Saturday, June 28, 2008

Supplementing Options - What to feed baby?

When you first start to supplement, you may wonder what options you have for baby. Many moms are very opposed to using formula and investigate such things as rice, soy, or goat milk. Some moms wonder if they can use juice, solids, or cow's milk. In general, all these things do depend on your baby's age.

Here are my ideas based on what I've read and also done that worked.

For babies younger than 6 months old or for those who really aren't eating any solids of any significance at all, your options are pumped breastmilk or formula. The American Academy of Pediatrics (AAP) recommends the following options in terms of nutrition for very young babies from their first choice to the last:
1. Breastmilk via nursing
2. Mom's pumped breastmilk via bottle or other device
3. Pumped Breastmilk from a donor
4. Formula

The AAP also recommends that babies get breastmilk exclusively for the first 6 months - meaning no water, gripe water, formula, etc. For babies who must have a supplement, formula is the next logical choice, unless mom is able to pump or get donated pumped milk. Of course, some moms chose to use formula for various reasons and that is ok on here with us, but please do note the guidelines and that BM is considered best. So, if baby must be supplemented before 6 months old, use formula or BM before offering solids, as that is more in line with what is best for baby. That means, no rice milk, soy milk, cow's milk, water, gripe water, etc, etc...and no solids.

For older babies that need to be supplemented, mom may be able to get away with increasing solids or offering some limited other types of liquids - provided that baby is able to "make up" any deficits when with mom - so perhaps getting in an extra nursing session at night. Just make sure that you don't displace good fat/calories with a lesser source or that you don't skimp on it during the day at daycare without offering baby a chance to "catch up" later. Most babies who are nursing well remove milk much more efficiently than the pump - so even if mom has trouble pumping, most babies who are nursing effectively and efficiently will do just fine to make up the difference later that day when they are with mom. Just make sure you are offering frequently and not limiting time or access.

If baby is older than 6 months, but younger than 12 months and you need to boost nutrition or perhaps are struggling because you can't pump enough for all of baby's bottles for say, daycare, then you might be able to use some other foods. For instance, avocado is very high in fat and calories. Beans are high in protein and a good source of fiber. My daughter LOVED black beans! So, look to make sure that the solids they are eating are the "best choice", meaning if your child isn't gaining well and must be supplemented or you can't pump enough for those bottles, then skip the "puffs" and chose a more nutritious option. Noodles with a bit of olive oil is a good choice. Always BF or bottle first, as BM or formula should be baby's primary source of nutrition - then follow up with a nice meal.

If baby needs some liquids (maybe on a hot day!), 4 oz of juice a day is all that is recommended - so you can mix that with water to make it go a bit further (and baby won't get too used to the super sweets!) or you can offer baby some ice water or water in a sippy. Juice should never be given in a bottle. But for a baby 6-12 months, you want to make sure that they get enough calories and if you are short on milk the best way to do that is from good solids or to use formula. So, skip the "puffs" and the regular cow's amounts of juice can be used (watch that 4 oz guideline!), or formula. Water can be given as a liquid to wash down food if baby is eating well and mom doesn't want to give formula and then offer to nurse or give pumped milk again, as appropriate.

Babies over 12 months of age have lots of options, including cow's milk, soy milk, etc. Again, the 4 oz juice rule is still in effect! So, chose good nutritious options and supplement as needed with regular WHOLE milk (baby's need the fat until they are 2 years old for optimal brain development!).

So, I hope this helped you think through some more options for supplementing based on age. Let me know what you think or if any of this helped you!

Friday, June 20, 2008

Frustrated Mama Tip: Paced Bottle Feeding for Getting Back to Breast

Paced bottle feeding is a way to slow the feeding down for baby.

It has several benefits as follows:
  • It makes the feed more variable, like the breast – so baby doesn’t get to gulp down “easy” milk. This often makes BF easier for a baby that has gotten a preference for the faster/easier flow of the bottle.
  • It prevents baby from gulping so much air – which helps with spitting up and reflux.
  • It helps prevent baby from overeating – which helps with spitting up and reflux, as well as setting baby up to gain too much weight too fast which has implications later on for baby as fat cells never go away!
  • It helps baby maintain their oxygen saturation. Many bottle fed babies experience decreases in oxygen saturation due to the mechanics of the bottle.
Basically, with the bottle, the flow is continuous. Once they suck – they must continue to suck/swallow/suck/swallow or choke as the mouth fills again and again with fluid. Thus, the pattern is typically, gulp, gulp, gulp, gulp, GASP, gulp, gulp, gulp, GASP, SPUTTER, Gulp, Gulp….etc. This pattern also has the nasty side effect of making mom think baby was “hungrily gulping” down the bottle (which they’ll take after BF even if they are full because they don’t know better) and make her think she was starving the poor babe. Paced gives baby a chance to end the feeding, instead of being forced to finish.

After awhile all infants learn to end a feeding when full by turning away or spitting it out, but very young babies and babies with little or no bottle experience (i.e., BF babies) don’t know to do this. Thus, they also end up associating being “overfull” with being satisfied. Then, they end up taking in these huge volumes. There is some research that suggests a link between all this and obesity later in life…as the person learns to think that they are only full when stuffed to the gills…Babies who used paced feeding also take in less food. If we remember that the average BF baby only eats 24 oz or so a day, you can again see where paced puts baby back at a more normal volume.

That all said – lots of good reasons to use paced feeding whether you are BF or not!

Here is how to do paced feeding:

Offer bottle to baby for 2 sips. Quickly remove the bottle. Wait for a clearing swallow and a breath, pop bottle back in for another 2 sips. Repeat.

This sounds easy, but it isn’t innate and it feels “Wrong” at first. Also, baby may be VERY mad and get angry at the bottle being taken out. Just remember, this is to help baby and he’ll get over being mad. My daughter was very angry at first, but quickly learned to like it and ejected the bottle every couple sips to get some air. Much more like BF. For a baby who really likes that easy/fast bottle flow, it disrupts the meal enough that often they realize that the breast is a better place to be – no interruptions! They are left alone to nurse and drink to their own content. I’ve found MANY former babies who liked to do the “breast freak out” eventually went on to prefer the breast over the bottle after using paced feeding.

Let me know what you think of this "Frustrated Mama Tip". I hope this helps you as much as it helped me!

Thursday, June 19, 2008

New Mama Trap: Baby Acting Hungry

The most common reason that I hear for supplementing is that the baby was "acting hungry". Usually this means baby was fussy. Unfortunately for most moms, babies are fussy creatures. Baby's behavior should NEVER be used as an indicator of if baby "got enough" or not. The ONLY reliable indicator of intake is weight gain and output (i.e., wet/poopy diapers). If those are good, there is NO WAY baby did not "get enough" from nursing no matter how he is acting.

I've had a screaming fatty and a perfectly content baby that gained NOTHING in two weeks. If I had gone on just behavior, well, I'd have fed that fatty even more...and my little content one would have continued to have no growth. And, a baby that is fully BF will "hungrily gulp down" a bottle just because the mechanics of the bottle are different. Doesn't mean they are hungry and "wanted" the bottle. Many a supplementing mama has fallen into that trap.

So, if you are on here wondering if you should supplement or not ask yourself this - is baby losing weight? Are you only wanting to supplement because baby is fussy or because baby really isn't doing well in terms of his output or his weight gain? And, if baby is gaining SOME, but maybe not as much as your doctor would like, the first step is ALWAYS to FIX the breastfeeding, not to supplement right away. Even if the baby is a slow gainer, he isn't in danger. There is TIME to fix this without getting into the terrible trap of supplementing. Ask for a referral to a lactation consultant. We'll talk more about gaining issues in another post.

Are you feeding baby frequently enough? I've found that babies not doing well a lot of time are put on "schedules" and expected to go 3 hours between feedings. Breastmilk digests in 90 minutes. BF babies, as a rule, don't go 3 hours usually when they are newborn and some well into the first year. Count feedings from the START of one feeding to the START of the next, regardless of how long it took baby to eat. Fussiness can often be attributed to a frantic very hungry "too long between meals" baby. So, if baby nurses at 8 am and eats for 45 minutes, you'd feed him again around 10 am, or 2 hours later, even though he ate for 45 minutes. Start to start.

Friday, June 13, 2008

Welcome to Breastfeeding & Supplmenting

Hi there,

If you are here, then you are probably supplementing your baby or thinking about it. You may be here because your baby isn't doing well or you are having a hard time making exclusive breastfeeding work. You may be here because you chose to supplement for your own reasons. I hope this blog will help other women who are struggling to find good advice on supplementing. Much of the advice and information out there is for moms who breastfeed (on the breast and exclusively) or who exclusively formula feed. So, for those of us who supplement with formula or breastmilk or who exclusively pump and bottlefeed breastmilk, there is no real source of support or information. We hang out in this no man's land of being judged by people who breastfeed and people who formula feed. Both think we are bonkers!

While I do think breastfeeding is best, I know (from personal experience) that exclusive breastfeeding isn't always possible. I also don't think formula is evil. I will encourage moms to avoid formula, when feasible, but I certainly don't judge moms who chose formula or who are ready to wean to formula. I've "been there - done that" and I did supplement both my kids with formula and was grateful to have it to make up the difference between what I could produce and what they needed to thrive and do well.

Welcome. Feel free to post comments and questions. I'll try to post new ideas and answers to common questions at least weekly.