Feeding

Breastfeeding or Formula feeding ?

The American Academy of Pediatrics (AAP) recommends that babies be breastfed exclusively for about the first 6 months. Following the introduction of solid foods, breastfeeding should continue through the first year of life and even beyond, if desired.

But breastfeeding isn’t possible or preferable for all new moms. Deciding to breastfeed or bottle feed a baby is usually based on the mother’s comfort level with breastfeeding and her lifestyle. In some cases, breastfeeding may not be recommended for a mom and her baby. If you have any questions about whether to breastfeed or formula feed, talk to your pediatrician.

Remember, your baby’s nutritional and emotional needs will be met whether you choose to breastfeed or formula feed.

About Breastfeeding

Breastfeeding your newborn has many advantages. Perhaps most important, breast milk is the perfect food for a baby’s digestive system. It has the nutrients that a newborn needs, and all of its components — lactose, protein (whey and casein), and fat — are easily digested. Commercial formulas try to imitate breast milk, and come close, but cannot match its exact composition.

Also, breast milk has antibodies that help protect babies from many infectious illnesses, including diarrhea and respiratory infections. Studies suggest that breastfed babies are less likely to develop medical problems such as diabetes, high cholesterol, asthma, and allergies. Breastfeeding also may decrease the chances that a child will become overweight or obese.

Breastfeeding is great for moms too. It burns calories, so nursing moms get back in shape quicker. Breastfeeding also may protect mom from breast cancer and ovarian cancer.

Some moms find breastfeeding easier and quicker than formula feeding — it needs no preparation and you don’t run out of breast milk in the middle of the night. Also, breastfeeding costs little. Nursing mothers do need to eat more and may want to buy nursing bras and pads, a breast pump, or other equipment. But these expenses are generally less than the cost of formula.

Breastfeeding meets a variety of emotional needs for both moms and babies — the skin-to-skin contact can enhance the emotional connection, and providing complete nourishment can help a new mother feel confident in her ability to care for her newborn.

Limitations of Breastfeeding

With all the good things known about breastfeeding, why doesn’t every mother choose to breastfeed?

Breastfeeding requires a big commitment from a mother. Some new moms feel tied down by the demands of a nursing newborn. Because breast milk is easily digested, breastfed babies tend to eat more often than babies who are fed formula. This means mom may find herself in demand as often as every 2 or 3 hours in the first few weeks. This can be tiring, but it’s not long before babies feed less frequently and sleep longer at night.

Some new mothers need to get back to work outside the home or separate from their babies from time to time for other reasons. Some of these moms opt for formula feeding so other caregivers can give the baby a bottle. Mothers who want to continue breastfeeding can use a breast pump to collect breast milk to be given in a bottle so their babies still get its benefits even when mom isn’t available to breastfeed.

Other family members (dads most of all) may want to share in feeding the baby. When mom is breastfeeding, dad or siblings may want to stay close by. Helping mom get comfortable, or providing a burp cloth when needed, will let them be part of the experience.

When breastfeeding is established, other family members can help out by giving the baby pumped breast milk in a bottle when mom needs a break.

Sometimes a woman may feel embarrassed or worried about breastfeeding. These feelings usually disappear once a successful breastfeeding process is set. It’s often helpful to seek advice from those who’ve gone through the experience. Most hospitals and birthing centers can provide in-depth instruction on breastfeeding techniques to new mothers.

Your pediatrician, nurse practitioner, or nurse can answer questions or put you in touch with a lactation consultant or a breastfeeding support group.

In some cases, a mother’s health may affect her ability to breastfeed. For example, mothers undergoing chemotherapy for cancer and moms who are infected with human immunodeficiency virus (HIV, the virus that causes AIDS) should not breastfeed.

If you have a medical condition or take any medicines regularly, or if you or your baby gets sick, talk with your doctor about whether it’s OK to breastfeed. If you have to stop nursing temporarily, continue to pump breast milk to maintain milk production.

In some situations, it may not possible to breastfeed, such as when a baby is sick or born prematurely. Mothers should talk with their baby’s doctor about expressing and storing milk. Even if the infant cannot breastfeed, breast milk may be given via a feeding tube or bottle.

Sometimes mothers who have inverted nipples may have trouble breastfeeding, but with the help of a lactation consultant this usually can be overcome. Likewise, women who have had plastic surgery on their breasts should be able to successfully breastfeed. Talk with your doctor if you have any concerns.

Avoid using pacifiers or bottles until breastfeeding is established, usually after the first month of life. Introducing them before breastfeeding might cause “nipple confusion,” and can lead to an infant giving up the breast.

About Formula Feeding

Commercially prepared infant formula is a nutritious alternative to breast milk. Bottle feeding can offer more freedom and flexibility for moms, and it makes it easier to know how much the baby is getting.

Because babies digest formula more slowly than breast milk, a baby who is getting formula may need fewer feedings than one who breastfeeds. Formula feeding also can make it easier to feed the baby in public, and lets the father and other family members help feed the baby, which can enhance bonding.

Limitations of Formula Feeding

Just as breastfeeding has its unique demands, so does bottle feeding. Bottle feeding requires organization and preparation, especially if you want to take your baby out. Also, formula can be pretty expensive.

It’s important to make sure that you have enough formula on hand, and bottles that are clean and ready to be used.

Here are a few guidelines for formula feeding:

• Carefully follow directions on the label when preparing formula.
• Bottles left out of the refrigerator longer than 1 hour and any formula left in the bottle that a baby doesn’t finish should be discarded.
• Prepared bottles of formula should be stored in the refrigerator up to 24 hours and can be carefully warmed just before feeding. You don’t have to warm formula, but most babies prefer it.
• A bottle of formula can be warmed by holding it in running warm water or setting it in a pan of warm water. A bottle of formula (or breast milk) should never be warmed in a microwave. The bottle can heat unevenly and leave “hot spots” that can burn a baby’s mouth.

How Often Do Newborns Eat?

Your newborn will nurse about 8 to 12 times per day during the first weeks of life. In the beginning, mothers may want to try nursing 10–15 minutes on each breast, then adjust the time as necessary.

Breastfeeding should be on demand (when your baby is hungry), which is generally every 1–3 hours. As newborns get older, they’ll nurse less often and have longer stretches between feedings. Newborn babies who are getting formula will likely take about 2–3 ounces every 2–4 hours. Newborns should not go more than about 4–5 hours without feeding.

Signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• sticking out their tongues
• placing their hands and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers’ breasts
• crying

A feeding schedule is not necessary; you and your baby will eventually establish your routine. Babies know (and will let their parents know) when they’re hungry and when they’ve had enough. Watch for signs that your baby is full (slowing down, spitting out the bottle or unlatching from breast, closing the mouth, turning away from the breast or bottle) and stop the feeding when these signs appear.

As babies grow, they begin to eat more at each feeding and can go longer between feedings. There may be other times when your infant seems hungrier than usual. Continue to nurse or feed on demand. Nursing mothers need not worry — breastfeeding stimulates milk production and your supply of breast milk will adjust to your baby’s demand for it.

Is My Newborn Getting Enough to Eat?

New moms often worry about whether their babies are getting enough to eat. It’s important for all infants to be seen by their pediatrician 48 to 72 hours after a mother and newborn leave the hospital. During this visit, the baby will be weighed and examined, and feeding questions and concerns can be addressed.

You can be assured that your baby is getting enough to eat if he or she seems satisfied, produces about six to eight wet diapers a day, has regular bowel movements, sleeps well, is alert when awake, and is gaining weight. A baby who is fussing, crying, seems hungry, and does not appear satisfied after feeding may not be getting enough to eat. If you’re concerned that your baby isn’t getting enough to eat, call your doctor.

Many infants “spit up” a small amount after eating or during burping, but a baby should not vomit after feeding. Vomiting after every feeding might be a sign of an allergy, digestive problem, or other problem that needs medical attention. If you have concerns that your baby is spitting up too much, call your doctor.

Should Newborns Get Nutritional Supplements?

Breast milk has the right combination of vitamins and easily absorbed iron for newborns. A healthy infant being nursed by a healthy mother does not need any additional vitamins or nutritional supplements, with the exception of vitamin D.

The AAP recommends that all breastfed babies begin getting vitamin D supplements within the first few days of life, continuing until they get enough vitamin D-fortified formula or milk (after 1 year of age).

Iron-fortified formula contains the right blend of vitamins and minerals for a baby, so supplements usually aren’t necessary. Infants drinking less than 1 liter, or about a quart, of formula a day may need a vitamin D supplement.

Water, juice, and other foods usually aren’t necessary during a baby’s first 6 months. Breast milk or formula provides everything babies need nutritionally until they start eating solid foods. Talk to your doctor if you have any questions about feeding your newborn.

Breastfeeding your baby

Breastfeeding is the most natural way to feed your baby. It provides all the nutrition your baby needs during the first six months of life, satisfies their hunger and thirst at the same time. It also helps to create a loving bond between you and your baby.

Breast milk has a number of health benefits for your baby:

• breastmilk contains all the nutrients your baby needs for the first 6 months
• it also satisfies the baby’s thirst
• it helps develop the eyes and brain and other body systems
• the act of breastfeeding helps with jaw development
• it helps the baby resist infection and disease, even later in life
• it reduces the risk of obesity in childhood and later in life
• it contains a range of factors that protect your baby while their immune system is still developing

Breastfeeding also has many benefits for mothers. Not only is it convenient, cheap, and always available, it also:

• reduces the risk of haemorrhage immediately after delivery
• reduces your risk of breast and ovarian cancer
• is convenient and cheap
• can soothe your baby
• prolongs the amount of time before you get your period again

Getting started

You can usually start breastfeeding within the first hour or so of your baby’s birth.

The first milk in your breasts is called colostrum. This milk is quite thick and may be yellowish in colour. It’s very rich in protein and antibodies that will help give your baby a great start in life. Mature breast milk gradually replaces the colostrum in the first few days after birth.

Ideally, you should try to maintain close skin-to-skin contact with your baby immediately after the delivery. If you hold your baby against your chest and between your breasts for a while, there’s a good chance he or she will find your nipple and begin feeding without any help. Your midwife or a lactation consultant can also help guide you and your baby into position.

Good positioning and attachment

The key to successful breastfeeding is comfortable positioning and good attachment.

If your baby is well-attached to your breast you are less likely to experience breastfeeding problems like cracked nipples, and your baby will get the most amount of milk out of your breast.

There are lots of different ways to position and attach your baby for breastfeeding, but here are some general tips:

• Sit comfortably with your back and feet supported – you can be fully upright or you might prefer to be laying back a little bit.
• Unwrap your baby and hold him or her close against you.
• Turn your baby on his or her side so they are wrapped around you with their nose level with your nipple.
• Make sure you support your baby’s neck and shoulders with your hand, but don’t hold your baby’s head — allow him or her to find the best position for attaching to your breast.
• Bring your baby to your breast, not your breast to your baby.
• Gently brush your baby’s mouth with the underside of your areola (the area around the nipple) — this will usually cause your baby to open their mouth very wide.
• When your baby opens their mouth, bring him or her quickly to your breast so they take a good mouthful of breast tissue.
• As you bring your baby to your breast it can help to hold your breast like you would a sandwich, with your nipple aimed at the roof of your baby’s mouth.

Signs that your baby is well-attached include:

• Your baby’s chin should be tucked into your breast, and his or her mouth should be wide open with the bottom lip curled back.
• Your baby’s nose will be clear or only just be touching your breast.
• More of your areola will be visible above your baby’s top lip than below it.
• Your baby’s cheeks should not be sucking in and there should be no clicking noise during sucking.
• There should be no nipple pain — but you might feel a stretching sensation as your nipple adjusts to breastfeeding.

How often will my baby feed?

During the first week of life most babies will gradually develop a pattern of feeding eight to twelve times in a 24-hour period. You should feed your baby whenever he or she shows signs of hunger.

You will know your baby is getting enough breast milk if he or she:

• is feeding at least 8 times a day (with some of those feeds occurring overnight)
• has at least 5 wet disposable nappies or 6 to 8 wet cloth nappies per day
• has 2 or more soft or runny bowel movements per day for around the first 6 weeks of life (babies have fewer bowel movements once they reach about 6 weeks)
• is gaining weight and growing as expected
• is alert when awake, and reasonably contented

Building your milk supply

When it comes to breastfeeding, supply equals demand. The more you feed your baby, the more milk your breasts will make. Some tips for establishing and maintaining a good milk supply include:

• let your baby feed until he or she stops sucking and swallowing and lets go of your breast, and then offer your second breast
• offer your breast at night as well as during the day
• avoid giving any extra feeds from bottles, as this reduces your baby’s need to suck at your breast and reduces your milk supply
• avoid the use of dummies (pacifiers)

Bottle feeding with formula

Breastfeeding is best for your baby. If breastfeeding isn’t possible or you choose not to breast feed, commercial infant formulas should be used as an alternative until 12 months of age. Lots of different brands of infant formula are available from your supermarket, chemist or local shops. When prepared correctly, they all contain enough nutrients for healthy growth in babies.

Most infant formula is made by taking cow’s milk and treating it so it is suitable for human babies. Formula can come as:

• a powder, which you make up by adding it to water that you have sterilised by boiling
• a liquid, which is sold in a carton and is sterile and ready for you to feed your baby

It’s usually more economical to buy infant formula as a powder and prepare it as you need it.

How much formula and how often?

Feed your baby on demand, whenever they show signs of hunger.

Up to the age of about 6 months, most babies will drink around 150ml of formula per kilogram of body weight, each day. This is just an estimate — some will need more formula, some will need less. Every baby is an individual.

Signs that your baby is getting enough formula include:

• they have 6 or more wet nappies per day
• they are gaining a healthy amount of weight
• they are active, alert and happy

Which formula is best for my baby?

There is no evidence that one brand of formula is better than another. However, you should consider:

• choosing a formula based on cow’s milk, unless there is a cultural, religious or health reason to use a different formula
• choosing a formula with a lower protein level, which may reduce your baby’s risk of being overweight or obese in later life
• only using special formulas (HA, AR, lactose-free or soy formula) if they are recommended by a doctor
• taking into account price and affordability

Whey or casein-based formula?

Whey and casein are the 2 main types of protein in infant formula, and in breast milk.

Your baby’s first formula should usually be one that contains whey protein as the main type of protein. These formulas are often labelled as ‘suitable from birth’, ‘newborn’ or ‘whey dominant’.

You may notice that some formulas are labelled as ‘follow-on’ or ‘Step 2’ formula. These are casein-dominant formulas and they should only be given to babies aged 6 months and over.

Generally speaking, there is no need to switch from a whey-dominant formula to a follow-on formula as your baby gets older. Your baby can stay on their first formula as you start to introduce solids, and until they are 1 year old.

Added extras

Many formulas today contain extra ingredients. Some of these are explained below:

• LCPUFAs (DHA and AA) — These are long-chain polyunsaturated fatty acids thought to be important in the development of the brain and eyes. Breast milk contains LCPUFAs (especially DHA and AA), and LCPUFAs are now commonly added to infant formulas as well.
• Alpha-lactalbumin (Alpha-Pro or OPTIPRO) — This is thought to be especially nutritious for babies because it is the main type of whey protein present in breast milk. Some formulas have been developed to contain higher levels of alpha-lactalbumin, and a slightly lower overall protein content. This might be beneficial for babies.
• Probiotics and prebiotics — Just like adults, babies have ‘good’ bacteria living in their bowel to help keep them healthy. These bacteria are affected by the type of food your baby eats. Probiotics (good bacteria such as Bifidobacteria or Lactobacillus) and prebiotics (sugars that help promote the growth of good bacteria) are added to some formulas because they may help maintain a healthy balance of gut bacteria.
• Lutein — This is a nutrient that may play a role in eye health.

Special types of formula

These formulas are also available in supermarkets, and are designed for babies with special nutritional needs. The vast majority of babies don’t need a special formula, and it’s best to only use these formulas under medical supervision.

• HA or hypoallergenic formula — This is cow’s milk-based formula in which the large protein molecules have been broken down (hydrolysed) into smaller pieces. Studies have shown there is no solid evidence that hydrolysed formulas can help in preventing allergies in infants or children. Talk to your doctor, pharmacist or community nurse if you are worried about allergies in your baby.
• Lactose-free formula — These formulas are for babies with a diagnosed lactose intolerance. Lactose intolerance is quite rare in babies under one year old.
• Soy formula — These formulas are made with soy protein and don’t contain any dairy products or lactose. Soy formulas may be used in babies who have to avoid dairy-based products for cultural or religious reasons. They are also sometimes used in babies who have been diagnosed with a lactose intolerance.
• AR (anti-regurgitation) formula — These are specially thickened formulas that are sometimes used to treat reflux in formula-fed babies. Reflux, which causes spitting up in babies, is a normal occurrence and it usually improves by itself as your baby gets older. Special treatment is only necessary if your baby has severe reflux with poor weight gain and a lot of discomfort.

What about plain cow’s milk?

Cow’s milk and milk from other animals (such as goats or sheep) should not be given instead of infant formula. Neither should plant-based milks, such as soy, rice or almond milk. Wait until your baby is 12 months old before you introduce any of these as a regular drink.

Feeding twins

The first few weeks of feeding your twins is likely to be a challenge, so seek out and accept help and support. Rest as often as you can during the early weeks after delivery so that you can enjoy feeding and being with your twins.

Your doctor, lactation consultant and early childhood nurse can give you advice relating to positioning, pillows and equipment to make feeding your twins easier.

What to think about when feeding twins

Breast milk is the best nutrition and it is particularly important for twins, who might be smaller than other babies. Mothers can produce enough breast milk to feed more than one baby.

Starting to breastfeed twins might be a challenge if you are unwell or exhausted after your delivery. Newborn twins usually need small frequent feeds, because they can’t stay on the breast for a long period.

If your babies are premature and small, they might have a weak and ineffective suck. This might cause a delay in breast milk production.

Sometimes one or both of your babies will need to supplement their feeds with expressed breast milk or formula. You might be advised to do this if they are not gaining weight well, or if one baby is smaller or weaker than the other. Weigh your babies regularly and talk to your doctor, lactation consultant or early childhood nurse if you have any concerns.

It is tempting to allocate one breast to each baby, but it’s best not to. Babies will grow and develop better if they feed on both sides. Swap at each feed to help you balance your milk production, especially if one baby has a much stronger suck.

Any amount of breast milk is good. But if you can’t exclusively breastfeed, or don’t want to, you can use mixed feeding (breastfeeding and formula) or full formula feeding.

Time management

You have the choice of feeding twins together or separately. It makes sense to feed twins at the same time if you can, although you might choose to feed them one at a time in the early days when you are first learning how to breastfeed.

Feeding at the same time

When one baby wakes up for a feed, wake the other baby. This will help you to have as much time as possible between feeds to rest or sleep. To do this, you might need help at feeding time to position or support the babies.

Feeding one after the other

If you don’t have support at feeding time, or if one or both babies are small, it can be hard to get both to the breast with a good attachment. In that situation, you might want to feed one baby at a time. But it will be easier if you change to feeding together when you can.

Positions for feeding your twins at the breast

There are many ways to position twins, depending on their age. There is no ‘right’ way – choose whichever position works best for you and your baby. Some examples are shown below.

Twin, football, clutch or underarm hold is the easiest and most practical position for small babies when you are on your own. It is the most comfortable if you have had a caesarean section, as there is no pressure on your stomach.

Front ‘v’ hold allows you to lie back and is useful when feeding at night or, if you can, sit comfortably.

Parallel hold is easier when babies are older because you have less control of their heads in this position. Both the babies lie in the same direction.

A useful piece of equipment is a twin-feeding pillow, which was developed to help twins feed together. These firm pillows create a supportive surface and make it much easier to latch babies to the breast.