Feeding your Infant

Nutrition plays a vital role in your child’s growth and development, especially during the first two years of life. As pediatricians, we always recommend breastfeeding as the best source of nutrition for your newborn. We encourage mothers to continue breastfeed for as long as possible during the first year of life. Breastmilk is unique in that it provides your baby not only with the best nutrition, but it also provides special substances that help to protect your baby from infections and illnesses. If you are unable to breastfeed, there are many formulas on the market which provide an excellent alternate source of nutrition. There is no one best formula, it is a personal choice, and different formulas are tolerated differently by individual babies. You will have to try different formulas and decide which is best accepted by your infant. Never give cow’s milk to your baby before one year of age. It does not contain the correct amount of fat and nutrients to help your baby to develop and could cause your child to develop a protein allergy that will affect them later in life.

How often should my baby feed?
Each infant may be slightly different in his or her feeding pattern, but in general, there are a few guidelines to help you with feeding your new baby. Breastfed babies usually need to nurse every two to three hours and will typically feed on each breast during each feed. The length of time that an infant feeds can be widely variable. On average, most babies feed 10-15 minutes on each side. Formula fed infants usually feed every three to four hours and finish the bottle within 30 minutes. Most term infants will take two to three ounces at each feed. If your baby is taking an unusually long time to feed, is choking on the feeds, turns blue, can’t catch his breath, or becomes sweaty when feeding, please let your pediatrician know immediately. These behaviors could be signs of a serious medical problem.

Most new parents worry about getting their baby on a set feeding schedule. While it is a good idea for the baby to get used to routines and schedules, it is generally best to allow the baby to set his own feeding schedule within the general guidelines above. As long as the baby is eating approximately every two to five hours and gaining weight appropriately, you should allow him to do so. During the first two weeks of life, an infant should not sleep more than five hours between feeds. This may put him at risk of hypoglycemia.

Parents will often tell us that their baby needs to eat every hour to hour and a half. Many times what may happen is that the baby is crying every hour and the parents first response is to feed the baby. Of course, the baby will calm down and feed, even though he may not be ready for a full feed. When your infant cries and it has not been two to three hours since the last feed, check for other reasons for the crying. Most of the time, the baby is crying because he needs his diaper changed, is too cold or hot, was woken up by a loud noise, or needs to be comforted. Don’t always assume that crying means the baby wants to be fed.

How much should my baby eat?
As mentioned above, typically breastfed babies feed for a total of 20-30 minutes, and formula fed babies consume two to three ounces initially with each feeding. These amounts can be somewhat variable with different infants. The best indication that your baby is getting the correct nutrition is your child’s growth. We will be tracking this growth with each visit. During the first few days of life your baby will lose 5-10% of his birth weight as he is learning how to feed. This weight should be gained back by 10-12 days of life. Typically infants will double their birthweight by six months and triple it by one year.

Babies are generally reliable in letting you know when they have had enough at any given feed and also when they are still hungry and want more. Your infant may eat five ounces at one feed and two the next feed. This is completely normal. With this in mind, it is possible to overfeed your infant and this possibility needs to be addressed. If your baby is taking an unusually large amount at each feed and always seems to spit-up after the feed, he is probably taking too much at a time. You may want to try cutting back on the amount he eats and to monitor his growth closely. We are happy to help you with this task.

Can I give my baby water?
In general, your baby should not be given any plain water to drink for the first four months. Giving water will reduce the amount of formula that your baby takes and will lead to poor nutrition. In the first few months, it can also lead to electrolyte imbalances and major problems for your baby. When using water to mix formula, you should always use either distilled bottled water or boil the water yourself and allow it to cool before mixing it with the formula. This is the best way to prevent your baby from becoming ill from bacteria or parasites that may live in tap water. Make sure you always follow the instructions for mixing on the formula label. Always level the scoops and do not dilute the formula.

When should I burp my baby?
Burping is important to help remove air from your baby’s stomach that he swallows during the feed. Breastfed babies should be burped between breasts and at the end of the feed. Bottle-fed babies should initially be burped after each ounce of formula or breastmilk. Some babies swallow more air than others, and you will get a feel for how much air your baby swallows and how frequently he needs to be burped as you get used to feeding him.

There are several good techniques for burping your baby, and you will determine which method works best for you and your child. The first is to place your baby on your chest with his head resting on your shoulder. Pat or rub in an upward motion firmly on his back. The second method is to sit your baby on your lap either facing forward or sideways and support the chest and head with one hand while patting or rubbing the baby’s back with your other hand. The third method is to place your baby face down on your lap, making sure the face is not buried and that he can still breathe while patting or rubbing his back as in the other methods.

Spitting Up (Wet Burps)
“Spitting up” or “wet burps” is when your baby brings up small amounts of formula or breastmilk, typically after a feed or when burping. Most babies will spit up on occasion, and some babies spit up with every feed. Frequently, this is caused by gastroesophageal reflux which is very common in babies. Most babies outgrow this condition by six months of age. As long as your baby continues to grow and gain weight appropriately, there is usually no cause for concern. Sometimes, the spit up comes out of the nose as well as the mouth. In these cases, make sure you have a bulb syringe (nasal aspirator) available as babies rely on their nose to breathe and do not know how to breathe through their mouths. There are steps you can take to help reduce the incidence of spitting up and allow your baby to feed more comfortably:

Burp your baby frequently during the feeding (after each breast or each ounce)
Use nipples with smaller holes to slow the feeding down
Make sure there is no air in the nipple, you may want to use special bottles that allow air to enter from the bottom of the bottle rather than the nipple
Keep your baby lying in an upright position at a 30-degree angle for 30-60 minutes after the feeding

Vomiting
When should you be concerned that your baby is doing more than just spitting up? Vomiting is when your baby brings up larger amounts of the feed. Usually, this will appear to be more forceful in nature. Again, you want to have a bulb syringe available for those times when the formula or breastmilk comes out of the nose. Anytime that your baby begins vomiting and is not just having wet burps, please call us for an appointment so that we can see your child. If your child is gradually experiencing worsening episodes of vomiting that are becoming projectile in nature, we need to know immediately. This could be a serious condition that requires surgery. The other scenario that we worry about is if your child has had any kind of blow to the head and develops vomiting. In this case, your baby needs to be seen immediately in our office or in the emergency room.