本文发表在 rolia.net 枫下论坛Cuddles, kisses, and consistency. To baby, these are a few of his favorite things. Add in proper nutrition and you are on the path to parenting success. Whether the nourishment comes from a bottle of breast, only you can choose. Both are discussed here for your knowledge and heartfelt deliberation. No matter what your choice, know that successful lactation alone, like raindrops on roses, will not deliver perfection in parenting. There is much more to good mothering than just bringing a baby to breast.
Feeding your baby is perhaps the most basic task of managing your infant. Since a baby’s sucking and rooting reflexes are well developed at birth, he will satisfy those reflexes by rooting and sucking on anything near his mouth. Whether feeding is accomplished by a bottle or the breast is not nearly as important as the gentle, tender cuddling you give him during feeding. Your decision to bottle or breastfeed must be free of any coercion or manipulation. Guilt or a quest for approval is never in line with clear thinking. Instead, confidently base your decision on accurate, honest information.
Nothing beats breastfeeding for physiological benefits to baby. That is plain fact. Mother’s milk is the complete and perfect food-nothing short of miraculous. Easily digested, it provides excellent nutrition and contains the right balance of proteins and fats. It also provides additional antibodies necessary for building your baby’s immune system.
According to the American Academy of Pediatrics, there is strong evidence that breast milk decreases the incidence and/or severity of diarrhea, lower respiratory infection, bacterial meningitis, and urinary tract infection. The Academy also points out various studies demonstrating breast milk’s protection against Sudden Infant Death Syndrome, allergic diseases, Crohn’s disease, ulcerative colitis, and other chronic digestive disease.
There is more good news. Unlike formula, which needs to be prepared, stored, warmed, and packed for every outing, breast milk is always ready whenever and wherever you go. And you never need to wonder about the milk’s freshness. Inside mother, it won’t go bad. Breastfeeding is also known to speed the return of mother’s uterus to its normal size and shape which is another healthy consideration for a postpartum mom.
BREASTFEEDING TRENDS
Despite numerous benefits to breastfeeding, the American Academy of Pediatrics notes that the number of mothers opting to breastfeed is lower than expected. “Although breastfeeding rates have increased slightly since 1990, the percentage of women currently electing to breastfeed their babies is still lower than levels reported in the mid-1980’s and is far below the Healthy People 2000 goal.” says the AAP.
Why do nearly half of all mothers choose against the nourishment, convenience, and physical closeness of breastfeeding? Why do over a half of all mothers initially choosing breastfeeding opt out so early on? Are they simply callous women, cold to the nourishment and nurture of their babies, who are more concerned with freedom than baby’s physical well-being? Of course not. There is more to their choice and change of heart than is perceived on the surface. Possibly, the decision to quit breastfeeding is actually a disturbing necessity for distraught and fatigued moms unable to cope with endless demands.
The PDF moms reveal an interesting twist on the breastfeeding story. A convenient sampling of over 240 mothers following the PDF principles demonstrated that 88% of mothers who start with the program breastfeed, and 80% of those moms breastfeed exclusively with no formula supplement. And while the national average was 21.6% of mothers breastfeeding into the fifth month, a full 70% of PDF mothers continued into the fifth and six month. On average PDF moms breastfeed 33.2 weeks. Add to these statistics the benefits of uninterrupted nighttime sleep, and you will better appreciate the wonderful benefits of a flexible routine.
For PDF mothers, there is no questioning or second-guessing what will happen next and when. The routine for these moms provides greater understanding of their babies’ needs, helping them connect with their babies sooner. If problem occur, they typically fall so far outside a baby’s normal pattern of behavior that mother quickly picks up on this distress. Breastfeeding under these conditions is delightful, not demanding.
But even with these wonderful statistics, transforming a woman into a good mother is one thing breastfeeding cannot do. There is not “good mother” hormone, and much more is required than just bringing a baby to breast. While strong support for breastfeeding does exist, no one should choose breastfeeding at all costs. The well-being of your entire family is also a critical consideration. Although breast milk is a significant link to the physical well-being of a baby, the act of breastfeeding itself is not the genesis of baby’s psychological health. It is not a silver bullet assuring a love attachment or security.
If you want to ensure optimal development, provide a predictable routine for your baby. It will best complement baby’s overall advancement and attachment in all critical areas of development. Combine this with breastfeeding and your truly can offer a total package for your baby.
IS THERE REALLY A DIFFERENCE?
Demand-feeding’s more standard, moderate approach, as used by Julia and Barbara, instructs parents to feed their babies every two to three hours based on the baby’s hunger signals. On the other hand, PDF parents will feed their babies on a flexible routine every two to three hours. In terms of nutrition, both methods are the same. But as demonstrated earlier, the physiological outcomes are drastically different because one method is child-led and the other parent-directed.
Preparation for Parenting offers an alternative to hyper-scheduling at one extreme and AP style of nursing at the other. It has enough structure to bring security and order to your baby’s world, yet it has enough flexibility to give mom freedom to respond to any need at anytime. PDF moms feel comfortable handling this freedom to assess and decide need and offer her baby guidance.
Some moms rely too heavily on watching and waiting for their babies to signal a desire to nurse. They may be discouraged when their babies nurse so irregularly or want to nurse every hour. These mothers may worry about their babies getting enough food. The expectation that a baby should nurse whenever usually leads to frustration for both mother and baby and may be the single greatest reason mothers give up breastfeeding so quickly.
Waiting on the baby’s signal for food may also compromise the child’s health. Some newborns may not cry to signal hunger readiness for five to six hours, and crying is not always a signal of hunger. Weak and sickly babies may not have the energy to cry, so the advice of sit back and let the baby direct the show could allow serious medical problems to go unnoticed that would otherwise be picked up through routine feedings. It is the predictability within the routine that helps PDF moms pick up any deviation from the norm. Deviation cues stand out because there is a pattern of norm cues.
“Just listen to your baby’s cues” is common breastfeeding advice and good advice if you know what to listen and look for. Babies provide parents two sets of response cues-those that are immediate need (e.g. hunger, sleep, and messy diaper cues) and those that represent a parenting style. Behavior patterns can be attributed to parenting styles as much as temperament. For example, the three-month-old baby who has a pattern of waking two, three, or four times in the middle of the night to nurse is responding to his mother’s parenting style. In this case, the need cue for food may be legitimate, but the greater question centers on the greater parenting style cue-why is a child of this age repeatedly hungry at night? Mothers will say, “But my baby is waking for comfort nursing, not just food.” We would still ask the same question at this age. A baby nursing for comfort so many times during the night is a cue that your parenting style during the day is causing too much discomfort.
A baby nursing every hour is another double cue. It’s telling you two things. It may signal that your baby is not getting the rich, high-chloride hind milk and, equally important, that your baby is not getting enough healthy sleep. Healthy sleep facilitates healthy nursing. Fatigue is another parenting style cue. If mom is continually waking up each morning fatigued and discouraged from her middle-of-the-night experience, that is her body’s and emotion’s way of telling her that what she is doing is not working.
In contrast, the babies who are growing and sleeping contently and securely through the night are also responding to a parenting style. This is a healthy response signaling that their tummies are content and their hearts are secure in mom and dad’s parenting. What about the mom who wakes in the morning feeling rested? That sense of restedness is a positive response cue to what she is doing. Parents must learn how to distinguish between immediate need cues and parenting style cues. Both are important. One is for short-term benefit and one is for long-term gain.
MILK PRODUCTION
If breastfeeding is your choice, there are a few basic principles you must understand. The most important one is that breastfeeding success is based on demand and supply. The supply of milk produced by the glands is proportional to the demand placed on the system. The greater the demand, the greater the supply. But how do you define demand?
Steven’s mother heard that milk production is directly related to the number of feedings offered. The more feedings she gave, the greater her milk production would be. While there is some truth here, the statement is greatly misleading. Certainly a mother who takes her baby to breast seven times a day will produce more milk than the one who offers only two feedings; however, there are limits. A mother who takes her baby to her breast twelve, fifteen, or twenty times a day will not necessarily produce any more milk than the mom who takes her baby to breast eight or nine times a day.
The problem is not the amount of milk overall, but the quality of the milk taken in by baby. First, babies on a routine of fewer feedings will take in more calories at each of those set feedings than babies who feed ad lib. The difference here is qualitative feeding, as with a baby on routine, versus quantitative feeding, meaning more feedings of lesser quality.
With qualitative feeding, you eliminate the need for continual snacking. Many feedings become exactly that. Baby feels like a little something to tide her over. No meal is desired. Such snack feeding provides baby only a partial meal consisting of the lower-calorie foremilk and not the higher-calorie hindmilk essential for growth. Mom thinks she is doing more for baby through endless breast availability. In actuality, she’s delivering less than her best. Baby often quits suckling before optimum nourishment is offered. How disheartening for both.
Part of a mother’s ability to produce milk is tied to the demand placed on her system. Several factors are associated with the demand side of breast milk production, with two specific to this discussion. First, there is the need for appropriate stimulation at each feeding. That means the strength of the infant’s suck must be sufficient. A second factor for the PDF baby is the correct amount of time between feedings. Without proper stimulation, no matter how many times an infant goes to the breast, milk production will be limited. Too many snack feeding with too little time in between may reduce proper stimulation. Thus, baby gets only foremilk which is much lower in calories than the most desirable hindmilk. Too few feedings, which allow too much time in between feedings, reduce mother’s milk production. Both proper time lapse and stimulation are needed for breastfeeding success.
References to breast stimulation refer to the intensity of baby’s sucking. The urgency of a baby’s hunger drive will consistently influence the sucking reflex. This drive for food is related to the time needed for milk digestion and absorption into baby’s system. An infant fed on a basic 2.5- to 3-hour routine and whose digestive metabolism is stable will demand more milk. In turn, this stimulates greater milk production than the infant demanding less milk more often. Here then lies your key to efficient milk production. Work on getting full feedings.
THE LET-DOWN REFLEX
When a baby begins to suckle on his mother’s breast, a message is sent to the mother’s pituitary gland which in turn releases several hormones. The hormone prolactin is necessary for milk production and the hormone oxytocin is required for milk release. The most important factor in the continued release of prolactin is proper nipple stimulation. Without this stimulation, milk will not be produced no matter how many times an infant goes to the breast, because a consistent routine will help maximize milk production.
Before the milk is let down, you baby will receive a milk substance stored in the ducts under the areola (the flesh encircling the nipples). This foremilk, as it is called, diluted and limited in nutritional value. Oxytocin then causes the cells around the milk glands to contract, forcing milk into the ducts. When that happens, the milk is said to have been “let down”. For some mothers, this experience includes a tingling or pressure sensation. Without let-down, the milk would remain in the glands. In the absence of any sensation, the most reliable sign of let-down is your baby’s rhythmic swallowing of milk. The milk released is called hindmilk or mature milk. This high-protein and high-fat-content milk is rich in calories (thirty to forty per ounce).
Mothers following PDF have little or no problem with the let-down reflex. There are two reasons for this. First, routine plays an important part in proper let-down. Not only does the mind need a routine to maintain order and efficiency, but the body does as well. The very nature of inconsistent feeding wears on a woman’s body. A second reason is the high confidence level of the mother who follows a routine. There is no worrisome fear or anxiety for moms who know what happens next. Mother is confidant and her confidence aids the successful working of her let-down reflex.
BREAST MILK AND BABY’S DIGESTION
An empty stomach does not trigger the hunger drive. Efficient and effective digestion and absorption of food does. This is where the various food groups get broken down into proteins, fats, and carbohydrates. After the break-down, the nutrition is assimilated into the body via the blood. Absorption, which takes place primarily in the small intestine, is the process by which broken-down food molecules pass through the intestinal lining into the bloodstream. As absorption is accomplished, the blood-sugar level drops sending a signal to the hypothalamus gland. The red alert is triggered: Baby now needs food. So, it is blood-sugar dropping, not the empty tummy, which signals feeding time.
Breast milk is digested faster than formula, but that doesn’t justify unlimited breastfeedings to try and play catch-up. Rather than comparing breast milk to formula, it is more useful to look at the amount of breast milk consumed at each feeding. The AP Style of demand-feeding does not distinguish between snack time and mealtime. For these mothers, a feeding is a feeding. The child who nurses frequently and takes in fewer ounces, especially of foremilk, will naturally be hungry more often. PDF moms look to deliver full meals at each feeding.
PROPER POSTION FOR NURSING YOUR BABY
During the first few days of nursing, find a comfortable position for baby and you. This may be a matter of personal preference or an eclectic assortment based on situational needs. A pillow may be helpful under your supporting arm to lessen stress on your neck and upper back. Correct positioning of your precious bundle is imperative in successful lactation. How comfortable you are with this experience is also directly affected by the angles you impose on baby and yourself.
With your nipple, stroke lightly downward on your baby’s lower lip until she opens her mouth. Take care not to touch her upper lip as this creates confusion for baby. A her mouth opens wide, center your nipple and pull her close to you so that the tip of her nose is brushing slightly against your breast and her knees are resting on your abdomen. With baby correctly latched on, nursing should not be painful. Successful latching is made difficult if the baby’s head is toward the breast, but the body is allowed to turn away. If there is discomfort, remove her and try again. Patience in the process pays off as you discover what is best for you both.
When the baby nurses, she should take both the nipple and all or much of the areola into her mouth. Encourage the baby to latch on the areola, though she ay seem satisfied with only the nipple. Also, see that your baby’s entire body is facing you (head, chest, stomach, and legs). She will not latch on correctly if her head is facing you but the rest of her body isn’t. While this may sound awkward and impossible, baby has only one thing in mind when approaching the breast. Ideal positioning is not an issue for her consideration. You need to take charge here. To further assist in achieving successful feeding, there are three correct and interchangeable nursing positions: cradle, side-lying, and football hold.
Cradle Position
Cross Cradle Position
This position works well: · If you are learning to breastfeed · If you have a small baby.
Cradle Position
This position works well: · After you are comfortable with breastfeeding
The cradle position is most common. Sitting in a comfortable position, place your baby’s head in the curve of your arm. You may desire to place a pillow under your supporting arm to lessen the stress son your neck and upper back. When the baby nurses, he should take both the nipple and all or much of the areola courage and assist the baby in latching on the areola. With this approach, your baby’s entire body should face you (head, chest, stomach, and legs). Again, he will not latch on correctly if his head is facing you but the rest of his body is not. With your nipple, stroke lightly downward on his lower lip until he opens his mouth. When his mouth opens wide, center your nipple and pull him close to you so the tip of his nose is touching your breast and his knees are touching your abdomen.
Side-lying Position (above left)
Side-Lying Position
This position works well: · If you find it too painful to sit · If you want to rest when you breastfeed · If you have large breasts · If you had a caesarean birth
This position is commonly used by moms recovering from a cesarean delivery. Your stomach and your baby’s stomach should be facing each other, and your baby’s head should be near the nipple. With your nipple, stroke lightly downward on his lower lip until he opens his mouth. When his mouth opens wide, center your nipple and pull him close to you so the tip of his nose is touching your breast.
Football Hold Position (above right)
Football Position
This position works well: · If you are learning to breastfeed · If you have a small baby · If you have large breasts · If you have flat or sore nipples· If you had a caesarean birth
When using this position, place one hand under the infant’s head pulling him close. The breast is lifted and supported by the other hand. With the fingers above and below the nipple, introduce the baby to the breast by drawing him near.
A nursing baby often has a remarkably strong suck. If you try to pull the nipple away, she will just suckle harder. Just once, suddenly interrupt a feeding to answer the door and you quickly will discover baby’s intensity in this area. To remove her without hurting yourself, slip your little finger between the corner of her mouth and your breast. That will break the intense suction, allowing you to take her off easily.
HOW OFTEN SHOULD I NURSE MY BABY?
How often you should feed your baby depends on baby’s age. As a general rule, during the first two months you will feed your baby approximately every 2.5- to 3-hour from the beginning of one feeding to the beginning of the next. Sometimes it may be less and sometimes slightly more, but this time frame is a healthy average. In actual practice, a 2.5-hour routine means you will nurse your baby 2 hours from the end of the last feeding to the start of the next, adding back in 20 to 30 minutes for feeding to complete the cycle.
A 3-hour routine means you will nurse your baby 2.5 hours from the end of the last feeding to the start of the next. When you add 20 to 30 minutes for the actual feeding time, you will complete your 3-hour cycle. With these recommended times, you can average between 8 to 10 feedings a day in the early weeks. These times fall well within recommendations of the American Academy of Pediatrics.
While 2.5- to 3-hour routines are a healthy norm, there may be occasions when you might feed sooner. But take heed; consistently feeding exclusively at 1.5- to 2-hour intervals may wear a mother down. Extreme fatigue reduces her physical ability to produce a sufficient quantity and even quality of milk. Add postpartum hormones to the mix and it isn’t any wonder some women simply throw in the towel. Bear in mind, the word consistently is operative. As stated, there will be times when you might nurse sooner than 2.5 hours, but that should not be the norm. At the other extreme, going longer than 3.5 hours in the early weeks can produce too-little stimulation for successful lactation.
THE FIRST MILK
The first milk produced is a thick, yellowish liquid called colostrums. Colostrum is at least five times as high in protein as mature milk with less fat and sugar. As a protein concentrate, it takes longer to digest and is rich in antibodies. Some mothers experience tenderness in the first few days before mature milk comes in. This is due to the thickness of the colostrums and the infant sucking especially hard to remove it. A typical pattern is suck, suck, suck, then swallow. When mature milk becomes available, your baby responds with a rhythmic suck, swallow, suck, swallow, suck, swallow. At that point, the hard sucking is reduced and the tenderness should dissipate.
A clicking sound and dimpled cheeks during nursing are two indicators that your baby is not sucking adequately. Take the following test yourself. Curl your tongue and place it near the roof of your mouth, and then pull it away. You should hear a clicking sound. When your baby is nursing, you should not hear that sound nor see dimpled cheeks. It means your baby is sucking his own tongue not the breast. If you hear clicking, remove baby from breast and then re-latch him. If this continues, contact your pediatrician.
Even with a complete understanding of how the breast works and the many benefits of colostrums, mothers may still wonder if their babies are getting enough food in that first week. Consider these important clues. One sign that your baby is receiving adequate nutrition is his stooling pattern. Newborn stools in the first week transition from meconium, greenish black and sticky in texture, to a brownie batter transition stool, to a sweet odor, mustard yellow stool. The yellow stools is a totally breast milk stool and a healthy sign. After the first week, two to five or more yellow stools along with seven to eight wet diapers daily are healthy signs that your baby is getting adequate milk to grown on. Healthy baby growth indicators are discussed in Chapter 5. A bottle-fed baby will pass firmer, light brown to golden or clay colored stools strong in odor.
AFTER YOUR MILK COMES IN
Unless specified by your pediatrician, normally a baby does not need additional water or formula prior to mother’s milk coming in because your baby is getting colostrums. Once your milk is in, your nursing periods will average fifteen minutes per side. As mentioned, some babies nurse faster, and some nurse slower. Studies show that in established lactation, a baby can empty the breasts in seven to ten minutes per side, providing he or she is sucking vigorously. This astounding truth is not meant to encourage less time at the breast. Rather, it’s a clear demonstration of a baby’s ablity for speed and efficiency.
Under normal circumstances, baby takes what is needed within thirty minutes. The idea that non-nutritive sucking beyond this time enhances a baby’s security or heightens a baby’ sense of love is interesting but lacks serious scientific support. Security and love result from the overall parent-child relationship not one isolated factor. If you feel your baby has a need for non-nutritive sucking, a pacifier can meet the need without compromising your routine. But even with this, be careful not to over use the pacifier.
Usually a woman’s milk comes in between three and six days. During that period, some weight loss (up to 10% of birth weight) is normal and expected but should be regained by ten to fourteen days. We recommend that babies be weighted between ten and fourteen days. If there is a problem, it will show up on the scales. Catching it early allows for correction and is obviously much safer. Weight gain, as well as three to five or more yellow stools daily for the first month and five to seven wet diapers per day after the first week, are good indicators that your baby is getting enough milk for healthy growth.
NURSING PERIODS
Current wisdom governing the length of nursing periods for the first few days is fairly consistent. We suggest the following:
The Very First Nursing Period
If possible, nurse your baby soon after birth. This will be sometime within the first hour-and-a-half, when newborns are usually most alert. We suggest you strive for fifteen minutes per side or a minimum of ten minutes per side. Remember to properly position the baby on the breast. If your baby wants to nurse longer during this first feeding, allow him or her to do so. In fact, with the first several feedings, you can go as long as the two of you are comfortable. Both breasts need ot be stimulated at each feeding and the initial time frame mentioned above will allow for sufficient breast stimulation.
The First Five Days
For the next three to five days, maintain your basic 2.5- to 3- hour routine, nursing fifteen to twenty minutes on each breast. This means your average nursing period falls between thirty and forty minutes per feeding during this first week. Babies are usually sleepy during the first several days after birth. As a result, some will fall asleep right at the breast after a few minutes of nursing. That means you may have to work on keeping your baby awake at the breast. You can rub his feet, stoke his face, change a diaper, talk to him, or remove his sleeper, but he must eat. Keeping him awake will help him take in full feedings as opposed to snacking. It’s your key to success both in terms of early lactation and establishing a healthy routine. In our experience, mothers who work to get a full feeding during the first week have a baby who naturally transitions into a consistent 3-hour routine within seven to ten days. Keep this goal in mind when putting in the extra effort. The payoff is the confidence and comfort for both baby and you.
Some mothers nurse fifteen to twenty minutes from each side, burping their baby before switching breasts. Other mothers find it helpful to employ a ten-ten-five-five method. They alternate between each breast after ten minutes (burping the baby between sides) and then offer each breast for five additional minutes. This second method is especially helpful when you have a sleepy baby. This disruption prompts your baby to wakefulness and assures that both breasts are stimulated. Please note that these figures are goals based on averages. Some newborns nurse faster and more efficiently. Others nurse efficiently but slightly slower. If your baby wants to nurse longer, let him do so.
JAUNDICE IN NEWBORNS
A mild degree of jaundice is common in most newborns. This is not a disease, but a temporary condition characterized by a yellow tinge to the skin and eyes. Jaundice, caused by the pigment bilirubin in the blood, is usually easily controlled. However, it could develop into a dangerous situation when ignored or left untreated. If the condition appears more pronounced after the second day, frequent blood tests are done and conservative treatment is initiated.
Babies with moderately raised levels of bilirubin are sometimes treated with special fluorescent lights that help to break down the yellow pigment. Also, part of the treatment is an increase in fluid intake. In this case, your pediatrician may recommend other liquid supplements, although exclusive breastfeeding is usually the best way to correct this condition, even feeding as often as every 2 hours. Because bilirubin is eliminated in the stool, make sure your baby has passed his first stool (meconium). Your doctor will determine the program of treatment best suited for your baby. Because a newborn with jaundice will tend to sleep more, be sure to wake your baby for feeding at least every 3 hours.
BREAST VERSUS BOTTLE
We know there is substantial nutritional and health-benefit disparity between breast milk and formula during the first twelve weeks of baby’s life. By six months of age, the disparity is still present but to a lesser degree than in the first twelve weeks. According to the American Academy of Pediatrics, this six-month term is the minimum recommended duration. Between six and nine months, the difference between what is best and what is good continues to narrow. That is partly due to the fact that other food sources are now introduced in your baby’s diet. Between nine and twelve months, the nutritional value of breast milk drops and food supplements are usually needed. In our society, breastfeeding beyond a year is done more out of a preference for nursing than an absolute nutritional need.
When it comes to nourishing baby, mother’s milk is clearly superior to formula. Now for the stickier issue of nurturing. Is breast superior to bottle? In times past, experts said yes. Stressing the value of breastfeeding, they associated bottle-feeding with child rejection. Considered to be lacking warmth, a bottle-feeding mom was accused of renouncing her biological role as a woman and her emotional role as a mother. Others considered bottle-fed children to have less of an advantage in life than those who were breast-fed. In truth, studies over the last sixty years which attempted to correlate methods of infant feeding with later emotional development failed to support any of these conclusions. A mother’s overall attitude toward her child far outweighs any single factor, including manner of feeding.
BOTTLE-FEEDING
Bottle-feeding is not a twentieth-century discovery, but a practice that has been in existence for thousands of years. Our ancestors made bottles out of wood, porcelain, pewter, glass, copper, leather, and cow horns. Historically, unprocessed animal’s milk was the principal nourishment used with bottle-feeding. Since this milk was easily contaminated, infant mortality was high.
During the first half of this century when bottle-feeding was vogue, selection was relatively limited. Not so today. Your grocer’s shelves are filled with options. Besides that standard glass and plastic bottles, there are those with disposable bags, designer imprints, handles and animal shapes. All of these come in a clever range of colors and prints. This perhaps is more for mother’s amusement than baby’s. Adding to the confusion is a varied selection of supposedly proper nipples. You can find everything from a nursing nipple that is most like mom to an orthodontic nipple. There are juice, formula, water and even cereal nipples, so baby can suckle her table food. With so many choices, do not go to the store without adequate rest.
In truth, the most important consideration when buying nipples is making sure you purchase one with the right-size hole. With too large a hole, the child drinks too fast. Excessive spitting up and projectile vomiting can be signs of too rapid a fluid intake. Remembering this simple tip can save you many midnight mop-ups. Conversely, a hole which is too small creates a hungry and discontented child. Imagine the frustration! These simple tips will prevent what could be major feeding problems for your baby and you.
FORMULA
Take time to sit and hold your baby while feeding with a bottle. What better time to sneak in the rest you deserve, not to mention the cuddling your baby requires. Holding your baby at this time also will help prevent your child from becoming attached to the bottle. You control the feeding with the bottle in your hands-not baby.
Generally, avoid feeding baby while he is lying completely flat, such as when the mother is nursing in the lying-down position. Swallowing while lying down may allow fluid to enter the middle ear leading to ear infections. For the same reason, avoid propping up the bottle. Putting a child six months and older to bed with a bottle is a no-no. This is true not only for health factors relating to ear infections but also for oral hygiene. When a child falls asleep with a bottle in his mouth, the sugar in the formula remaining in the mouth coats the teeth resulting in tooth decay.
Most important in bottle-feeding is what goes in the bottle. Sometimes the choice may be made for you, either by the hospital where you deliver or by your pediatrician. If either your husband or you have a history of milk allergies, mention that to your doctor. It may influence the type of formula your pediatrician recommends. Formulas today have properties closely matched to those of breast milk, including the proper balance and quantity of proteins, fats, and carbohydrates. Cow’s milk and baby formula are not the same. Formula is designed for a baby’s digestive system; cow’s milk is not. Cow’s milk is not suitable for children less than one year old. For more specific information regarding the different manufacturers of formula, check with your pediatrician.
The amount of formula taken at each feeding will vary with the baby’s age. On average, as with breast-fed babies, it is anywhere from one-and-a-half to three ounces per feeding in the first several weeks. This amount gradually increases as baby grows. If you prepare a four-ounce bottle for each feeding and allow your baby to take as much as he or she wants, the baby will tend to stop when full. While a larger baby might take more formula, that is not always the case. As with breast-fed babies, the feeding routine or lack of routine is the primary influence on the establishment of predictable hunger patterns not the substance or the amount of food offered.
Again, we cannot overstate breast milk’s advantage in infant nourishment. However, if you choose not to nurse, you can’t nurse, or if you decide to discontinue nursing within the first twelve months, the decision will not make you an unloving mother. Just as breastfeeding doesn’t make you a good mother, bottle-feeding won’t make you a bed one.
BURPING YOUR BABY
Baby needs to burp. Initially, formula-fed babies must be burped every one-half ounce. By the time your baby is four to six months old, he or she will probably be able to consume six to eight ounces before burping. Both breastfeeding and bottle-feeding offer a certain amount of spitting up. You’ll learn to expect it. (Spitting-up is covered in Chapter 10.)
1. Place the palm of your hand over baby’s stomach. Now hook your thumb around the side of your baby, wrapping the rest of your fingers around the chest area. Your hand should be your baby’s only support. Rest his bottom on your knee, but allow all of his weight to be placed on your support hand. Next, lean the baby over your hand. If the baby is wiggling or needs further support, hold his or her hands in your supporting hand. Cup your hand and begin patting your baby’s back.
NOTE: Whenever you pat your baby’s back as described here, do so firmly but without excessive force.
2. Place your baby high on your shoulder with your shoulder placing direct pressure on his or her stomach. The baby’s head and arms should freely dangle over your shoulder. Remember to hold on tightly to one leg so your baby doesn’t wiggle away from you. Pat the baby’s back firmly.
3. In a sitting position, place your baby’s legs between your legs and drape the baby over your thigh. While supporting the baby’s head in yor hands, bring your knees together for further support and pat the baby’s back firmly.
Sitting up. Hold your baby in a sitting position on your lap, supporting her head and back with one hand and her chin and chest with the other. Gently pat her back. Over your shoulder.Hold your baby upright with her head on your shoulder and chest against yours. With one arm supporting your baby’s bottom, gently pat her on the back with your other hand, or rub her back upward. Across your lap. Lay your baby down across your lap. Support her head with one hand, and gently rub or pat her back with your other hand.
4. Cradle the baby in your arm with his or her bottom in your hands. (The baby’s head will be resting at your elbow.) Wrap one arm and leg around your arm. Make sure the baby is facing away from you. This position allows one hand to be free at all times.
NOTE: At times air will become trapped in the intestines of your baby. Most babies don’t like to expel gas. They will tighten their bottoms and resist the normal expulsion of gas making them very uncomfortable. One way to assist your baby in releasing gas is to place him or her in a knee-chest position. Place your baby’s back next to your chest and pull his or her knees up to the chest. This will help to alleviate your baby’s discomfort.更多精彩文章及讨论，请光临枫下论坛 rolia.net
Feeding your baby is perhaps the most basic task of managing your infant. Since a baby’s sucking and rooting reflexes are well developed at birth, he will satisfy those reflexes by rooting and sucking on anything near his mouth. Whether feeding is accomplished by a bottle or the breast is not nearly as important as the gentle, tender cuddling you give him during feeding. Your decision to bottle or breastfeed must be free of any coercion or manipulation. Guilt or a quest for approval is never in line with clear thinking. Instead, confidently base your decision on accurate, honest information.
Nothing beats breastfeeding for physiological benefits to baby. That is plain fact. Mother’s milk is the complete and perfect food-nothing short of miraculous. Easily digested, it provides excellent nutrition and contains the right balance of proteins and fats. It also provides additional antibodies necessary for building your baby’s immune system.
According to the American Academy of Pediatrics, there is strong evidence that breast milk decreases the incidence and/or severity of diarrhea, lower respiratory infection, bacterial meningitis, and urinary tract infection. The Academy also points out various studies demonstrating breast milk’s protection against Sudden Infant Death Syndrome, allergic diseases, Crohn’s disease, ulcerative colitis, and other chronic digestive disease.
There is more good news. Unlike formula, which needs to be prepared, stored, warmed, and packed for every outing, breast milk is always ready whenever and wherever you go. And you never need to wonder about the milk’s freshness. Inside mother, it won’t go bad. Breastfeeding is also known to speed the return of mother’s uterus to its normal size and shape which is another healthy consideration for a postpartum mom.
BREASTFEEDING TRENDS
Despite numerous benefits to breastfeeding, the American Academy of Pediatrics notes that the number of mothers opting to breastfeed is lower than expected. “Although breastfeeding rates have increased slightly since 1990, the percentage of women currently electing to breastfeed their babies is still lower than levels reported in the mid-1980’s and is far below the Healthy People 2000 goal.” says the AAP.
Why do nearly half of all mothers choose against the nourishment, convenience, and physical closeness of breastfeeding? Why do over a half of all mothers initially choosing breastfeeding opt out so early on? Are they simply callous women, cold to the nourishment and nurture of their babies, who are more concerned with freedom than baby’s physical well-being? Of course not. There is more to their choice and change of heart than is perceived on the surface. Possibly, the decision to quit breastfeeding is actually a disturbing necessity for distraught and fatigued moms unable to cope with endless demands.
The PDF moms reveal an interesting twist on the breastfeeding story. A convenient sampling of over 240 mothers following the PDF principles demonstrated that 88% of mothers who start with the program breastfeed, and 80% of those moms breastfeed exclusively with no formula supplement. And while the national average was 21.6% of mothers breastfeeding into the fifth month, a full 70% of PDF mothers continued into the fifth and six month. On average PDF moms breastfeed 33.2 weeks. Add to these statistics the benefits of uninterrupted nighttime sleep, and you will better appreciate the wonderful benefits of a flexible routine.
For PDF mothers, there is no questioning or second-guessing what will happen next and when. The routine for these moms provides greater understanding of their babies’ needs, helping them connect with their babies sooner. If problem occur, they typically fall so far outside a baby’s normal pattern of behavior that mother quickly picks up on this distress. Breastfeeding under these conditions is delightful, not demanding.
But even with these wonderful statistics, transforming a woman into a good mother is one thing breastfeeding cannot do. There is not “good mother” hormone, and much more is required than just bringing a baby to breast. While strong support for breastfeeding does exist, no one should choose breastfeeding at all costs. The well-being of your entire family is also a critical consideration. Although breast milk is a significant link to the physical well-being of a baby, the act of breastfeeding itself is not the genesis of baby’s psychological health. It is not a silver bullet assuring a love attachment or security.
If you want to ensure optimal development, provide a predictable routine for your baby. It will best complement baby’s overall advancement and attachment in all critical areas of development. Combine this with breastfeeding and your truly can offer a total package for your baby.
IS THERE REALLY A DIFFERENCE?
Demand-feeding’s more standard, moderate approach, as used by Julia and Barbara, instructs parents to feed their babies every two to three hours based on the baby’s hunger signals. On the other hand, PDF parents will feed their babies on a flexible routine every two to three hours. In terms of nutrition, both methods are the same. But as demonstrated earlier, the physiological outcomes are drastically different because one method is child-led and the other parent-directed.
Preparation for Parenting offers an alternative to hyper-scheduling at one extreme and AP style of nursing at the other. It has enough structure to bring security and order to your baby’s world, yet it has enough flexibility to give mom freedom to respond to any need at anytime. PDF moms feel comfortable handling this freedom to assess and decide need and offer her baby guidance.
Some moms rely too heavily on watching and waiting for their babies to signal a desire to nurse. They may be discouraged when their babies nurse so irregularly or want to nurse every hour. These mothers may worry about their babies getting enough food. The expectation that a baby should nurse whenever usually leads to frustration for both mother and baby and may be the single greatest reason mothers give up breastfeeding so quickly.
Waiting on the baby’s signal for food may also compromise the child’s health. Some newborns may not cry to signal hunger readiness for five to six hours, and crying is not always a signal of hunger. Weak and sickly babies may not have the energy to cry, so the advice of sit back and let the baby direct the show could allow serious medical problems to go unnoticed that would otherwise be picked up through routine feedings. It is the predictability within the routine that helps PDF moms pick up any deviation from the norm. Deviation cues stand out because there is a pattern of norm cues.
“Just listen to your baby’s cues” is common breastfeeding advice and good advice if you know what to listen and look for. Babies provide parents two sets of response cues-those that are immediate need (e.g. hunger, sleep, and messy diaper cues) and those that represent a parenting style. Behavior patterns can be attributed to parenting styles as much as temperament. For example, the three-month-old baby who has a pattern of waking two, three, or four times in the middle of the night to nurse is responding to his mother’s parenting style. In this case, the need cue for food may be legitimate, but the greater question centers on the greater parenting style cue-why is a child of this age repeatedly hungry at night? Mothers will say, “But my baby is waking for comfort nursing, not just food.” We would still ask the same question at this age. A baby nursing for comfort so many times during the night is a cue that your parenting style during the day is causing too much discomfort.
A baby nursing every hour is another double cue. It’s telling you two things. It may signal that your baby is not getting the rich, high-chloride hind milk and, equally important, that your baby is not getting enough healthy sleep. Healthy sleep facilitates healthy nursing. Fatigue is another parenting style cue. If mom is continually waking up each morning fatigued and discouraged from her middle-of-the-night experience, that is her body’s and emotion’s way of telling her that what she is doing is not working.
In contrast, the babies who are growing and sleeping contently and securely through the night are also responding to a parenting style. This is a healthy response signaling that their tummies are content and their hearts are secure in mom and dad’s parenting. What about the mom who wakes in the morning feeling rested? That sense of restedness is a positive response cue to what she is doing. Parents must learn how to distinguish between immediate need cues and parenting style cues. Both are important. One is for short-term benefit and one is for long-term gain.
MILK PRODUCTION
If breastfeeding is your choice, there are a few basic principles you must understand. The most important one is that breastfeeding success is based on demand and supply. The supply of milk produced by the glands is proportional to the demand placed on the system. The greater the demand, the greater the supply. But how do you define demand?
Steven’s mother heard that milk production is directly related to the number of feedings offered. The more feedings she gave, the greater her milk production would be. While there is some truth here, the statement is greatly misleading. Certainly a mother who takes her baby to breast seven times a day will produce more milk than the one who offers only two feedings; however, there are limits. A mother who takes her baby to her breast twelve, fifteen, or twenty times a day will not necessarily produce any more milk than the mom who takes her baby to breast eight or nine times a day.
The problem is not the amount of milk overall, but the quality of the milk taken in by baby. First, babies on a routine of fewer feedings will take in more calories at each of those set feedings than babies who feed ad lib. The difference here is qualitative feeding, as with a baby on routine, versus quantitative feeding, meaning more feedings of lesser quality.
With qualitative feeding, you eliminate the need for continual snacking. Many feedings become exactly that. Baby feels like a little something to tide her over. No meal is desired. Such snack feeding provides baby only a partial meal consisting of the lower-calorie foremilk and not the higher-calorie hindmilk essential for growth. Mom thinks she is doing more for baby through endless breast availability. In actuality, she’s delivering less than her best. Baby often quits suckling before optimum nourishment is offered. How disheartening for both.
Part of a mother’s ability to produce milk is tied to the demand placed on her system. Several factors are associated with the demand side of breast milk production, with two specific to this discussion. First, there is the need for appropriate stimulation at each feeding. That means the strength of the infant’s suck must be sufficient. A second factor for the PDF baby is the correct amount of time between feedings. Without proper stimulation, no matter how many times an infant goes to the breast, milk production will be limited. Too many snack feeding with too little time in between may reduce proper stimulation. Thus, baby gets only foremilk which is much lower in calories than the most desirable hindmilk. Too few feedings, which allow too much time in between feedings, reduce mother’s milk production. Both proper time lapse and stimulation are needed for breastfeeding success.
References to breast stimulation refer to the intensity of baby’s sucking. The urgency of a baby’s hunger drive will consistently influence the sucking reflex. This drive for food is related to the time needed for milk digestion and absorption into baby’s system. An infant fed on a basic 2.5- to 3-hour routine and whose digestive metabolism is stable will demand more milk. In turn, this stimulates greater milk production than the infant demanding less milk more often. Here then lies your key to efficient milk production. Work on getting full feedings.
THE LET-DOWN REFLEX
When a baby begins to suckle on his mother’s breast, a message is sent to the mother’s pituitary gland which in turn releases several hormones. The hormone prolactin is necessary for milk production and the hormone oxytocin is required for milk release. The most important factor in the continued release of prolactin is proper nipple stimulation. Without this stimulation, milk will not be produced no matter how many times an infant goes to the breast, because a consistent routine will help maximize milk production.
Before the milk is let down, you baby will receive a milk substance stored in the ducts under the areola (the flesh encircling the nipples). This foremilk, as it is called, diluted and limited in nutritional value. Oxytocin then causes the cells around the milk glands to contract, forcing milk into the ducts. When that happens, the milk is said to have been “let down”. For some mothers, this experience includes a tingling or pressure sensation. Without let-down, the milk would remain in the glands. In the absence of any sensation, the most reliable sign of let-down is your baby’s rhythmic swallowing of milk. The milk released is called hindmilk or mature milk. This high-protein and high-fat-content milk is rich in calories (thirty to forty per ounce).
Mothers following PDF have little or no problem with the let-down reflex. There are two reasons for this. First, routine plays an important part in proper let-down. Not only does the mind need a routine to maintain order and efficiency, but the body does as well. The very nature of inconsistent feeding wears on a woman’s body. A second reason is the high confidence level of the mother who follows a routine. There is no worrisome fear or anxiety for moms who know what happens next. Mother is confidant and her confidence aids the successful working of her let-down reflex.
BREAST MILK AND BABY’S DIGESTION
An empty stomach does not trigger the hunger drive. Efficient and effective digestion and absorption of food does. This is where the various food groups get broken down into proteins, fats, and carbohydrates. After the break-down, the nutrition is assimilated into the body via the blood. Absorption, which takes place primarily in the small intestine, is the process by which broken-down food molecules pass through the intestinal lining into the bloodstream. As absorption is accomplished, the blood-sugar level drops sending a signal to the hypothalamus gland. The red alert is triggered: Baby now needs food. So, it is blood-sugar dropping, not the empty tummy, which signals feeding time.
Breast milk is digested faster than formula, but that doesn’t justify unlimited breastfeedings to try and play catch-up. Rather than comparing breast milk to formula, it is more useful to look at the amount of breast milk consumed at each feeding. The AP Style of demand-feeding does not distinguish between snack time and mealtime. For these mothers, a feeding is a feeding. The child who nurses frequently and takes in fewer ounces, especially of foremilk, will naturally be hungry more often. PDF moms look to deliver full meals at each feeding.
PROPER POSTION FOR NURSING YOUR BABY
During the first few days of nursing, find a comfortable position for baby and you. This may be a matter of personal preference or an eclectic assortment based on situational needs. A pillow may be helpful under your supporting arm to lessen stress on your neck and upper back. Correct positioning of your precious bundle is imperative in successful lactation. How comfortable you are with this experience is also directly affected by the angles you impose on baby and yourself.
With your nipple, stroke lightly downward on your baby’s lower lip until she opens her mouth. Take care not to touch her upper lip as this creates confusion for baby. A her mouth opens wide, center your nipple and pull her close to you so that the tip of her nose is brushing slightly against your breast and her knees are resting on your abdomen. With baby correctly latched on, nursing should not be painful. Successful latching is made difficult if the baby’s head is toward the breast, but the body is allowed to turn away. If there is discomfort, remove her and try again. Patience in the process pays off as you discover what is best for you both.
When the baby nurses, she should take both the nipple and all or much of the areola into her mouth. Encourage the baby to latch on the areola, though she ay seem satisfied with only the nipple. Also, see that your baby’s entire body is facing you (head, chest, stomach, and legs). She will not latch on correctly if her head is facing you but the rest of her body isn’t. While this may sound awkward and impossible, baby has only one thing in mind when approaching the breast. Ideal positioning is not an issue for her consideration. You need to take charge here. To further assist in achieving successful feeding, there are three correct and interchangeable nursing positions: cradle, side-lying, and football hold.
Cradle Position
Cross Cradle Position
This position works well: · If you are learning to breastfeed · If you have a small baby.
Cradle Position
This position works well: · After you are comfortable with breastfeeding
The cradle position is most common. Sitting in a comfortable position, place your baby’s head in the curve of your arm. You may desire to place a pillow under your supporting arm to lessen the stress son your neck and upper back. When the baby nurses, he should take both the nipple and all or much of the areola courage and assist the baby in latching on the areola. With this approach, your baby’s entire body should face you (head, chest, stomach, and legs). Again, he will not latch on correctly if his head is facing you but the rest of his body is not. With your nipple, stroke lightly downward on his lower lip until he opens his mouth. When his mouth opens wide, center your nipple and pull him close to you so the tip of his nose is touching your breast and his knees are touching your abdomen.
Side-lying Position (above left)
Side-Lying Position
This position works well: · If you find it too painful to sit · If you want to rest when you breastfeed · If you have large breasts · If you had a caesarean birth
This position is commonly used by moms recovering from a cesarean delivery. Your stomach and your baby’s stomach should be facing each other, and your baby’s head should be near the nipple. With your nipple, stroke lightly downward on his lower lip until he opens his mouth. When his mouth opens wide, center your nipple and pull him close to you so the tip of his nose is touching your breast.
Football Hold Position (above right)
Football Position
This position works well: · If you are learning to breastfeed · If you have a small baby · If you have large breasts · If you have flat or sore nipples· If you had a caesarean birth
When using this position, place one hand under the infant’s head pulling him close. The breast is lifted and supported by the other hand. With the fingers above and below the nipple, introduce the baby to the breast by drawing him near.
A nursing baby often has a remarkably strong suck. If you try to pull the nipple away, she will just suckle harder. Just once, suddenly interrupt a feeding to answer the door and you quickly will discover baby’s intensity in this area. To remove her without hurting yourself, slip your little finger between the corner of her mouth and your breast. That will break the intense suction, allowing you to take her off easily.
HOW OFTEN SHOULD I NURSE MY BABY?
How often you should feed your baby depends on baby’s age. As a general rule, during the first two months you will feed your baby approximately every 2.5- to 3-hour from the beginning of one feeding to the beginning of the next. Sometimes it may be less and sometimes slightly more, but this time frame is a healthy average. In actual practice, a 2.5-hour routine means you will nurse your baby 2 hours from the end of the last feeding to the start of the next, adding back in 20 to 30 minutes for feeding to complete the cycle.
A 3-hour routine means you will nurse your baby 2.5 hours from the end of the last feeding to the start of the next. When you add 20 to 30 minutes for the actual feeding time, you will complete your 3-hour cycle. With these recommended times, you can average between 8 to 10 feedings a day in the early weeks. These times fall well within recommendations of the American Academy of Pediatrics.
While 2.5- to 3-hour routines are a healthy norm, there may be occasions when you might feed sooner. But take heed; consistently feeding exclusively at 1.5- to 2-hour intervals may wear a mother down. Extreme fatigue reduces her physical ability to produce a sufficient quantity and even quality of milk. Add postpartum hormones to the mix and it isn’t any wonder some women simply throw in the towel. Bear in mind, the word consistently is operative. As stated, there will be times when you might nurse sooner than 2.5 hours, but that should not be the norm. At the other extreme, going longer than 3.5 hours in the early weeks can produce too-little stimulation for successful lactation.
THE FIRST MILK
The first milk produced is a thick, yellowish liquid called colostrums. Colostrum is at least five times as high in protein as mature milk with less fat and sugar. As a protein concentrate, it takes longer to digest and is rich in antibodies. Some mothers experience tenderness in the first few days before mature milk comes in. This is due to the thickness of the colostrums and the infant sucking especially hard to remove it. A typical pattern is suck, suck, suck, then swallow. When mature milk becomes available, your baby responds with a rhythmic suck, swallow, suck, swallow, suck, swallow. At that point, the hard sucking is reduced and the tenderness should dissipate.
A clicking sound and dimpled cheeks during nursing are two indicators that your baby is not sucking adequately. Take the following test yourself. Curl your tongue and place it near the roof of your mouth, and then pull it away. You should hear a clicking sound. When your baby is nursing, you should not hear that sound nor see dimpled cheeks. It means your baby is sucking his own tongue not the breast. If you hear clicking, remove baby from breast and then re-latch him. If this continues, contact your pediatrician.
Even with a complete understanding of how the breast works and the many benefits of colostrums, mothers may still wonder if their babies are getting enough food in that first week. Consider these important clues. One sign that your baby is receiving adequate nutrition is his stooling pattern. Newborn stools in the first week transition from meconium, greenish black and sticky in texture, to a brownie batter transition stool, to a sweet odor, mustard yellow stool. The yellow stools is a totally breast milk stool and a healthy sign. After the first week, two to five or more yellow stools along with seven to eight wet diapers daily are healthy signs that your baby is getting adequate milk to grown on. Healthy baby growth indicators are discussed in Chapter 5. A bottle-fed baby will pass firmer, light brown to golden or clay colored stools strong in odor.
AFTER YOUR MILK COMES IN
Unless specified by your pediatrician, normally a baby does not need additional water or formula prior to mother’s milk coming in because your baby is getting colostrums. Once your milk is in, your nursing periods will average fifteen minutes per side. As mentioned, some babies nurse faster, and some nurse slower. Studies show that in established lactation, a baby can empty the breasts in seven to ten minutes per side, providing he or she is sucking vigorously. This astounding truth is not meant to encourage less time at the breast. Rather, it’s a clear demonstration of a baby’s ablity for speed and efficiency.
Under normal circumstances, baby takes what is needed within thirty minutes. The idea that non-nutritive sucking beyond this time enhances a baby’s security or heightens a baby’ sense of love is interesting but lacks serious scientific support. Security and love result from the overall parent-child relationship not one isolated factor. If you feel your baby has a need for non-nutritive sucking, a pacifier can meet the need without compromising your routine. But even with this, be careful not to over use the pacifier.
Usually a woman’s milk comes in between three and six days. During that period, some weight loss (up to 10% of birth weight) is normal and expected but should be regained by ten to fourteen days. We recommend that babies be weighted between ten and fourteen days. If there is a problem, it will show up on the scales. Catching it early allows for correction and is obviously much safer. Weight gain, as well as three to five or more yellow stools daily for the first month and five to seven wet diapers per day after the first week, are good indicators that your baby is getting enough milk for healthy growth.
NURSING PERIODS
Current wisdom governing the length of nursing periods for the first few days is fairly consistent. We suggest the following:
The Very First Nursing Period
If possible, nurse your baby soon after birth. This will be sometime within the first hour-and-a-half, when newborns are usually most alert. We suggest you strive for fifteen minutes per side or a minimum of ten minutes per side. Remember to properly position the baby on the breast. If your baby wants to nurse longer during this first feeding, allow him or her to do so. In fact, with the first several feedings, you can go as long as the two of you are comfortable. Both breasts need ot be stimulated at each feeding and the initial time frame mentioned above will allow for sufficient breast stimulation.
The First Five Days
For the next three to five days, maintain your basic 2.5- to 3- hour routine, nursing fifteen to twenty minutes on each breast. This means your average nursing period falls between thirty and forty minutes per feeding during this first week. Babies are usually sleepy during the first several days after birth. As a result, some will fall asleep right at the breast after a few minutes of nursing. That means you may have to work on keeping your baby awake at the breast. You can rub his feet, stoke his face, change a diaper, talk to him, or remove his sleeper, but he must eat. Keeping him awake will help him take in full feedings as opposed to snacking. It’s your key to success both in terms of early lactation and establishing a healthy routine. In our experience, mothers who work to get a full feeding during the first week have a baby who naturally transitions into a consistent 3-hour routine within seven to ten days. Keep this goal in mind when putting in the extra effort. The payoff is the confidence and comfort for both baby and you.
Some mothers nurse fifteen to twenty minutes from each side, burping their baby before switching breasts. Other mothers find it helpful to employ a ten-ten-five-five method. They alternate between each breast after ten minutes (burping the baby between sides) and then offer each breast for five additional minutes. This second method is especially helpful when you have a sleepy baby. This disruption prompts your baby to wakefulness and assures that both breasts are stimulated. Please note that these figures are goals based on averages. Some newborns nurse faster and more efficiently. Others nurse efficiently but slightly slower. If your baby wants to nurse longer, let him do so.
JAUNDICE IN NEWBORNS
A mild degree of jaundice is common in most newborns. This is not a disease, but a temporary condition characterized by a yellow tinge to the skin and eyes. Jaundice, caused by the pigment bilirubin in the blood, is usually easily controlled. However, it could develop into a dangerous situation when ignored or left untreated. If the condition appears more pronounced after the second day, frequent blood tests are done and conservative treatment is initiated.
Babies with moderately raised levels of bilirubin are sometimes treated with special fluorescent lights that help to break down the yellow pigment. Also, part of the treatment is an increase in fluid intake. In this case, your pediatrician may recommend other liquid supplements, although exclusive breastfeeding is usually the best way to correct this condition, even feeding as often as every 2 hours. Because bilirubin is eliminated in the stool, make sure your baby has passed his first stool (meconium). Your doctor will determine the program of treatment best suited for your baby. Because a newborn with jaundice will tend to sleep more, be sure to wake your baby for feeding at least every 3 hours.
BREAST VERSUS BOTTLE
We know there is substantial nutritional and health-benefit disparity between breast milk and formula during the first twelve weeks of baby’s life. By six months of age, the disparity is still present but to a lesser degree than in the first twelve weeks. According to the American Academy of Pediatrics, this six-month term is the minimum recommended duration. Between six and nine months, the difference between what is best and what is good continues to narrow. That is partly due to the fact that other food sources are now introduced in your baby’s diet. Between nine and twelve months, the nutritional value of breast milk drops and food supplements are usually needed. In our society, breastfeeding beyond a year is done more out of a preference for nursing than an absolute nutritional need.
When it comes to nourishing baby, mother’s milk is clearly superior to formula. Now for the stickier issue of nurturing. Is breast superior to bottle? In times past, experts said yes. Stressing the value of breastfeeding, they associated bottle-feeding with child rejection. Considered to be lacking warmth, a bottle-feeding mom was accused of renouncing her biological role as a woman and her emotional role as a mother. Others considered bottle-fed children to have less of an advantage in life than those who were breast-fed. In truth, studies over the last sixty years which attempted to correlate methods of infant feeding with later emotional development failed to support any of these conclusions. A mother’s overall attitude toward her child far outweighs any single factor, including manner of feeding.
BOTTLE-FEEDING
Bottle-feeding is not a twentieth-century discovery, but a practice that has been in existence for thousands of years. Our ancestors made bottles out of wood, porcelain, pewter, glass, copper, leather, and cow horns. Historically, unprocessed animal’s milk was the principal nourishment used with bottle-feeding. Since this milk was easily contaminated, infant mortality was high.
During the first half of this century when bottle-feeding was vogue, selection was relatively limited. Not so today. Your grocer’s shelves are filled with options. Besides that standard glass and plastic bottles, there are those with disposable bags, designer imprints, handles and animal shapes. All of these come in a clever range of colors and prints. This perhaps is more for mother’s amusement than baby’s. Adding to the confusion is a varied selection of supposedly proper nipples. You can find everything from a nursing nipple that is most like mom to an orthodontic nipple. There are juice, formula, water and even cereal nipples, so baby can suckle her table food. With so many choices, do not go to the store without adequate rest.
In truth, the most important consideration when buying nipples is making sure you purchase one with the right-size hole. With too large a hole, the child drinks too fast. Excessive spitting up and projectile vomiting can be signs of too rapid a fluid intake. Remembering this simple tip can save you many midnight mop-ups. Conversely, a hole which is too small creates a hungry and discontented child. Imagine the frustration! These simple tips will prevent what could be major feeding problems for your baby and you.
FORMULA
Take time to sit and hold your baby while feeding with a bottle. What better time to sneak in the rest you deserve, not to mention the cuddling your baby requires. Holding your baby at this time also will help prevent your child from becoming attached to the bottle. You control the feeding with the bottle in your hands-not baby.
Generally, avoid feeding baby while he is lying completely flat, such as when the mother is nursing in the lying-down position. Swallowing while lying down may allow fluid to enter the middle ear leading to ear infections. For the same reason, avoid propping up the bottle. Putting a child six months and older to bed with a bottle is a no-no. This is true not only for health factors relating to ear infections but also for oral hygiene. When a child falls asleep with a bottle in his mouth, the sugar in the formula remaining in the mouth coats the teeth resulting in tooth decay.
Most important in bottle-feeding is what goes in the bottle. Sometimes the choice may be made for you, either by the hospital where you deliver or by your pediatrician. If either your husband or you have a history of milk allergies, mention that to your doctor. It may influence the type of formula your pediatrician recommends. Formulas today have properties closely matched to those of breast milk, including the proper balance and quantity of proteins, fats, and carbohydrates. Cow’s milk and baby formula are not the same. Formula is designed for a baby’s digestive system; cow’s milk is not. Cow’s milk is not suitable for children less than one year old. For more specific information regarding the different manufacturers of formula, check with your pediatrician.
The amount of formula taken at each feeding will vary with the baby’s age. On average, as with breast-fed babies, it is anywhere from one-and-a-half to three ounces per feeding in the first several weeks. This amount gradually increases as baby grows. If you prepare a four-ounce bottle for each feeding and allow your baby to take as much as he or she wants, the baby will tend to stop when full. While a larger baby might take more formula, that is not always the case. As with breast-fed babies, the feeding routine or lack of routine is the primary influence on the establishment of predictable hunger patterns not the substance or the amount of food offered.
Again, we cannot overstate breast milk’s advantage in infant nourishment. However, if you choose not to nurse, you can’t nurse, or if you decide to discontinue nursing within the first twelve months, the decision will not make you an unloving mother. Just as breastfeeding doesn’t make you a good mother, bottle-feeding won’t make you a bed one.
BURPING YOUR BABY
Baby needs to burp. Initially, formula-fed babies must be burped every one-half ounce. By the time your baby is four to six months old, he or she will probably be able to consume six to eight ounces before burping. Both breastfeeding and bottle-feeding offer a certain amount of spitting up. You’ll learn to expect it. (Spitting-up is covered in Chapter 10.)
1. Place the palm of your hand over baby’s stomach. Now hook your thumb around the side of your baby, wrapping the rest of your fingers around the chest area. Your hand should be your baby’s only support. Rest his bottom on your knee, but allow all of his weight to be placed on your support hand. Next, lean the baby over your hand. If the baby is wiggling or needs further support, hold his or her hands in your supporting hand. Cup your hand and begin patting your baby’s back.
NOTE: Whenever you pat your baby’s back as described here, do so firmly but without excessive force.
2. Place your baby high on your shoulder with your shoulder placing direct pressure on his or her stomach. The baby’s head and arms should freely dangle over your shoulder. Remember to hold on tightly to one leg so your baby doesn’t wiggle away from you. Pat the baby’s back firmly.
3. In a sitting position, place your baby’s legs between your legs and drape the baby over your thigh. While supporting the baby’s head in yor hands, bring your knees together for further support and pat the baby’s back firmly.
Sitting up. Hold your baby in a sitting position on your lap, supporting her head and back with one hand and her chin and chest with the other. Gently pat her back. Over your shoulder.Hold your baby upright with her head on your shoulder and chest against yours. With one arm supporting your baby’s bottom, gently pat her on the back with your other hand, or rub her back upward. Across your lap. Lay your baby down across your lap. Support her head with one hand, and gently rub or pat her back with your other hand.
4. Cradle the baby in your arm with his or her bottom in your hands. (The baby’s head will be resting at your elbow.) Wrap one arm and leg around your arm. Make sure the baby is facing away from you. This position allows one hand to be free at all times.
NOTE: At times air will become trapped in the intestines of your baby. Most babies don’t like to expel gas. They will tighten their bottoms and resist the normal expulsion of gas making them very uncomfortable. One way to assist your baby in releasing gas is to place him or her in a knee-chest position. Place your baby’s back next to your chest and pull his or her knees up to the chest. This will help to alleviate your baby’s discomfort.更多精彩文章及讨论，请光临枫下论坛 rolia.net