems, seems irritable during and after feeds.
  • Breathing problems
  • Throwing up blood (looks like coffee grounds) or bile (green/yellow).
  • Throwing up 2 hours after feeds
  • Throwing up large amounts of feed
     

Tips:

  • Wind/burp [Hyperlink-Burping] your baby thoroughly during and after the feed.
  • Give smaller but more frequent feeds. It is important to keep the overall amount of food given per day unchanged.
  • Feed your baby in an upright position
  • Hold your infant upright for 20 minutes after feeding, this may help with baby’s digestion.
  • Make sure that the whole in the teat is not too big.
  • Follow manufacturer’s instructions when making a formula feed.
  • Raise your baby’s head when laying him/her down.
  • Use feed thickeners after consulting your doctor. For mothers who are breastfeeding, this can be mixed with expressed breast milk and given by spoon either before or during a feed. It can also be mixed with cooled boiled water.
  • Seek professional help, the doctor may prescribe some medications such as antacids. Antacids neutralizes the stomach’s acidity. Antacids may be also added to expressed breast milk.
  • For babies being bottle fed, the doctor will recommend an appropriate formula like Ronalac AR [Hyperlink].
     
  • Other tips:
    • Always be prepared, pack extra clothes for you and your baby.
    • Use wipe down bed sheets

Overfeeding is giving your baby milk more than he/she needs. It also means that the baby’s petite stomach is uncomfortably overloaded with milk, and extra nutrients are being inadequately digested.

Giving extra milk in one feed will not necessarily enable your baby to go longer between feeds, but will make your baby gain weight. Increasing the chance of becoming overweight and sometimes obese.

Symptoms:

Overfeeding show similar symptoms as milk allergy [Hyperlink], lactose intolerance, regurgitation [Hyperlink] and colic [Hyperlink]. Some of the symptoms include: flatulence, reflux, irritability and sleep [Hyperlink] disturbances.

Tips:

  • Allow your baby to decide if he wants to stop or take more milk by removing the teat.
  • Don’t force your baby to finish the bottle if he/she doesn’t seem to want more.
  • Avoid fast flow teats.

Intolerance & Allergy

Lactose intolerance is intolerance to lactose (a sugar) found in milk. The body does not produce adequate amounts of the enzyme lactase that breaks lactose down. The undigested lactose causes gastrointestinal discomfort.

Lactose intolerance is more common in premature babies than full-term babies. And is common in school aged children.

The amount of lactose in breast milk is independent of the mother's consumption of lactose. Meaning, if a nursing mother cuts down dairy products, her milk will contain the same amount of lactose. This does not mean that the mother should breastfeed.

Symptoms:

Symptoms are similar to milk protein allergy.

  • Diarrhea
  • Abdominal cramps
  • Bloating
  • Gas 
  • Irritability

Special Infant Formulas:

Special formulas are specially formulated for lactose intolerant infants, like Ronalac LF [Hyperlink].

Read more:
Lactose Intolerance [Hyperlink – lactose intolerance 6-12 months]
Lactose Intolerance [Hyperlink – lactose intolerance 1-3 years]
Lactose Intolerance [Hyperlink – lactose intolerance 4-10 years]

Milk protein allergy is allergy to one of the proteins found in dairy products. It is almost impossible for babies to get allergic to breast milk. Yet, babies can be sensitive to dairy in mom’s diet, where dairy proteins pass through breast milk to the allergic baby.

Milk allergy affects 1 in 50 infants.  It begins to develop in the first few months of life. Formula fed babies are at higher risk of developing a milk protein allergy than breastfed babies because most formulas are cow, goat or soy milk based. Many dairy-sensitive babies outgrow their sensitivity by 6-18 months, and most outgrow it by 3 years.

Milk protein allergy is different from lactose intolerance. Therefore, switching to lactose-free dairy products won’t help.

Allergy develops after repeated exposure to dairy products. Once allergy develops symptoms appear within few hours

Symptoms:

You will notice that some symptoms are similar to that of colic [Hyperlink]
 

  • Skin reactions:
    • Eczema
    • Hives
    • Dry skin
    •  Itchy rash
    • Swelling
  • Respiratory:
    •  Wheezing
    • Sneezing
    • Cough
    • Stuffy nose
    • Runny nose.
  • Gastrointestinal:
    • Vomiting,
    • Bloating
    • Abdominal pain
    • Diarrhea
    • Bloody diarrhea
    • Constipation
  • Other:
    • Irritability
    • Sleep disturbances
    • Weight loss
    • Low weight gain
       

How to Overcome Allergy?

Nursing moms should eliminate dairy products after consulting their doctors. Some babies are highly sensitive (nursing moms should cut out all dairy products) and others may be less allergic (nursing moms should eliminate some dairy sources from their diet).

It takes few days to a couple of weeks to completely eliminate cow’s milk protein from nursing mom’s system.

A nursing mom may try to reintroduce dairy into her diet to test again for reaction. If allergy persists, the mother is advised to cut out dairy products again for at least another month. For severely allergic babies, it’s best to wait at least 6 months before reintroducing dairy. Avoiding the allergen makes it less likely for the allergic baby to develop a lifelong or life threatening allergy.

Special Infant Formulas for Allergy:

Hypoallergenic formulas like Hypolait [Hyperlink] are specially designed to suit infants with sever milk protein allergy. The protein in Hypolait formula is ultrafiltrated and extensively hydrolyzed. Ronesca also offers Ronalac HA [Hyperlink], for babies with mild milk protein allergy. The protein in Ronalac HA is partially hydrolyzed.

Always consult your physician before switching to any formula.

Weight Gain During Pregnancy

Gaining weight during pregnancy is quite natural. However, there should be no large weight gain during the first trimester. Around 45% of weight gain happens between weeks 26-32 with another 20% occurring in weeks 32-40.

The weight gain associated with the best pregnancy outcomes depends on the mother’s weight at the beginning of the pregnancy. The Body Mass Index (BMI) is a useful tool in measuring this and a BMI of 24 is associated with the optimum pregnancy outcome.

BMI is calculated by dividing weight in kilograms by height in metres squared.

Pre-pregnancy BMIOptimum pregnancy weight gain
<19.812.5 – 18.0kg (27 – 40lb)
19.8 – 26.011.5 – 16.0kg (25 – 35lb)
26 – 297.0 – 11.5kg (15 – 25lb)
>296.0kg (13lb)

Burping

When babies drink from a bottle, breastfeed or cry, they tend to swallow air. Some babies suffer from trapped air at every feed and others don’t seem to have a problem – there’s no normal circumstance.

Burping (also referred to as winding) is helping your baby to get rid of air swallowed during feeding from the stomach, up the esophagus and out of the mouth.

Read more:
What Causes Tummy Gas?
Why Should I Burp My Baby?
When Should I Burp My Baby?
How to Burp My baby?

There is no exact age to stop burping a baby. It differs from child to child, some parents stop burping their babies at 6 months or even earlier, and others at 9 months.

It all depends on:

  • The baby’s ability to sit on their own and move (crawl, flip…). When your child reaches those milestones, air that have been swallowed will rise up on its own and gets expelled.
  • Baby’s digestive system getting more mature.

Colicky babies and babies with reflux tend to be burped for long.

Colic

  • Intense crying
  • Continuous crying episodes that lasts minutes or hours
  • Usually impossible to comfort baby
  • Crying episodes common in the evening.
  • Occurs at the same time of the day.
  • Passage of stool or gas after crying.
  • Flushing (red face)
  • Tight fists
  • Legs bent up toward chest

Stiff abdomen

The cause of colic is unknown.

Some suspect that colic is caused by:

  • Allergies e.g. cow’s milk allergy
  • Lactose intolerance
  • Inadequate beneficial bacteria in intestine
  • An un-fully developed digestive system (that may explain why preterm babies are at higher risk).
  • Increased peristaltic movement (increased gut movement)
  • Gastro-esophageal reflux
  • Trapped air

 

Babies of mothers who smoked during pregnancy have higher chances of developing colic.

It is believed that colic affect both genders equally and has nothing to do with birth order or whether the baby is breastfed or formula fed.

Always consult your doctor before giving your infant any medications.

There is no known medicine that cures colic, but there are medications that may ease colic with little evidence and benefit. Effectiveness may also vary from one infant to another.

The good news is that colic fades away on its own at 3 months.

Safe Medicines that May Ease Colic:

  • Probiotics: Help in maintaining good bacteria in the digestive tract.
  • Anti-gas medicines: e.g. Simethicon drops (contraindicated for babies who take thyroid medicine).
     

Are Herbs Safe & Useful in Easing Colic?

Some might find herbs useful in decreasing crying episodes, BUT:

  • There are no enough studies about herbs, and none have been proved to be helpful.
  • They may contain harmful or even toxic substances such as alcohol and opium
  • May be contaminated.
  • May cause allergy
  • May interfere with normal feeding
  • Those found in pharmacies may have ingredients that may not be labelled

 

Lifestyle, Home Remedies & Tips to Ease Colic:

  • Diet: After consulting the doctor, breastfeeding mothers are advised to:
    • Undergo a hypoallergenic diet and that exclude cow’s milk products. Example of foods that you must ban (after consulting your doctor) are: dairy foods, eggs, nuts, fish and soy.
    • Stay away from the following foods: Garlic, spicy foods and ‘windy’ foods like onions, broccoli, cabbage, cauliflower and beans.
  • Use a bottles that are designed to reduce the amount of air swallowed by baby
  • Formula fed babies:
    • If your baby is allergic to cow's milk or has milk intolerance (or if you have doubts), change to a hypoallergenic milk like Ronalac HA [Hyperlink]. The whole milk proteins in Ronalac HA is broken down, making them easier to digest. You should see an improvement within 3 days, if not you can go back to regular formula, Ronalac 1 [Hyperlink].
    • For babies that may have difficulty digesting lactose, change to low lactose formula like Ronalac Gentle [Hyperlink]
  • Give your baby breaks during a feed to burp.
  • Give your baby smaller but more frequent feeds
  • Hold the baby’s head higher than body when feeding. (Bottle feeding positions) [Hyperlink]
  • Use a pacifier [hyperlink]
  • Gently rock baby
  • Gently press or make circular motion on infants abdomen
  • Place baby’s abdomen on your knees, and make gentle circular motion on the back
  • Take a walk or go for a drive. You can also keep baby in motion using a stroller.
  • Sing for your baby.
  • Make a continuous “shhh” sound or turn on the washing machine or vacuum. These sounds resemble mother’s heart sound in the womb, and may sooth the baby.
  • Give your baby a warm bath.
  • Swaddle [Hyperlink-swaddling] your baby
  • Take turns with your partner, grandparent, family member, friend and/or nanny. Having a colicky baby may be exhausting and frustrating.

Stool

The stools of breast fed and bottle fed babies are different with breast fed babies passing them slightly more often than bottle fed babies. In general, however, babies will pass them once a day either during or just after feeding.

Those of breast fed babies are bright mustard yellow in color and smell slightly sweet. They tend to be softer than those of bottle fed babies and their texture has been described as ‘loose’, ‘granular’ or ‘curdled’. Consistency and color can change as babies grow or if they are unwell.

The stools of bottle fed babies tend to be bulkier, more solid and smellier than those of breast fed babies. They are pale yellow or yellow/brown.

Parents should be advised to expect a change in their baby’s stools if they change from breast feeding to bottle feeding. The change should be done gradually [Hyperlink – How to introduce formula].

At the beginning of weaning, both breastfed and formula fed babies’ stools will become darker and smellier. They will probably also experience constipation initially

What is Diarrhea & What are the Causes?

Diarrhea is common, usually clears up quickly and normally is not serious. It is usually defined as passing watery stools more than 3 times in one day. Variation in a baby’s stools will occur due to diet and breastfed babies will tend to have softer stools and pass them slightly more often than bottle fed babies.

Diarrhea in breast fed babies can sometimes be caused by something in the mother’s diet. Spicy food, dairy products, alcohol and even laxatives can all make their way into breast milk and upset baby’s stomach.

Diarrhea is either short term (acute) or longer term (chronic) and both can have different causes. It can also occur during weaning when baby is getting used to different foods.

The side effects of antibiotics and other medicines can cause acute diarrhea. Other causes include: food poisoning, food allergy and infections whether bacterial, viral or parasitic. Babies’ gastro-intestinal systems are very sensitive and poor hygiene (both with parents and infants who are potty trained) can cause problems.

Diarrhea is classified as chronic if it lasts for more than two weeks. This can be due to bacterial infection but can also be the result of lactose or gluten intolerance.

Some diseases cause diarrhea including: IBS (irritable bowel disease), crohn’s disease and celiac disease.

To summarize the causes of diarrhea:

  • Food poisoning
  • Food allergy
  • Bacterial infection
  • Viral infection
  • Parasitic infection
  • Side effect of some medicines
  • Gastrointestinal disorders (IBS, Crohn’s and celiac diseases)
  • Improperly made formula feeds
  • Rarely: enzyme deficiencies

Effects of Diarrhea on Babies

Diarrhea can cause electrolyte imbalance. In other words, in alters the normal balance of water and salts in the body. Loss of electrolytes causes dehydration, and dehydration symptoms (mentioned below) appear quickly in babies. Dehydration is a serious issue especially in newborns.

Severe dehydration if no treated may cause seizures, brain damage or even death.

Monitoring Diarrhea:

  • Diarrhea should last no longer than 2 days in babies who are 3-12 months. If it does or if there are other symptoms present then parents are advised to consult their doctor.
  • Parents with young babies with diarrhea should monitor them carefully as dehydration is a real risk. (Dehydration symptoms below).
  • Call the doctor if diarrhea was accompanied with fever, abdominal pain, bloody stool, discoloration of stool and or vomiting
     

Signs of Dehydration:

  • Dry mouth and tongue
  • Glazed eyes
  • Drowsiness/unresponsiveness
  • Passing little urine
  • Irritability
  • Tiredness/ lack of energy
  • Absence of tears when crying
  • Loss of skin elasticity

If any of these signs are present, parents should contact their doctor immediately.

Tips to Relieve Diarrhea

  • Avoid:
    • Greasy foods
    • Dairy foods and drinks (milk, cheese, one exception is yoghurt as it contains useful bacteria)
    • Sweets
    • Soda
    • Fiber-rich foods
    • Certain fruits like peaches, pears and oranges
    • Juice containing sugars (sugars drive water with stool)
  • Offer:
    • Small meals
    • Starchy food like:
      • Rice. For babies some mothers use rice water when making a milk feed.
      • Boiled potato
      • Pasta
    • Bread
    • Certain fruits like Banana
    • Whole grains
  • Always offer fluids to avoid dehydration.
     

Tips to Prevent Diarrhea

  • Wash hands after diapering your baby
  • Wash your hands after using the toilet
  • Wash your hands when cooking or preparing milk
  • Follow healthy cooking practice
  • Wash toys
  • Wash baby’s hand frequently
  • For babies less than one year old: sterilize teats, pacifiers, feeding equipment

 

Other Tips:

  • Whether breast feeding or bottle feeding, mothers should be encouraged to continue to feed normally.
  • Weaned infants should eat as normally as possible and be offered frequent sips of water or diluted fruit juice. If baby refuses to eat, parents should offer drinks till normal appetite returns.
     

Treating Diarrhea:

Doctors may prescribe the following one or more of the following:

  • Antidiarrheal: not commonly prescribed to babies
  • Antibiotic: antibacterial or antiparasitic
  • Oral rehydration solution (ORS): It’s a fluid given orally to replace lost electrolytes and to prevent dehydration.
  • IV fluids: given in hospitals to severely dehydrated babies/children.

 

Always consult the pediatrician before giving your baby any medications.

Definition, Symptoms and Causes of Constipation:

Some infants will pass stools each day and others less frequently. Constipation is usually defined as infrequent, irregular bowel movements that are hard and difficult to pass – sometimes accompanied by straining and pain. Infants with constipation may also display loss of appetite, lack of energy, be irritable or have foul smelling flatulence (wind/gas) & stools and abdominal pain and discomfort.

Constipation in babies is common although less so with breast fed babies as breast milk is more easily digested and stools tend to be softer. Breast fed babies also have higher levels of a hormone called motiline. This increases the movement of the bowels.

Constipation can be caused by not enough feeds or fluids. It is also a side effect of some medicines – sedating antihistamines, opioids and antiepileptics.

With toddlers, it can also be due to potty training [Hyperlink – Potty training & constipation], not being very active, diet (not enough fruit and vegetables) or emotional causes like starting nursery or a new baby in the family.

Causes of Constipation

  • Milk protein allergy. In breastfeed, dairy in mother’s diet passing in milk.
  • New introduction of solid foods
  • Low fiber foods
  • Not taking enough fluids
  • Newly potty trained toddler [Hyperlink – Potty training & constipation]
  • Occasionally: food poisoning, food allergy or metabolic disorders
  • Very Rarely: congenital disorders and diseases, like:
    • Hirschsprung's disease: malfunctioning of large intestine.
    • Anorectal malformation: incomplete formation of anus and rectum
    • Spina bifida: spinal cord is not fully closed
    • Cystic fibrosis: malfunction of lungs that affect digestion
       

Signs of Constipation

  • Crying, discomfort, irritability or pain before passing stool
  • Dry hard stool
  • Trouble passing stool
  • Few bowel movements: less than 3 excretions a week
  • Foul-smelling wind (gas)
  • Foul-smelling stool
  • Hard abdomen (belly)
  • Loss of appetite
  • Lack of energy

Call the doctor if your child has bloody stool, loses weight or having one or less bowel movements every 5 days.

Tips to Relive Constipation

  • Avoid:
    • Starchy foods like: rice and pasta
    • Whole grain bread
    • Banana
    • Cooked carrots
    • Dairy foods and excessive milk
    • Processed foods
  • Offer:
    • Fiber rich foods including:
      • Fruits, like: pears, apples, peaches, apricots, blueberries, raspberries, strawberries, grapes
      • Veggies, like: broccoli, spinach and beans
    • Fruit juice
    • Water, avoid giving excessive amounts of water for more than 3 weeks.
  • Do:
    • Change formula milk into Ronalac AC [Hyperlink] for 2 weeks before going back to the regular formula Ronalac 1 [Hyperlink]
    • Change diet in breastfeeding mothers
    • Give the suggested amount of formula
    • Give plain water for children under 3 months
    • Limit foods with low fiber content like meat and icecream
    • Massage baby’s belly
    • Give a warm bath
    • Apply aloe vera lotion, olive oil or any prescribed medicated ointments at the anus if you notice any fissures (cuts at the opening of anus). Make sure area is clean.
  • Don’t:
    • Dilute milk, you should rather offer water between milk feeds
    • Use glycerin suppositories if you notice any cuts at the opening of anus
  • Insert the tip of greasy thermometer in rectum with caution and after consulting the doctor
     

Tips to Avoid Constipation

  • Make sure your child is well hydrated, limit sugary drinks
  • Include fiber rich foods in diet
  • Include foods containing probiotics like certain brands of yoghurt
  • If your child is being potty trained, you should back off a little
  • For children who are already potty trained, let your children sit on the toilet more often and for a longer. Give your child a book to read if the get bored.
     

Treating Constipation

Consult your doctor before giving your child any medications:

  • Laxatives, such as lactulose which drives water with stools
  • Glycerin suppositories
  • Probiotics

For anal fissures (tears at the opening of rectum): apply aloe vera lotion, olive oil, petroleum jelly, nitroglycerin rectal ointment or zinc oxide ointment. Do not give you baby any suppository if he/she has an anal fissure.

0-4 Mois

  • Le lait maternel (meilleur choix) et / ou:
  • Les préparations pour nourrissons enrichies en fer

4-6 Mois

Introduire les aliments suivants entre 4 et 6 mois, lorsque votre bébé est prêt:
 

  • Les céréales pour les  bébés enrichies en fer
  • Les viandes en purée, haricots et les légumineuses

Une fois que les céréales et la viande sont acceptées, ajouter:

  • Les légumes cuits et les fruits en purée
  • Des aliments commerciaux pour bébés avec un seul ingrédient
    Introduire chaque aliment seul et surveiller votre bébé pendant 3 à 5 jours avant d'introduire un autre nouveau aliment, pour vous assurer que votre bébé n'a pas une réaction allergique à un aliment.