The Feeding of Infants

Preliminary Facts

From the moment of birth and during the first three months your baby has three basic needs: eating, sleeping and “being in your arms”.
For sleeping, baby doesn’t need your assistance. So, when he cries, it’s only to obtain satisfaction for one of the two other needs. The cry to be fed is distinctive, it’s a “metronomic” cry! Don’t look to your watch to be sure that his cries means: “I am hungry.”!

As far as eating is concerned your baby will show signs of his very own personality by eating like an ogre or picking like a bird…

To feed your baby does not merely consist of giving the necessary calories. It is a privileged moment of communication. Feeding at the breast or feeding with the bottle, make the most out of it!

“I feed on the breast”.

Mother milk is able to meet baby’s nutritional needs until the age of 6 month, i.e. excluding any other additional food intake. If the milk production may sometimes appear not sufficient, on the other hand the quality has to be considered, nearly without any exception, always accurate.

Vitamins

The word “vitamin” refers to organic compounds required in minute amounts to catalyze cellular metabolism essential for growth or maintenance of the organism (Nelson Textbook of Pediatrics).

Vitamin D

A vitamin D supplement is recommended if you feed your child on the breast exclusively. Human milk doesn’t contain enough of this vitamin.
This vitamin, partly synthesized in the skin exposed to sunlight, is necessary for the calcium deposition in the bones and teeth: it’s called the “vitamin anti rickets”. The risk could be greater for this vitamin to be insufficient in the milk from darkly pigmented mother.
The daily average requirement for infants is around 40 microgr (400 to 800 I.U.)
Example: D Cure ®, 10 drops once a day.

Vitamin K

A vitamin K supplement is also recommended. Human milk doesn’t contain enough of this anti-hemorrhagic factor (Koagulationvitamine) which will be synthesized by the bacteria who progressively will colonise the colon of the newborn after the birth.
During the first week after birth, the decrease of coagulation factors linked to the deficiency of this vitamin is responsible in cases of Hemorrhagic disease of the newborn (spontaneous and prolonged bleeding). Administering of natural oil-soluble vitamin K intramusculary at the time of birth prevents the fall in vitamin K-dependent factors.). Unfortunately this unique dose is not uniformly effective in the prophylaxis (Nelson Textbook of Pediatrics).
Example: Vitamon K ®, 4 drops once a day, for two or three months.

Put the drops of the vitamins D and K together in a teaspoon full with water or milk.

“I feed with a bottle”.

Which milk is best?

You have the choice amongst a wide range of so-called “first-age milk” (Nutrilon standard 1, Nan PRO1, Enfamil 1, Novalac 1, …). A “first-age milk” consists of reconstituted cows’ milk. Every year the producers change their formulae in an attempt to make the milk more similar to mother’s milk.
All the first-age milks are basically pretty similar since their composition has to correspond to strict health norms (international standards, WHO). For instance the proteins are made from amino acids. Nine of the twenty-four amino acids are cold “essential”. Nonessential amino acids can be synthesized and neet not be supplied in the diet. New tissue cannot be formed without all of the essential amino acids simultaneously present in the diet…
Humans do not synthesize linoleic or linolenic acid. Both must be supplied in the diet and are, therefore, also “essential”.

Each artificial milk meets the nutritional needs until the age of 4 month, i.e. excluding any other additional food intake. The possible addition of flour should not prove necessary before the 4rd month. If a close family member (on mother’s side, father’s side, sister’s or brother’s side) has a medical history of allergies like asthma or eczema…a hypo allergic milk could possibly be considered (Nutrilon Pepti, Nan Ha PRO1, Novalac HA1…).
Between months four and five you should introduce the “solids”: fruits, vegetables, starchy food and cereals…

Vitamin(s)

If you feed your child by bottle, a vitamin D supplement is recommended.
Artificial milk contains a minimal quantity of it; the milk quantity taked every day is very different from one child to the other. Exceeding of vitamine D is dangerous.
The daily average requirement for infants is around 40 microgr (400 to 800 I.U.)
Example: D Cure ®, 8 drops/day, for two or three years.

“Which is the best bottle make?”

There are many different makes available. The choice is yours (teats in silicon or in rubber).
Distinguish between first age and second age bottles. Give the preference to a bottle made of glass. Don’t use a bottle made of plastic, which contains Bisphenol A and phtalates (endocrinologic side effects).

For a baby who has formerly been breastfed and is going to be weaned off, consider following makes more closely: Dr Brown ®, Avent ®. Their teats seem to be more readily accepted by breast-fed babies.

“How to prepare a bottle?”

General rule: always keep to the dosage on milk tin. 30 gr water + 1 level measuring spoon.

If you add mineral water, this should have a low salt content (Spa Reine, Chaudfontaine, Pierval, Evian…).
Clean tap water is acceptable but must not pass through a softening system as otherwise the salt content is too high.
In general, it is always best to prepare a bottle immediately before use. In this case a bottle heater proves superfluous as baby accepts room temperature water.
Should you need to prepare bottles in advance, always keep them in the fridge (for a maximum of 24 hours). In this case, baby might prefer to have his meal warmed up.

Bottle Care

Bottles: sterilisation is unnecessary. It’s easier to wash them immediately after use. For this you need hot water (and a bottle brush). After washing, let them dry on a clean towel.

Teats: idem (ad hoc mini-brush). If the teats are out of rubber immerge them once a day in boiling water, during three minutes. Rubber is a porous material and thus a potential “herd” for germs.

“How much should baby drink per meal?”

At breast and on the bottle: “On demand”, “Baby never drinks out of sheer gluttony.

If at the end of a feed, baby utters short strident cries that cease very soon, and you do not notice a shortening of intervals between the feeds, it is not necessary to increase the content of the bottle or the feeding time on breast.

Bottle-fed baby:

Do not force him to keep a pre-established rota. The corresponding instructions on tin of milk powder have merely indicative character.
When faced with a little glutton, do not blame the milk make (to be insufficient). On the other hand, do not force a baby to “finish the bottle”.

Breastfed baby:

Regarding the length of feed and the intervals between feeds do not impose a coercive schedule.
During the first month (and outside of the so called period of evening cries) a feed can take up to 1 or 1 ½ hours, including several breaks.

Later, and often from the 2nd month on, the length of feed will shorten to 5-10 minutes. Mothers are then often misled to believe that their baby is “drinking a smaller amount”.

“The beer glass principle” and “the law of all or nothing”:

When you are filling a glass of beer, you often have to have 2 or 3 attempts at it. The reason being, that the foam needs to settle. Now take this example and simply replace the word beer bottle by milk bottle or breast, and the word glass by baby’s stomach.
Depending on the time of day, baby will be happy with different amounts of milk; the size of his stomach seems to depend on the moment of intake. Feeding on the breast or by bottle, baby can take one or two breaks of varying length. Sometimes for burps and sometimes “just like that”, to give “the foam a chance to settle” So, he/she can have two or three goes at it.

Let’s imagine a baby who needs 100 g milk, and who is only granted 90 since for his age category this “corresponds to the amount mentioned on milk tin”. The refusal to grant him the additional 10 ml will automatically provoke violent, long drawn out and totally unnecessary cries!
The same disastrous effect has the denial of some additional slurps on the breast just because these would not “fall” within the required time (ten, twenty, thirty minutes, …).
All” makes baby happy, leads to muscular relaxation, “smiles to the angels” and a quick sleep…
Almost everything” to “nothing at all” being given, tension, grumpiness and fury will quickly succeed.

“How many meals a day should take baby?”

At breast and on bottle, “On demand”, 24h/7days. Baby only drinks when he/she is hungry.

There are “little bohemians” and “precision workers”.
In the first month, the number of feeds varies between 4 and 10 within 24 hours. The intervals in between are irregular and can range from 1 hour to 6 hours.

Here an example of a typical time table naturally occurring during the first three months:
In the morning baby sleeps; once awake he drinks calmly and it doesn’t take much to keep it that way.
Between 12am and 6pm, he sleeps profoundly for 3 to 5hours.
Between 6 and 12pm, baby often is very awake and may become agitated. The meals are frequent and interrupted: it is the famous and, at best, so-called “inexplicable evening crying period”.
Between midnight and 8am, he only wakes up because of hunger. Once satiated, baby quickly falls asleep again: this is already babies’ first attempt at “sleeping through the night”.

As the weeks go by, changes of rhythm occur, often abruptly and unforeseen. Sooner or later baby will acquire a “civilised” rhythm. Should this not be the case at month 4, there is still time to …very gently…help him along this path.

“When will baby sleep through the night?”

Very rarely, as soon as he leaves the maternity ward: most frequently between month 1 and 2, sometimes only at the end of month 4. It is not advisable to “thicken up” the contents of the bottle in order to accelerate the passage.

The first time baby lets you sleep for 8 to 10 hours in a row, you reached an eagerly expected milestone. Usually nothing heralds this event that occurs spontaneously and takes parents by surprise. The latter had got the knack of getting up at all hours of night, and will suddenly sleep late and wake up with a startle!

“My baby has the hiccups.”

To hiccup does not necessarily imply that the bottle has been incorrectly handled or that baby is simply too greedy at breast, even if the hick-ups often occur following a feed.
An hiccuping baby has been doing this often before birth, towards the end of the pregnancy.
The hiccups are very common in the first month. From the 2nd month on, it usually ceases. To “cut it short”, one can offer the baby a drink or lay him/her just a moment on his stomach.

“My baby regurgitates.”

If the regurgitations evolve into real vomiting around meal times (with stagnation or loss of weight) and at the same time baby seems “increasingly uncomfortable” (crying, howling, contortions) one should consider possibility of underlying medical problem.

“My baby has cramps?”

Are you sure of it?
Sometimes short cramps occur during a bottle feed, immediately after it or within an hour. If they are accompanied by burps or an unusual amount of wind, they are probably linked to the way baby drinks. Once again, to change milk make is not necessarily the solution. Sometimes a thickener without calories helps. Try also changing the teats.

What people call cramps generally are not. It’s just agitation, and most of the time, agitation is the expression of an unsatisfied baby. A baby cries when he needs something (to be fed or communicate), and he continues to cry when he didn’t get the right and the fully answer to his expectations.

Recall: between 6 and 12pm, baby often is very awake and may become agitated. The meals are frequent and interrupted: it is the famous and, at best, so-called “inexplicable evening crying period”.

Experience with different lying positions:
One of the best: ”The leopard on the tree branch”. Put your baby lying on stomach across your forearm, resting his head near your elbow, and walk, and talk, and sing…
If in this position, he remains crying, he is hungry for sure!

Patience and these “little tricks” prevent a long chain of “solutions” and hazardous treatments.
Should nothing work….phone your paediatrician!

“My baby is constipated.”

1) bottle-fed baby

Towards the end of the 1st week, a spell of constipation follows more or less quickly a spell of rather liquid stool. This is a classical drawback of bottle feed, and can persist during several weeks. In general, baby tries painstakingly to expel a little cork of dark, hard stool, followed by stool that has a “more normal” consistence and colour.

Treatment: introduce in the anus a thermometer or a glycerine suppository for infants. (Do not fear hypothetical danger of addiction.)

Not advisable:

  • sudden change of milk make or type of milk
  • giving honey or orange juice

NB:

  • green stool (even if repeatedly occurring) in a healthy, happy baby is no cause for concern or treatment.
  • greenish stool with phlegm are a normal occurrence in babies fed with hypo allergic milk or anallergic milk.

2) breastfed baby

Stool resemble ”scrambled eggs, more or less liquid, sprinkled with parsley.” At the beginning it occurs with every feed. In the following weeks, the stool appears less frequently, sometimes only once every three or four days. The consistence remains quite liquid. So there exists no real constipation.

“Possible treatment” if baby actually appears uncomfortable, thermometer or glycerine suppository.

“My baby has diarrhoea.”

A priori, there is no diarrhoea in breastfed babies.
By definition, acute diarrhoea consists of over frequent stool that is unusually liquid, and may lead to a loss of weight.

A diet with exclusively an oral rehydration solution (ORS) during the first day of loose stools is usually effective (see relevant page). It is absolutely indispensable to split up the meals in several portions. e.g. give bottles of 100 or even 50gr instead of 200gr the vomiting has ceased.
No medication is needed.
Often spectacular bouts of vomiting precede the diarrhoea. Do not panic! The splitting up of the daily intake (24hour ration) is in this case even more imperative: give 8 to10 bottles spread out throughout the day or feed with a tea-spoon every ten minutes.
After the first 24 hours, it’s important to return to the diet before the diarrhoea, but still to split the meals into little portions.

Of course, “feeding on demand” can only be resumed once the state of the stool has drastically improved.

“The art of being parent”

Between the 2nd week and the end of the 3rd month, most babies experience the “period of evening crying” for 2 to 4 hours, occurring between 5pm and 3am (most frequently in the time slot of 6 and 10pm).

Is there an end to the conventional “wisdom” handed down by the generations? To name only a few of the explanations for this phenomenon: “Baby is being capricious”, “is looking for his sleep”, “needs to exercise his lungs”. All those foolish suggestions generally culminate in the stern admonition to parents that if they want to avoid hell on earth they should “Just let baby cry”.

As a parent you are truly disoriented and frustrated by a behaviour you cannot explain, all is only aggravated by the repressive advice of your entourage. You have by now repeatedly and unsuccessfully tried to feed the baby in order to calm him down. You often complain about the long feeding sessions and bad digestion.

In reality, this period reflects an irrepressible need of contact, stimulation and tenderness. They are in actual fact, daily appointments with your baby that you should not miss.

One has to realise that this little human is practically born “without useful arms or legs”.
Although able to express needs, he is still totally unable to satisfy them. Furthermore, your baby is not a mere digestive tube as it is often suggested. Baby is a complex and subtle personality.

How many children are faced with a dietary change as only answer to their real expectations? Not to speak of those who are confronted to the solitude and silence of a locked room!

A pair of arms and gentle movement is nearly always the best sedative for those inexplicable evening cries. A kangaroo bag more than once proves a valuable ally in this endeavour.

The latest by month 3, the growing interest of baby in the surroundings and his increasing faculty to analyse it, make this difficult period disappear.

General rule

What development concerns, let your child do everything he wants to try, no matter the age; for instance, since the beginning to sit in a kangaroo bag type BabyBjörn, at six month sit in a chair, … and at 9 months participate to your meal and eat by himself with a spoon even if he spoilt himself, the table… and the ground!

”Baby needs Clothing and Food” but also to be listened to, looked at and touched.
Books or “well intentioned” people rarely offer the best solutions to all the different little problems that inevitably occur.

An adult will never suffer from what he received but well from what he lacked as a child.

Do not be afraid to devote time to your child. He has the right to expect everything from you. Cover him with love.

All the best!

Body Care
 
Some medical advices
 
Prescriptions
 
Medical Surveillance of Children in Belgium
 
The Surgery
 
What to know for your child’s, yours… and my benefit

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