Feed Me! Breasts, Bottles, & Beyond

Last Editorial Review: 12/28/2004

WebMD Live Events Transcript

Breastfeeding is best, but what can working moms do? What if you aren't able to nurse? We looked at bottle babies and which formula is right for your baby. When do you start feeding solids and what do you start feeding? Make it yourself or buy it? We asked these feeding questions and more when our baby expert Ann Douglas joined us on June 22, 2004.

The opinions expressed herein are the guests' 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.

MEMBER QUESTION:
I was breastfeeding for the first week. My baby had latch problems so my lactation consultant told me to bottle feed her till my nipples healed. I did that for three days now the baby refuses to breastfeed and I cannot get milk to pump out of my breast? I fear my supply is going to dry up. She was two weeks old 6/20/04. What should I do?

DOUGLAS:
Wow. That is a very challenging situation. I'm not quite sure what to recommend, because you have been working with a lactation consultant; however, I am surprised that a total interruption in breastfeedings was recommended during that all-important first week of breastfeeding.

I think you may want to consider consulting with a second breastfeeding expert, perhaps another lactation consultant or a pediatrician who has a lot of experience with troubleshooting breastfeeding problems, because it's important to get breastfeeding back on track as soon as possible. I wish you all the best, because you are clearly committed to breastfeeding your baby.

MODERATOR:
What tips do you have for new moms who want to breastfeed?

DOUGLAS:
The big thing is to try to find out as much as you can about breastfeeding ahead of time. Ideally, if you take prenatal classes there should be at least one session devoted to breastfeeding. You may also want to think about taking some separate breastfeeding classes ahead of time or visit a La Leche League meeting so you can get hooked up with breastfeeding support before your baby is born.

Another thing to do is find out where you can find answers to your breastfeeding questions. Before your baby arrives you may want to:

  • Jot down the number of the local La Leche league leader.
  • Check the yellow pages to see if there are any lactation consultants in practice in your community.
  • Contact your public health department to find out what kinds of breastfeeding support services are available locally.
  • Think about which friends you have who have successfully breastfed their own babies, because they may prove to be the best resource of all.

Of course it's always a good idea to read. In the back of my book, The Mother of All Baby Books, I include a number of recommendations of excellent books on breastfeeding. Fortunately, there is a wealth of breastfeeding information available today, so you can do a great job of researching ahead of time.

That's not to say there won't be a bit of a learning curve after your baby is born. There's a world of difference between looking at the mechanics of breastfeeding on the page and figuring them out in real life. Most of us find that there is a little bit of fumbling around, but that over time breastfeeding becomes a whole lot easier.

"There's a world of difference between looking at the mechanics of breastfeeding on the page and figuring them out in real life. "

MEMBER QUESTION:
Do you have any information about pumps? I have to go back to work and want my baby to have breast milk. Which pumps work the best? And is this a realistic plan -- pump for the day and breastfeed at night?

DOUGLAS:
When you're shopping around for a pump you may want to consider renting one of the top quality electric pumps as opposed to settling one of the poorer quality pumps. The reason is I rented one of the hospital quality electric pumps after my youngest child and I couldn't believe how much more milk I was able to pump as compared with some of the less expensive consumer-type products that I had used with my previous babies. Some of the truly creme de la creme hospital grade breast pumps even allow you to simultaneously pump from both breasts at once. If you are trying to extract milk quickly during your break or during your lunch hour, this can be a huge time saver. I can't speak highly enough of the Medela brand of breast pumps; they are simply fantastic in my opinion. So that's my two cents on breast pumps.

Obviously, you'll have to consider work wardrobe issues as well if you're going to be pumping breast milk on the job. You'll need to choose clothes that are easy to either lift up or open at the front to accommodate pumping at work. And it's also a good idea to choose garments that won't show staining too easily, should you leak a little milk before or after a feeding. Hey, it happens!

Another thing you might want to think about ahead of time is where you are going to pump at work. Ideally you will work for an progressive employer who understands that breastfeeding is a natural function and is good for babies, and therefore that the company should be supporting your efforts to breastfeed. Such forward thinking companies often provide comfortable rooms where mums can use a breast pump.

At the other end of the spectrum are employers who discourage mums from pumping in their offices and shame them into having to pump in the washroom stall. I personally think this is appalling, because I wouldn't dream of making my husband a steak dinner in the company washroom stall, so why should I have to collect breast milk for my baby's next feeding in the company washroom stall? I really think employers have to be much more supportive of the needs of breastfeeding families. Yes, I'm back on my soapbox again!

MEMBER QUESTION:
My wife breastfeeds our daughter. She works in the day (my wife; not our baby!) and pumps throughout. This gives me bottles to feed the baby during the daytime. We started her on solids -- mostly pears, apples, and rice cereal. Not sure what is the right amount to feed her. We mix in about 1 ounce of milk in each solid feeding. But, to be honest, our baby girl eats like a cow and always wants more. Can you overstuff a baby?

DOUGLAS:
It sounds to me like your baby is positively thriving, so I would just keep doing what you're doing, offering her food and letting her appetite be your guide. I think that feeding babies is one of those challenging areas of parenting, because every baby's appetite varies widely and we all have to figure out for ourselves how much food our baby really needs.

The best approach to take with babies, and older children, is to offer the food and watch for the cues they offer when they've had enough to eat. If, for example, she turns her mouth away when the spoon starts coming towards her, she's saying, thanks, dad, but I've already had enough. Instead of trying to convince her to have just one more bite, put down the spoon and let mealtime be done, because she is clearly full at that point. Young children haven't learned to disregard the message that tells them when they are full, and we don't want to train them to disregard this all-important message.

MEMBER QUESTION:
Can you mix formula and breast milk in the same bottle?

DOUGLAS:
Yes, you can. I'm assuming that you are topping up breast milk with formula because you don't have enough breast milk to make for a full feedings.

MEMBER QUESTION:
What's the frequency of breastfeeding the baby after first month?

DOUGLAS:
I am a strong advocate of demand feeding, so simply continue to offer the baby the breast when it appears the baby is hungry. This will ensure the baby receives the appropriate quantity of food. You probably will find your baby no longer needs to eat at the two to two and a half hour intervals that he or she did as a newborn, and the number of feedings decreases slightly now your baby is a little older.

However, don't be surprised if your baby goes through a growth spurt and the number suddenly increases for a one- to two-week time period. Sometimes this happens. This is Mother Nature's way of building up your milk supply to meet your baby's new increased demands for food.

MODERATOR:
While breastfeeding is best, for some families, for a variety of reasons, breastfeeding isn't an option. How do you choose a formula?

DOUGLAS:
What you want to do is talk to your baby's pediatrician to get his or her specific recommendations. There are far more formulas on the market today than there were even five to 10 years ago. For the most part, unless there is a reason to recommend an alternative your baby's pediatrician will probably recommend a cow's milk-based formula as opposed to soy or other alternative, but if your baby is unable to tolerate cow's milk, your pediatrician will help you find an appropriate substitute.

What you don't want is to start switching formulas from week to week because your baby is fussy or experiencing constipation, diarrhea, or some other physical concerns. If you start switching your baby's diet around dramatically you can make your baby even more uncomfortable and make it very difficult for your baby's doctor to pinpoint any underlying physical problems.

MEMBER QUESTION:
I've made a commitment to nurse for one year. Does that mean that I introduce formula at one year when I stop? If so, how long does a baby need breast milk or formula to supplement regular food and drink?

DOUGLAS:
Babies who are weaned from breastfeeding before 12 months of age should receive iron-fortified infant formula. If you are weaning your baby after that point you can switch directly to cow's milk. At this point your baby is likely to be eating a variety of foods, including iron-rich meats and egg yolks, so iron deficiency if less a concern, and iron fortification is one of the reasons for offering a baby formula.

MEMBER QUESTION:
How long do you keep giving the baby rice cereal? Once they take to other foods do you cut that back or keep mixing it in?

DOUGLAS:
If your baby totally loves rice cereal, you can keep this food in your baby's diet as long as you'd like. There's really no reason to stop offering rice cereal, but you will probably find that once your baby discovers the exciting world of other foods that have a lot more flavor, the rice cereal simply isn't going to have the same appeal that it did initially. So continue offering other foods and see where that takes your little culinary explorer. Good luck!

MEMBER QUESTION:
My 7-month-old is eating rice cereal. When is oatmeal OK to introduce? Because I eat that myself for breakfast, it would be a convenient thing to share with my baby but I heard that 9 months to 1 year for oatmeal is more appropriate.

DOUGLAS:
You would probably want to initially offer an infant-quality oatmeal cereal, rather than the oatmeal you have in your kitchen cupboard, simply because it may be milled a little more finely, and therefore will be able to blend to a smoother, finer consistency. With young babies we always have to be conscious of the risk of choking, and adult-quality oatmeal might be a bit too paste-like for babies, unless you ran it through the blender while it was still dry and then really watered it down after it was cooked.

But in terms of timing, my sources indicate that you're fine to introduce all the single-grain cereals relatively early on, along with all of the various fruits and vegetables. The most important thing to remember is to allow a three-day interval in between each new food so that you can quickly determine if a new food is responsible for triggering any allergic reaction that your baby may experience. You would want to be on the lookout for such symptoms as hives, acute diarrhea, projective vomiting, difficulty breathing, and so on.

One mum I know kept a food log and she noted in this food log every time she introduced a new food to her baby. That way if her baby did appear to be reacting to a particular food, she could quickly pinpoint what that food might be.

MEMBER QUESTION:
I've been told not to feed my baby homemade solids (strained sweet potatoes, carrots, etc.) unless the vegetables are organic . Do you agree? I'd like not to have to worry about it.

DOUGLAS:
In a perfect world we would only offer our children the purest foods, including organic foods, but not every parent's budget is able to afford this. So I don't necessarily think that we have to limit ourselves to organic foods only.

That's the answer to the first part of your question, but I should also talk for a moment about the joys and advantages of making your own baby food. Contrary to what a lot of parents believe, it does not require a lot of work or cleanup or planning. I know when you have a young baby you don't have an abundance of spare time, so anything that sounds like a huge chore you aren't going to want to take on, but making baby food is actually a lot of fun, especially the simple kinds, like bananas. All you have to do is peel the bananas, whip them in the blender, and freeze the pureed bananas in ice cube trays. Voila, you have a whole tray of banana cubes that can be individually defrosted whenever your baby wants some bananas for lunch or dinner.

Turning cooked veggies into baby food is only one step more complicated; you have to cook the vegetables first. So in the case of carrots, you would either peel the carrots or use frozen carrots and then cook them fully, then put them in the blender along with a little bit of water, and puree. You would then repeat the same process of turning them into carrot cubes and defrosting them as needed.

When you consider how little a bunch of bananas cost compared with a tiny jar of baby banana food, you can see the cost savings. You also get a tremendous amount of satisfaction from making the baby food. Plus, nothing at your dinner table that can be eaten by baby needs to go to waste -- the extra cup of carrots can be turned into tomorrow's lunch. So I would strongly encourage parents to consider making baby food rather than spending a small fortune on the commercial variety.

MEMBER QUESTION:
When do you start introducing solids?

DOUGLAS:
You can start introducing solids any time between four to six months. Basically, you start to look for signs that your baby may be looking for a little extra food than breast milk alone. At that point you start offering an iron-fortified rice or barley infant cereal that has been mixed with breast milk or formula. Initially you are offering very small quantities, something like 2 to 3 teaspoons twice daily. As your baby masters the mechanics in eating and swallowing solid foods, you then move on to other foods.

MEMBER QUESTION:
My baby doesn't seem to burp with solids the way she did with breast milk (even then she was never a big burper, but now with solids she burps even less). Is that normal?

DOUGLAS:
This is very normal, and may have as much to do with the texture of the food as with the fact that your baby is getting older and may be mastering the art of self-burping. She may be learning how to get those burp bubbles out on her own. But don't worry, mum. She still needs you for 10 million other things.

MEMBER QUESTION:
My baby is 7 months old and I introduced solids (rice cereal, sweet potatoes, squash, applesauce, and pears so far) to her at 6 months. Prior to that she was exclusively breastfed. She only had a stool every five days while breastfeeding and they were very soft and liquidy. Now she has a stool sometimes twice a day and they are hard, like a normal stool. Is that right? Someone told me that the stool should still be soft while baby is under a year but it seems to me that the hard stool makes sense with the solid food.

DOUGLAS:
This sounds totally within the range of normal to me. Baby stools do tend to change in color, texture, and dare I say it, odor, too, once they start eating solid food. So what you're describing sounds like that normal transition to me. I would only become concerned if the baby's stools were mucousy, blood-streaked, or otherwise highly abnormal in appearance, but what you are describing sounds like a normal infant stool.

MEMBER QUESTION:
I know you start solids with rice cereal, but is there any recommended order for introducing fruits and vegetables? If so, what is it?

DOUGLAS:
I have never heard of any such order, other than it's probably a good idea to introduce vegetables before fruits; the reason being a baby who develops a strong preference for sweet fruits may be less likely to want to eat vegetables.

"When you consider how little a bunch of bananas cost compared with a tiny jar of baby banana food, you can see the cost savings. You also get a tremendous amount of satisfaction from making the baby food."

MEMBER QUESTION:
If a baby is eating solids and still breastfeeding, do they need solids three times a day or is two times a day OK? Is breast milk their main source of nutrition?

DOUGLAS:
Breast milk will continue to be a baby's main source of nutrition for quite some time. As I noted earlier, the initial quantities of infant cereal are 2 to 3 teaspoons, so what we are doing initially is familiarizing a baby with the mechanics of eating. A baby could not thrive on these small quantities of solid food. It's up to you whether you offer solid foods two or three times a day. This may simply be a matter of your family's lifestyle. For example, whether you sit down and have breakfast in the morning or if it's more convenient to breastfeed at that time of day and offer solids at another time of day.

As your baby gets older, you baby will switch to a three-meal-a-day program, and as your toddler gets older, you'll introduce snacks, too. But initially we're just giving your baby the chance to practice eating, so it doesn't matter of your baby is eating two or three times a day.

MEMBER QUESTION:
There has been lots of debate about drinking -two to three glasses of wine and if that gets to your baby or not while breastfeeding. What is your opinion? How does what mom eats affect the breast milk?

DOUGLAS:
I have read a lot of stuff on this in recent years, and I think it is a really good idea to be cautious about consuming alcohol while you are breastfeeding. This issue has only been spotlighted in the last few years, which is surprising given how much attention has been given to alcohol on the developing fetus.

What I suggest is either you avoid alcohol entirely, or limit the drinks you consume, or you consider the timing of the consumption of drinks, so maybe you are having a glass of wine right after finishing a feeding so it has the maximum time to leave your system. However, I am not an expert on lactation and alcohol consumption, so I would suggest you ask a lactation consultant what they suggest and go by those recommendations. I simply would stress this is one of those situations where moderation is definitely in order.

MODERATOR:
We are almost out of time. Ann, do you have any final words for us?

DOUGLAS:
Thank you, first of all, for your great comments and questions today. I always love hearing what people have to say. My comment today: get help with any breastfeeding problems right away. What starts out small can snowball, so you want to get the information and support as soon as possible. Fortunately, the majority of breastfeeding situations work out extremely well, but when there is a problem it can be extremely frustrating for the mother and the baby. This is when some serious support is definitely in order.

MODERATOR:
Thanks to Ann Douglas for sharing her expertise and experience with us. For more information, please read her book, The Mother of All Baby Books, for tips on all aspects of parenting during the first year.



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