Newborn Series: Feeding

Feeding Your Baby
Nutrition Requirements: The average baby after 2 months of age will take 24 ounces per day (about 2 ½ to 4 ounces every 3-4 hours).  At 4 months, the average baby will take 32 ounces per day.  Formula or breast milk is all that they need.  We do not recommend giving water until 6 months of age and then no more than 6-8 ounces per day.

Starting Solids: We recommend starting solids (pureed Stage 1 foods) after 6 months. From an allergic standpoint, it is safe to start solids at 4 months, but from a mechanical standpoint, it is easiest to just start at 6 months after the tongue protrusion reflex has subsided.  If your baby demonstrates a lot of interest at 4 months, give them a trial of solids and see how they do.

Breastfeeding
Below are some of the common questions we hear but by no means a comprehensive list.  For more information, please refer to  www.breastfeeding.com or ask your lactation consultant.

Not Enough Breastmilk: For starters, make sure your baby has an adequate latch and suck to give you the proper stimulation and that you are keeping hydrated and maintaining good nutrition.  If these are adequate, options include over-the-counter supplements such as fenugreek and mother milk tea.  If this is unsuccessful, the next step is a medication called domperidone (also known as motilium).  Domperidone acts on the neurotransmitter dopamine which is responsible for prolactin secretion, the main signal from the brain for milk production.  The IV form is not available in the US due to an FDA warning about cardiac arrhythmias with large doses of IV domperidone which is not used anymore.  The oral form at correct dosages is safe and approved by the American Academy of Pediatrics.  Side effects include abdominal cramping and sometimes headaches, both of which usually resolve with a lower dose.  The dose is usually 20 mg 4 times per day for 2-3 weeks, then weaning down to 10 mg three times per day for 3 weeks then twice a day for a baseline dose.  Most women stay on this regimen for an average of 3 months, but it is safe long term. The best place to obtain this is from the internet at >www.inhousepharmacy.com. It is not available in US pharmacies because of the black box warning with IV domperidone.

Feeding Non-stop (every hour):
In the first 2 weeks of life this can be a common phenomenon called cluster feeding.  Try to keep up and as your breast milk supply increases and peaks, usually at 2-3 weeks, this typically will resolve, and your baby is satiated.  If it seems that your baby is continuing to cluster feed for hours at a time after the age of 3-4 weeks, there is probably an issue with caloric volume.  At this point, we should consider changing the feeding plan as this can take an unbearable toll on a mother’s wellbeing.

Will Not Take the Bottle:
We recommend introducing the bottle at around 3-4 weeks.  This is late enough that your baby will not get lazy or confused with breastfeeding and early enough that he will accept the bottle.  If your baby will not take a bottle, try different types of nipples.  Unfortunately, there is no clear-cut solution.  Sometimes this situation culminates in a very hard first week of daycare.

Formulas: Which ones should you use?
There are basically 4 types of formula-

• Cow milk protein-based formula- Enfamil, Similac or Good Start. Other generic brands such as Kirkland brand or Target brand are also perfectly suitable as long as they contain DHE.
  • Within this group are also available: lactose free formulas, lower lactose formulas with partially hydrolyzed proteins (Enfamil Gentle Ease) (for babies with lactose intolerance) and thickened formulas (Enfamil AR) (for babies with reflux)
• Soy protein-based formula-Prosoybee or Isomil.
• Hydrosylate formulas- Nutramigen or Alimentum (for milk protein allergies)
• Formula for Premature babies- Neosure 22- this is a formula with extra calories and nutrition.

We personally recommend starting with Enfamil Lipil and the Enfamil line of products because it has the highest concentration of DHE. DHE has been proven to help with brain and eye development.

For excessive gas/loose stools/pain

• First, try Enfamil Gentle Ease (partially hydrolyzed proteins and less lactose) or Nestle Good Start (has probiotics mixed in) or adding over the counter probiotics.
• Second line would be to switch a soy formula (Prosoybee) for presumed milk protein allergy.
• Lastly, would be to switch to a hydrosylated formula (Nutramigen) (with pre- digested proteins) for presumed true milk protein allergy.

For excessive pain with reflux
Try Enfamil AR- this formula is mixed with a rice substitute than becomes more viscous after it hits the stomach, making it less likely to reflux.