2.13.1 Weight gain in the baby

For the first few days, the newborn baby loses weight and thereafter she starts gaining weight. By 15 days, most babies will regain their birth weight. Thereafter babies will gain weight as follows.

Table 1.

The above table gives an approximate idea. However the best way to monitor your child’s growth is by growth charts. These allow you to monitor weight, height and head circumference. Your doctor may give you one or you can download this from <www.cdc.gov/growthcharts>.

2.13 How often to feed the baby

As with breast feeds with bottle feeds also, we advocate demand feeding. However you should try to keep a three hourly schedule. That does not mean that if your baby is demanding feed before her feeding time you should not give it or if baby is fast asleep you should wake her up to give the feed. Do not offer a bottle each time the baby cries, or sucks her fingers or thumb, because if you do that, the baby may drink a small amount and rest of the milk will be wasted. If the baby cries before the feed time, try in the beginning, to calm the baby by talking to her softly or rocking her or if necessary, give water. In giving water, do not add any sugar or glucose in the water. At times, you can use dummy (pacifier). If a dummy is kept clean, it is okay to use it (but do not use a dummy before the baby is 6 weeks old). Babies do like sucking so some may suck their thumbs or fingers while others will get used to the dummy (pacifier). Neither of these two habits do any harm unless it continues beyond three years of age.

It is very important that you should be sitting comfortably with the baby in your lap while feeding the baby. This will produce same amount of bonding between you and your baby as with breast feeding. Do look at your baby while you are feeding your baby and try to make an eye contact. Soon the baby will love to look at you while she is feeding and will have a very satisfying look. Never leave the baby on the cot with the bottle propped up with a pillow or cloth.

Looking after a baby, whether you breast feed or bottle-feed is time consuming. It is a 24 hours and 7 days job. However, it is one of the most satisfying phases of your life. For a career-driven mother, if there are no financial constraints and if it will not affect her career too much, she should try to take some time offfrom her work and spend at least 1 to 2 years looking after her baby. I did that and I still consider that as the best time of my life.

Nowadays many grandmothers and even grandfathers are willing to look after their grand-children so that their daughters or daughters-in-law can pursue their career. It is a very good gesture on their part. The only problem is that the mother misses out on the pleasure of looking after her baby.

2.12 Amount of feeds

Although the amount of milk that your baby will take is also written on the tins of milk powder, it is a very rough estimate. Some babies will take more and some less. So do not worry if your baby is taking less as long as your baby is satisfied and gaining weight.

2.11 Preparing the feeds

The bottles should be thoroughly cleaned and then sterilized by boiling. Milk should not be kept in the room temperature for more than 1 hour. After your baby has taken the feed, you must throw the remaining milk and rinse the bottle and nipple thoroughly. The water that is used for making the feed should be boiled or you can use bottled sterile water. Do not use very hot water for mixing the feeds, otherwise the vitamin-C will get destroyed.

Proportion of the water and the powder to be used should be strictly according to the instructions written on the tin of the powdered milk because if you add less amount of powder, baby will get less nutrients and thus will not gain weight and, if you add more than required, baby may get constipation and also can get dehydrated. Some brands of milk powder provide big size scoop, which has to be mixed in 60 ml of water while others provide small scoop, which has to be mixed in 30 ml of water.

2.10 Which milk to use?

Fresh cow’s milk, goat’s milk or sheep’s milk etc. are not suitable for babies who are less than 1 year of age as these do not contain the type of nutrients that baby needs. Powdered formula milk is better as these have been modified to suit the needs of the baby. They are usually made from skimmed cow’s milk and treated in such a way that babies can digest it. Vitamins, minerals, vegetable oils and fatty acids are added so that these meet the requirement of babies. Many different brands of powdered milk for infants are available in the market; you can use any of these. You should take your doctor’s advice to know if your preferred brand is appropriate for your baby.

2.9 Formula feeding

You may have decided not to breast feed right from the beginning or may have resorted to formula feeding after unsuccessful attempts at breast feeding or you may want to partially feed the baby with formula milk because you want to go out to work or have a busy social life.

The babies who are fed on formula milk do have more chances of getting infections and digestive problems but fortunately, if you take all precautions, this can be reduced to a minimum.

2.8 Giving bottle-feeds along with breast feeds

Many mothers do give formula feeds 2 to 3 times a day along with breast feeds. The reason they do this is because they want the baby to get used to the bottle as they think that otherwise baby will not drink from a bottle later on. The problem with getting a baby used to a bottle is that the baby will get so used to the bottle, that very soon she will stop taking breast milk. Therefore, if you really want to breast feed your baby for more than 9 months of age, then you should never give a bottle to your baby. However if you want to feed your baby for a shorter time and for this reason you want your baby to get used to bottle, you should give bottle to the baby only after the baby is 6 weeks old. If you give bottle to the baby before this age, most probably you will not succeed in breast-feeding even for the short time you had planned for.

2.7 Storing the milk

You can store the breast milk in the refrigerator for 48 hours. Before giving the milk to the baby, the bottle can be warmed by keeping it in a bowl of hot water. Once warmed it should not be put back in the refrigerator. When a food item is warmed (not heated to boiling point) bacteria starts growing in it and they continue growing until the food is very cold. As cooling can take few hours, by that time, enough disease producing bacteria have grown and, if this food item is eaten or drunk these bacteria can cause stomach infection.

2.6 Expressing breast milk

You may need to do this if the breast becomes very congested and painful due to too much milk in it. Or you may want to express the milk and store it so that it can be used in your absence. You can do this with your hands or with a pump. You have to compress the breast gently behind the areola, in a steady rhythm and in clockwise fashion. It may take you around 15 to 20 minutes to empty the breast. Start with one breast and then empty the other breast. It is essential to wash your hands and sterilize the bottles and cup, which you will use to collect the milk.

2.5 Should she avoid certain food items? Does anything she eat cause "cold" or "gas" in the baby?

Unfortunately, even nowadays, mothers are blamed for the colds or stomach pain that the baby gets. Mothers come to me with the guilt that they ate ice-cream or some other cold food item and probably because of that, their baby has caught a cold. There is no scientific evidence that any thing you eat affects the baby or any logic in it. Some say eating cabbage or too many chocolates produces gas in the baby but that also is doubtful. Any way there is never any need to eat too much of cabbage. If the mother has a cold and cough, baby may get this not through the milk but through the droplets when she coughs. Therefore, when she has cold and cough and she wants to prevent her baby getting the cold, she can wear a mask while handling the baby and wash her hands or use a hand sanitizer after touching her nose, so that the germs are not transferred via hands.

2.4 What should be the diet of a mother, who is breast-feeding her baby?

A mother who breast-feeds her baby should eat a well balanced diet; which means she should be drinking plenty of milk or eating milk products, eating meat, beans and dals, vegetables and fruits. She should be taking more than what she takes normally. She needs about 400 to 500 calories extra than her usual requirement. Drinking milk or eating milk products are essential because the calcium content is necessary for the baby’s bones and teeth. If the mother does not like milk or cannot tolerate it, then she should take calcium tablets with vitamin D daily. The mother, who breast-feeds her baby, usually loses the weight that she has gained during the pregnancy within 3 months. She should keep on checking her weight. If the weight loss is too much she should increase her calorie intake.

2.3 How often will a baby pass urine and stool?

In the first week of life baby may pass urine 5 to 6 times a day but after that the number of times increases and by around 1 month of age baby will be passing urine 15 to 20 times a day. However, when one is using disposable nappies it is difficult to count the number of times baby passes urine. If you are not sure whether the baby is passing enough urine or not you may use cloth nappies to check.

As far as stool is concerned, the number of times the baby will pass stool varies a lot. A breast fed baby usually passes yellow semi liquid stools. Usually in the first week of life the number of stool passing may be 5 to 10 a day or sometimes more. At times the baby will pass small amount of stool when she passes gas. Usually the number of times that baby passes stool decreases as the baby grows. By 1 month to 2 months of age, baby may pass stool once a day or at times she may not pass stool for 3 to 5 days and after that she will pass large amount of soft formed stool. This is normal and not constipation, and does not require treatment.

2.2 How often to feed the baby and at what interval?

Nowadays, we tell the mothers that the baby should be fed whenever the baby is hungry i.e. cries for feed and wants to suck. We call this demand feeding. You will find that after the first week of life your baby will usually set up her own routine. Some babies will finish their feed within 10 to 20 minutes at one go, while others will take a longer time. Some babies will have a set pattern of feeding; that is they will feed for 10 minutes, rest for 10 minutes, again feed for another 10 minutes, and then rest for 30 minutes. During this 30 minutes they may sleep (light sleep) and then wake up and feed for a short interval and then sleep for 3 to 4 hours. I observed this pattern with my baby and many other mothers have told me that their baby have had a similar pattern of feeding. When babies keep on demanding feeds again and again at short intervals, some mothers think that the milk secreted by breast is not enough and therefore they supplement breast milk with bottle feeds. This is one of the reasons because of which many mothers do not succeed in fully breast feeding. If your baby is passing urine frequently, and gaining weight after the first week of life, your baby is getting enough milk.

Usually by 3 months of age, babies drink milk at interval of 3 to 4 hours. They will probably sleep for 3 hours, stay awake for 3 hours, and then again sleep for 3 hours. At night, many babies do sleep for 6 to 7 hours. During this time, they may wake up only once for feed and then sleep again after that.

In 24 hours, a 3-month-old baby will sleep for about 15 hours. However not all babies follow the same pattern and if your baby follows a different pattern you do not need to worry about that.

2.1 Breast-feeding

A baby should be put on breast as soon as she is born and is crying vigorously. In case of caesarian section, the baby can suck from the breast as soon as the mother wakes up from the effect of anesthesia, i.e. about 4 to 6 hours after birth. She can keep on lying down, while someone else holds the baby and let the baby suck from the breast. You should tell the nurses in the nursing home or hospital that you want this to be done. Ask them not to give the baby a bottle at all. Only exception is when the mother is too ill and not able to feed the baby. For the first 1 or 2 days, milk secretion is very little in quantity and yellowish in color. This is known as colostrum. If the baby sucks well on the breast, then this amount of milk is enough for her. Initially she will probably demand it frequently, but very soon, you will find that enough milk will be secreted and your baby will sleep well in between the feeds. Actually the more the baby sucks on the breast, more milk will be secreted, as when the baby sucks, mother’s body gets the signal that milk is needed and therefore more milk will be produced.

At times, there is a problem initially in making the baby latch on the breast and thus she is not able to suck. This usually occurs if the baby has been given bottle feed before putting on the breast, but it may occur otherwise also. It may be because the way you are holding the baby, you and your baby are not comfortable or it may be due to flat nipple. You can try giving baby breastfeed while lying down.

Flat or inverted nipple is one of the commonest reasons for difficulty in making the baby latch on to the breast. The treatment for this should start when the mother is pregnant. She should pull the nipple out a few times a day after applying some cream. When the mother, who has flat nipple, is having difficulty in trying to feed the baby in spite of all the attempt of pulling out the nipple, she can use nipple shield for a while. After a few days, she will find that the baby will be able to suck without the nipple shield. Once the baby latches and sucks well on the breast, there is no reason why she will not succeed in breast-feeding. If your baby is born prematurely then the baby may not be able to suck well on the breast. In such a case, you may have to express the breast milk and give it to the baby with a bottle or a spoon. However if the baby is very premature the baby will have to be given expressed breast milk with a feeding tube. This is always done in a hospital or nursing home and by the nurses, who are experts in feeding these babies.

When the baby sucks over the breast, see that the areola (the dark portion around the nipple) is in the baby’s mouth. Sucking directly over the nipple alone causes cracked nipples. Also too much cleaning the skin over the nipple also causes dryness of the skin which causes cracked nipple. It is not advisable to clean the nipple before each feed. Cleaning once a day while taking bath is enough. Once cracked nipples occur, as this is very painful, it becomes very difficult to feed the baby. You can apply some lubricating cream over the nipple, after feeding, to ease the pain and help in healing. If the cracking is very severe, then you may have to stop feeding the baby for a day or two and give the baby expressed breast milk with a spoon or bottle. Do ask someone, who has experience in breastfeeding to help you.

Chapter 2 : FEEDING YOUR NEW BORN BABY

Breast-feeding is certainly best for your baby. You have probably heard or read about the advantages of breast-feeding.

• Its constituents are best suited to meet the nutrition for the baby and is easily digested
• Infections are less because milk comes directly from mother to the baby and therefore there is no chance of any germs entering it as it would from a bottle (even if you sterilize the bottles some germ contamination can still occur)
• It contains many substances that help the baby’s body to resist the germs (viral and bacterial)
• Besides these, there are many other advantages including stronger bonding between the mother and the baby

Most of the mothers that I come across in my practice do want to breast feed their babies, but some mothers do not succeed. The main reason is wrong advice from relatives and friends. Some mothers do want to breast feed, but cannot breast-feed their babies because they have to go out to work. In this chapter, I will be discussing about breast-feeding as well as about formula feeding.