Feed Me! Breasts, Bottles, & Beyond -- Ann Douglas --10/14/2003

WebMD Live Events Transcript

Breastfeeding is best, but what if you aren't able to nurse? We looked at bottle babies, asked when to start feeding solids, and what to start feeding. And do you make it yourself or buy it? We asked our feeding questions when out "Baby Booty Camp" instructor, Ann Douglas, joined us on Oct. 14, 2003.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Support for this WebMD University course provided by Blue Cross Blue Shield of Massachusetts.

Moderator: Welcome to WebMD University: "Bootie Camp: A Four-Week Guide to Baby's First Year." Your instructor today is Ann Douglas, author of "The Mother of All Baby Books." Today she will answer your questions about feeding your baby, from breastfeeding to bottles to solid food. You may send in your questions at any time during the event. Welcome back to WebMD University, Ann.

Douglas: It's great to be back.

Moderator: This week we are going to talk about feeding.

Douglas: And all kinds of recipes like pureed squash!

Wouldn't Martha Stewart be proud?

Moderator: I like squash -- I just didn't like wearing it when my children were babies!

Douglas: So it's the recycled squash you object to?

Moderator: Yup! Let's take a question.

Member question: My baby is just over 2 months old and seems to be spitting up the grains from the powder formula with what looks like to me stomach fluid. Should he be on something more solid (baby food)?

Douglas: Normally we don't really start worrying about starting solids until a baby is 4 to 6 months of age. I'm wondering if maybe there's something wrong with the particular batch of formula that you are using, because I've never heard of babies having granular bits after a feeding. Perhaps you might want to either try another batch of that manufacturer's formula again, or try another brand and see if that fixes the problem.

Or you may want to try going with a liquid formula (the down side, of course, to going the liquid formula route is that it isn't quite as convenient. You can't take small amount of powder in a container with you if you're going to be out and about in the day and mix the bottle at the last second without worrying about refrigeration issues. If you're lugging around a premixed bottle you have to worry about keeping it stored at an appropriate temperature).

So I can certainly understand going with the powdered product. So maybe give that particular brand one more chance and then start experimenting with other options. Good luck.

Moderator: We know that breast is best, but if you are using formula, how do you decide which one to use? Milk or soy? What about those new ones that say they have extra ingredients?

Douglas: We know of course that breast milk is best for babies, but if you decide to go with formula today you have a smorgasbord of different choices. Whether you go with a milk-based formula, soy-based formula or another type of formula is one of those issues you will want to talk though with your child's pediatrician. Most of the time with the majority of babies it makes sense to stick with a milk-based formula.

For families with a history of cow-based allergies your pediatrician may recommend an alternative such as a soy-based formula. This is one of those perennial topics of infant nutrition, so you'll want to do some reading on this issue so you'll have pros and cons of your various choices and you can ask appropriate questions of your pediatrician when deciding which type of formula will be best for your baby.

Member question: His doctor told me not to switch. He's on Enfamil Lipil with iron. She then said that if it's stomach fluid he's spitting up to give him an antacid. What's you opinion about that?

Douglas: Trust your doctor's advice. It's really hard in a chat like this for me to get a full sense of what's going on and of course, I am not an MD. So I would say listen to what she has to say, because she has taken the time to take a full medical history of your son and obviously has some valuable insights in the situation.

Member question: My 4.5-month-old daughter still wakes up every two hours to nurse at night. Would feeding her formula or solids help?

Douglas: Generations of sleep-deprived parents have asked themselves the exact same question, but in the majority of cases feeding babies extra food does not resolve the underlying sleep problem. In fact, if you get into the habit of introducing a nighttime feeding or offering your baby additional food at a nighttime feeding, you risk making that nighttime feeding an ingrained habit, something that will only add to your sleep challenges down the road.

Having a baby who wakes up in the night to nurse or have a bottle once or twice a night at age 4 and a half months is not at all unusual; in fact, it's the norm, and sometimes I think in our desperation to get a decent night's sleep we sometimes have a tendency to rush Mother Nature along a little bit when it comes to the whole sleep issue.

You would be better to just look for other cues that your baby might be ready for a bit more food or more solid food during the day rather than relying on her sleep habits as your only clue that she might possibly be ready for solids in her diet.

Here are some indications that you might use in judging whether or not a baby is beginning to be ready for solid food:

  • Nurses or drinks her formula eagerly and seems to be looking for more food when the breast or bottle is empty.
  • Wants to eat more often than she has up until now.
  • Physically able to sit up with support and has control of her head and neck muscles (she will need to be able to assume a sitting or semi-sitting position in order to eat solid food safely).
  • She can keep her tongue flat and low so that you can insert the spoon in her mouth.
  • She knows how to close her lips over the spoon and how to use her lips to remove the food.
  • She is able to keep food in her mouth instead of letting it ooze out her mouth.
  • She is able to tell you she has had enough to eat by turning her head away.

These are far more reliable signs she is ready for solid foods than her sleep patterns at nighttime. Hope this helps to shed a little light on this issue.

Member question: When I returned to work I put my baby on formula. But I couldn't handle working and being away from him. So I'm home full time, poorer but happier. Can I go back to breastfeeding? Is there anyway to start it up again?

Douglas: Some women have been successful in "relactating," but it can depend on how long ago it was since you stopped nursing, whether you were nursing on a part time or full time basis, how old your baby is, and so on. If you are going to be nursing on a part-time rather than full-time basis you will find this is an easier goal to achieve once a baby has been weaned.

The secret is to start slowly and to get support from a qualified lactation consultant or other breastfeeding expert who has had experience in relactating, because there can be some challenges involved. As you've probably read, it is much easier for babies to get milk from a bottle than it is a breast, and human beings being what they are, some babies don't want to do the extra work involved getting milk from a breast once they've experienced easy street in land of the bottles.

That's not to say the situation is totally hopeless; it most certainly is not. I know mums who have been successful in this very situation, but I would not be being honest with you if I said it was easy and something you could accomplish overnight. Give it your best shot and make sure you have access to the support you need to accomplish your goal in breastfeeding your baby. Good luck.

Member question: If you normally breast feed and want to supplement with formula (if you go out for the evening) how much do you give?

Douglas: That's the $10,000 question, isn't it? After all, we breastfeeding mums don't have lines on our breasts to tell us how much milk our babies have consumed. So sometimes a little guesswork is in order. It's better to err on the side of leaving too much formula than too little; trust me, if you're leaving baby behind with dad he will appreciate if he has 10 times as much as he needs as opposed to you being stingy with the formula!

So you can assume if you are missing one feeding, if your baby is quite young, your baby will drink between 4 and 8 ounces, but again, that's only a wild guess on my part. What if your baby is totally famished tonight and decides to have a 12-ounce feeding? So do yourself, dad, and baby a favor and leave a couple of cans of formula behind. If worse comes to worse you'll have a few cans left for the next time you decide to enjoy a night out on the town by yourself.

By the way, good for you for deciding to take a bit of a break from your baby. I know it's sometimes hard to get away because mums and babies feel so connected to one another, but it's really important to preserve some of your own interests and friendships after you become a mum. So whether it's showing up at your once-a-month book club meeting or taking in the occasional movie with your college roommates, it's great that you're managing to get out on your own every now and again.

Moderator: In a situation like that, wouldn't it be best to pump breast milk and use that in a bottle instead of formula?

Douglas: Absolutely. I am a total fan of breast pumps, although if you're going to pump, you want a serious breast pump. It's like comparing one of those manual pencil sharpeners that always breaks the lead in your pencils versus one of those high-powered electric pencil sharpeners that does the job quickly and effortlessly (I may have scared you with the pencil sharpener image).

What I am trying to say is that a really good quality breast pump will extract breast milk from your breast very quickly and efficiently. I rented a top-quality model when my youngest child was born, and within about 10 minutes I could have about 4 ounces extracted while I sat and watched TV or listened to music. Compare this with the pitiful $30 battery antique model I used when my first baby was born in the late 1980s. I could only ever get half an ounce of breast milk with that horrible contraption, roughly enough to fill one ice cube in our ice cube tray.

Do you know how many pumping sessions it used to take to fill a four-ounce bottle? Yes, 8 pumping sessions. Yes, it was quite an endeavor to leave a bottle of breast milk so my husband and I could go out to dinner on our own now and again. If I came back and discovered my baby had only drank part of the bottle and had to pour the rest down the drain -- the horror!

So if you're going to pump, which I strongly recommend that you try to do, what I would suggest is that you consider renting one of the truly top quality models. You can often track these down at either a medical supply store, from your local La Leche League leader, or your hospital or health unit. It may take a little bit of legwork to find out who rents these in your community, but it's definitely worth investment of time and money. Good luck.

Member question: What is your opinion on feeding schedules for infants? Is it a good idea to establish a pattern for them, or to let them ask to eat when they are hungry, no matter when or how often it is?

Douglas: I have mixed feelings on this issue. I very much believe when babies are quite young that they should be fed on a demand schedule; in other words, when the baby wakes up and wants to nurse then the baby should be offered the breast, whether 6 or 12 times a day, or however many times a day. After all, babies are programmed to know what they need and to ask to have their needs met accordingly.

As babies get older, however, and begin to approach their first birthday, I think we can start to teach them to start following a feeding schedule that more closely resembles the feeding patterns of older members of the family. Of course, a baby will still be eating many more times a day than mum, dad, and any older siblings. A baby will probably eat four to six, and perhaps eight times a day. Baby can start sitting at the table at meal times and sitting at the high chair for snacks, as well, so Baby is associating sitting in the high chair.

I'm not suggesting that you lug yourself and baby down to the kitchen if your 8 month old is still waking up for a midnight feeding. That would be crazy. But what you want to do is slowly but surely help your baby to develop feeding habits that more closely resemble those of the rest of the family.

That raises the whole issue of introducing normal table foods to your baby. A lot of people think you have to go out and buy a lot of special baby food for your baby. After all, isn't that why there's a whole aisle of baby food in the grocery store? After you've covered off the initial instant cereals, like oatmeal and rice cereals, which are easier to buy in their commercial formulations, there's no reason why you have to start buying all the tiny, and sometimes prohibitively expensive, jars of pureed baby food when you could easily make a lot of this baby food yourself.

If, for example, you're having peas for dinner as part of your family's dinner tonight you can puree some of those peas and serve them to your baby. The advantage of doing this is you end up introducing your baby to the very types of foods that your family likes to eat on a regular basis. That way your baby won't experience culinary culture shock when he or she stops eating all the stuff in the baby food jars and then discovers that your family actually eats radically different stuff that doesn't in any way resemble anything that's in a baby food jar.

You'll also save yourself a small fortune. If you look at the price of a baby food jar of pureed bananas and the cost of a typical banana you'll quickly see that you can save a huge amount of money by pureeing your own baby food and then freezing the pureed fruits and vegetables in ice cube trays and storing these cubes in freezer bags. One little tip for you, however: An awful lot of vegetables are orange, so label your freezer bags, otherwise after a while you'll have a hard time figuring out which bag is the squash, the sweet potatoes, and which are the yams.

I hope some of these tips are helpful, and that they inspire you to give your blender a bit of a workout. You may feel intimidated about making baby food, but I have to tell you it's the easiest thing in the world. I am probably one of the least culinarily inclined people on the planet, and yet I took great pride in making baby food for my kids. So you can pull it off too.

Moderator: How important is it to introduce foods one at a time?

Douglas: It's very important to introduce foods one at a time in case your baby ends up reacting to the new food. If you were to have three new foods on your child's plate at dinner tonight and your baby broke out in a mystery rash in the morning you would have no way of knowing whether the culprit was the peas, the orange juice, or the broccoli (Personally I would blame the orange juice, but that's just me). If you allow a few days' gap before you introduce the next new food, you won't have to go into detective mode when a new rash appears. It will be obvious to you that the food that was introduced last night may be to blame for this strange prickly rash or other symptom that your child is exhibiting.

Also, you should think about the fact that children are sometimes resistant to new foods (how's that for an understatement). Your baby may not be as willing to try new foods if everything on the menu tonight is new. Studies have shown that children of all ages are more willing to try new foods if the new food is surrounded by familiar foods.

Here's an interesting stat, by the way, about introducing new foods. Studies have found that some children have to be exposed to a new food up to 15 times before they will accept it, so don't assume that your child is not a fan of brussel sprouts, just because she's turned her nose up at them the last dozen times you've served them. Maybe you're just three times away from turning her into a brussel sprouts fan!

Member question: My mother-in-law won't stop mentioning that putting rice cereal in a baby's bottle helps with sleeping through the night because the baby is more full. This is totally false, right? Our child isn't even born yet and I'm already going nuts over all the unneeded and outdated advice. How do I deal?

Douglas: I am taking a deep breath on your behalf, because I am just shaking my head. I can't understand, A, why this myth gets handed down from generation to generation, and B, why mothers-in-law sometimes feel a need to pass on bad advice, even before people have had a chance to have their babies.

OK, I feel better now. I think I can climb back off my soapbox. To answer your question, you are absolutely right. There is no truth to that old myth about putting cereal in the bottle to make the baby sleep longer. We now know that doing so can cause a major choking risk. Every pediatrician on the planet will tell you it's a very bad idea, so if your mother-in-law suggest it again, you might want to drag her off to your baby-to-be's first pediatric appointment so that she can ask the question for herself and get suitably lectured by the pediatrician in question.

Sometimes members of the older generation will only listen to authority figures like MDs, so don't be afraid to let your baby's doctor set the record straight on important issues like this. It can help to prevent intergenerational warfare. Good luck.

Moderator: I, on the other hand, am a good mother-in-law and do not offer bad advice to my daughter-in-law who is expecting our first grandchild. I'm just giving her your book, "The Mother of All Baby Books."

Douglas: Thank you!

Member question: When does baby start holding a bottle on his own?

Douglas: Of course, like everything else baby related, there can be considerable variations as to when a baby can hold the bottle for herself, but most babies will start holding the bottle for themselves sometime between 9 and 12 months of age.

Before this time, you will need to hold the bottle for your baby, because while they may be able to hold the bottle in place momentarily, they can easily become distracted, let go of the bottle, and it will roll or slide away. Every once in awhile you'll read of a tragedy in the newspaper where a baby choked or there was a near choking involved in the case where someone rolled up a diaper and tucked it under the bottle so the bottle was supported, so an adult did not have to hold the bottle for the baby. Not only is propping a bottle very dangerous, because it makes it difficult for the baby to remove the bottle from her mouth if she starts to choke, it also short-changes the baby in the cuddling department.

In fact, one of the things parents are told to check out when checking out daycare centers, is to see if the daycare center staff pick up babies when the babies are being bottle fed so the babies don't miss out on any cuddling time while they are being fed. Otherwise, they can be deprived of a lot of important human contact, contact that breastfed babies receive by virtue of simple biology. You can't breastfeed a baby from across the room. So it's an important point to keep in mind. When babies are little and they're being fed, hold them.

Moderator: Before we wrap up for today, do you have any final comments for us, Ann?

Douglas: It is really a lot of fun to make your own baby food and it helps to set the stage for promoting healthy nutrition within the family. We know that childhood obesity is a growing challenge in our society, so this is one of the ways that we can take charge of our children's health right from day one. I would encourage you to seriously consider being your child's nutritional advocate from birth on.

Moderator: Thanks for joining us, members, and thanks to Ann Douglas for sharing her expertise and experience with us. For more information, please read "The Mother of All Baby Books," by Ann Douglas.



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