Nutrition: Baby and Beyond (cont.)

Member: She refuses the bottle during the day and we are constantly playing with her. She will eat her food but not the bottle.

Dr. Paula: Again, your baby's refusal of daytime bottles supports the idea that your baby really doesn't need more milk and certainly doesn't need it at night. What she wants you can give her simply by holding her and don't worry about her total milk intake. It will rearrange itself in a few weeks so that she gets the 16-20 ounces she needs during daytime hours. Remember, don't give up!

Member: I breastfed my first child for two and a half years. I now have a four month old who has just gone completely to formula. My question is whether or not it is possible to build a milk supply back up enough to at least pump and supplement with breast milk if not to go completely back to nursing. I would love to nurse again but because of some complications in the beginning, formula has always been a part of the equation and has only increased as my supply decreased from not nursing frequently enough. Any suggestions?

Dr. Paula: Yours is also an unfortunate but common situation. Most women who have only quit breastfeeding for one month or less can in fact reinstitute breastfeeding. You may need the consultation of a lactation specialist to get started but a breast pump and a lot of fluids and determination can get you where you want to be. A device that allows your breast milk to be enhanced by additional formula can also be useful in getting your baby to suck on your breasts again directly, and it is well known that direct sucking on your breast will get you the success you want faster than other methods such as pumping. This is a worthy goal but don't be too hard on yourself. Whatever you produce is beneficial no matter what the amount. Good luck!

Member: I'd like to breastfeed and use formula. At what age is it OK to start introducing formula?

Dr. Paula: Breast milk is best for the entire first year of life and the addition of formula is usually associated with a decrease in breast milk production. Therefore, it would be best to delay the use of formula when possible for as long as possible, certainly at least until after the first three months when most immunologic factors are transferred from breast milk to baby. Many circumstances interfere with full breastfeeding and you should not feel pressured by the breast milk quality to do anything that might harm you, but continue breastfeeding for as long as you reasonably can.

Member: I am pregnant with my fourth child. I was only able to breastfeed my first for a few weeks, my second for a few weeks, and my third not at all. I had terrible postpartum [depression] with my last two. Does it offer any advantage to only breastfeed for a few weeks?

Dr. Paula: Any amount of breastfeeding is a great gift to give your new child. Interestingly, some research strongly points to nursing as an advantage for women with a history of postpartum depression and you may want to inquire about this with the intention of delaying the addition of formula for both your benefit and your baby's. Certainly, a happy, healthy mother is of vital importance to your infant so let that be your guiding principle. Gynecologic endocrinologists are the specialists you would want to check with.

Member: I have an almost 4-month-old, when is a good time to introduce cereal? What are some signs I can look for from my baby?

Dr. Paula: Early introduction of solids such as cereal is now understood to be less than a good idea for your infant and when possible, delaying this introduction until close to 6 months would be best. We now know that adding cereal or other foods earlier than 6 months contributes to the development of allergies, eczema, and asthma, as well as obesity. Most important, never add cereal to a bottle as that system is not only developmentally inappropriate but it can be harmful to your child's health. I'm glad you asked about signs of readiness and the most important one is being able to sit up with little or no support. Most infants are close to or even beyond 6 months when this happens. Babies smacking their lips when you're eating dinner doesn't mean they want your food. There will be plenty of time soon for exotic foods; wait now for everyone's benefit.

Moderator: When you do start on solids, is there a preferred order?

Dr. Paula: Although many doctors pay little attention to the order of food introduction when giving new parents instructions, there is good, solid research to support introducing foods in a conscientious manner one at a time and in simple to complex order. That is, always start with single-component foods rather than mixtures, and choose low-allergenic type foods over the more risky ones such as wheat and egg. Wheat and egg should not be introduced until a year of age even for children with no family history of allergies. The list is long but start with cereals. Move on to fruits and vegetables and only move on to complex proteins when your baby is closer to a year of age. Complex proteins include animal protein and fish protein. Simple proteins exist in vegetables like soybeans and in dairy products.

Member: Is there a certain amount of cereal/fruits/veggies for my 7-month-old? When should I start finger food and what kinds of finger foods?

Dr. Paula: One of my golden rules is to let your child lead the way. Quantity of food is one of those important areas of control that you should relinquish to your baby with some caveats. Your new eater may not have the skill to ingest as much as she needs in the first few weeks, so offer solids several times a day even if only a few tastes occur each time. This will familiarize your infant with the technique for swallowing solids as well as for the taste and texture and digestion of them.

Similarly, finger foods depend on your child's development. An important tip is to put whatever finger foods you offer not only in front of your child but also in each of your child's hands. The balance your child needs for ordinary hand to mouth coordination at this age is best achieved with the two-handed approach; not to mention you will still have the opportunity to spoon feed when her hands are already occupied. Most infants are not ready for finger foods until after 8 months, but teeth are not a requirement as an infant's hard gums can do satisfactory damage to soft food as any breastfeeding mom whose been bit can attest to. Don't fret over quantity and attend to quality in choosing your child's menu.

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