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Breastfeeding is the natural way to feed a newborn baby and we encourage it. The decision to nurse or to feed with formula has to be your own. Babies grow equally well on breastfeeding or formula feeding. Occasionally, nursing mothers may have to supplement with formula. This should not in any way induce a feeling of inadequacy on the part of the mother. Continue breastfeeding or formula feeding your baby up to 1 year of age. No regular milk (whole, 2% or skim) is to be given to babies under 1 year of age. At the 1-year checkup, the doctor will advise you on how to introduce regular milk into your baby’s diet.

Nursing (Suggestions for Breast Feeding)

• Good Diet – Adequate protein, vitamins and fluids are all important.
• Sufficient Rest – Strenuous housework can wait. Daytime naps are refreshing.
• Breast Care – Washing with water is sufficient for cleanliness; a breast cream with lanolin is helpful for dry or sore nipples.
• Frequent Nursing – Be sure to allow yourself sufficient time for nursing. For successful nursing, a relaxed, worry-free atmosphere and a sense of self-confidence are essential. Frequent stimulation and emptying of the breasts is necessary for the development of full milk production. Usually, no more than 15-20 minutes are necessary at one breast. It is preferable to offer both breasts at the same feeding time. Alternate the breast you start with at successive feedings so that both breasts are emptied every 6-8 hours. Nurse the baby every 2-3 hours. In the first few weeks, your baby would need at least eight feedings every 24 hours.
• Patience – It takes 2-5 days before the milk “comes in” (begins to flow well).
• Burping – Burping the baby midway in the feeding is advisable. Remember that some babies may not burp at all.
• Normal Sensations – All of the following are normal:
  • Mild breast discomfort before feedings
  • Nipple pain at beginning of feedings
  • Leakage of milk between and during feeding
  • Uterine contractions, painful or pleasurable, during feedings.
• Supplemental Feedings – In the beginning, supplementary formula should be used as little as possible. You may supplement with formula if the baby is hungry after nursing.

Formula and Milk Feeding
Most iron-fortified formulas are nutritious. Whole milk or 2% is usually introduced after 12 months of age. Regular whole milk, 2% or skim milk is not recommended to any child under 1 year of age. Before preparing the formula, read the instructions on the packaging carefully. We prefer to use the “demand” schedule as opposed to feeding the baby by the clock. In towns with central water supplies, sterilization of water is not necessary. Bottles and nipples should be thoroughly cleaned with soap and water every time. If you are using well water, then sterilization is necessary. Well water should be evaluated for fluoride and nitrate levels. You can have your water tested through your county health department. If baby has difficult with bottle feeding, you may need to try different nipple sizes or different brands of nipples.

Water
Water is generally not required in the first few months of life if the baby is breast or bottle feeding well.

Vitamins, Fluoride and Iron
Breastfed babies will need supplementary vitamins and iron (like Poly-Vi-Sol with Iron). Babies on formula do not need supplementary vitamins and iron.

• Vitamin D - 4001U per day is recommended for breastfed infants, especially those who are deeply pigmented or have limited sunlight exposure. Generally an ADC multivitamin such as Tri-Vi-Sol can be used.
• Fluoride - Supplementation is not needed during the first 6 months of life. Thereafter 0.25 mg is recommended for the exclusively breastfed infant.
• Iron – For exclusively breastfed infants, approximately 1 mg/kg per day is recommended after 4-6 months of age, preferably from iron-fortified cereal or elemental iron if sufficient cereal is not consumed.

Giving Baby Foods Other Than Milk
Although feeding practices have changed over the years, most babies do not need solid foods before 4 months of life. Breast milk or simulated breast milk formulas are adequate for providing all the nutrients and vitamins needed. Many contented breastfed babies who are growing and gaining normally do not require anything else before age 6 months. The following is a guide for introducing solid foods: 

• Age 4 months – cereal (preferably those prepared for babies such as rice, oatmeal, barley, etc.)
• Age 5 months – strained vegetables and/or fruits
• Age 6 months – meats and/or vegetable meat combinations
• Age 7 months – egg yolks (up to 2-3 whole yolks per week), yogurt and cottage cheese
• Age 8 months – teething biscuits, Zwieback, Cheerio’s

When foods are introduced, give a plain food rather than mixtures and start with a small amount. For example, give one or two teaspoons of rice cereal twice daily and gradually increase as desired, up to three or four tablespoons. A vegetable or fruit feeding can be increased to 1/3 or ½ jar. If baby seems to experience some distress from a food, wait 2-3 days and try again. If the same distress occurs, avoid that food and report about it at your next visit. Cereals may be mixed with formula, breast milk or water. Babies have to learn how to swallow it so make it loose enough so it will slide off a small, relatively flat spoon easily. As skills in swallowing improve, thicker preparations will be tolerated. Initially food may be pushed out rather than swallowed. This is not because of dislike, but because baby hasn’t yet learned to swallow efficiently.

At age 8 months of age, even without teeth, most babies can handle table foods which are relatively safe and in small pieces (junior foods are a convenience, but not essential). You may also use a blender or food processor so that baby can eat what you are eating, as long as the foods are not seasoned, salted or sweetened. Avoid foods containing pieces of nuts and never give your child under 3 year of age popcorn, peanuts, crackerjacks or gum. Brittle foods like raw carrot, apple, pears, crisp bacon, when given to your toddler, should be allowed only when the child is sitting in a high chair or at the table where you can observe him and where stumbling cannot occur. As your child’s intake of different foods increases, milk intake may decrease. This is good as the need for milk and/or milk products will provide adequate calcium but if the child does not like such foods, there are alternatives.

Never force or tease your child to eat! Appetites vary and offering a variety of foods in a relaxed, pleasant way is the best policy to follow.

Additional Comments
Twelve months of age is a reasonable time to change from formula to 2% or whole milk. We do not advise skim milk since its salt content is high and there is a biologic value in having butterfat in the diet. Fruit juices may be introduced at almost any age but are not needed as long as baby is breastfed or taking a simulated breast milk formula. When given it should not be heated. There is no need to use the relatively expensive commercial baby fruit juices. Frozen orange juice mixed with tap water is excellent. Start with ½ oz. per day and gradually increase to 4 oz. per day if your baby is at least 6 months of age. This will provide a good amount of Vitamin C, so there will be no need for supplemental vitamins when your baby goes over to whole milk.

Babies do not need desserts such as custards and puddings. Avoid such sweet items as well as salty foods as long as you can. There is enough sugar and salt in a well-rounded diet without adding these items. They do taste good, but may pose a threat to health.

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Amherst Pediatric Associates
25 Hopkins Road
Williamsville, NY 14221
(716) 632-8050 (phone)
(716) 632-2297 (fax)

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