Wednesday, July 2, 2008

Supplementing Options - Supplementing the Older Baby

A couple of moms have asked for more information on supplementing and daycare issues - namely, what to do when you can't pump enough and have to supplement. So, this post is an expansion on what we covered in the previous supplementing options post.

Obviously, a mom with a younger baby who wasn't pumping enough for daycare bottles would need to supplement with formula, unless she had a friend who could donate milk. But, a mom with an older baby has some options!

Let's say baby is at daycare for 8 hours. All babies are different, so some babies need more or less frequent feedings and amounts do vary. That all said, we are going to assume here that baby is in daycare from 8 am to 5 pm - which is a standard time for most parents who drop off before work, do an 8 hour work day, and then return to pick up baby. So, for most babies - that's a 9 hour day at daycare. Most older babies will be eating/drinking about every 3 hours. We'll base this on a baby that is around 8 months old, eating solids fairly well, and is on the above schedule. Again, your baby may be different but this post is to just give you a sample and some ideas. And, this also assumes that mom is nursing well and fine when with baby.

For this time frame you'd need 3-4 bottles (or sippy cups!). I'd limit breastmilk bottles 2-4 oz total. This way you'd only need 12 oz of BM max a day. One of those "bottles" could be a 6 oz cup with 4 oz juice and 2 oz water mixed - or you can serve this in one 6 oz or two 3 oz cups (remember that the American Academy of Pediatrics says no more than 4 oz juice for baby a day, ok? "Fruit juice should be used as part of a meal or snack. It should not be sipped throughout the day or used as a means to pacify an unhappy infant or child. Because infants consume fewer than 1600 kcal/d, 4 to 6 oz of juice per day, representing 1 food serving of fruit, is more than adequate. Infants can be encouraged to consume whole fruits that are mashed or pureed."). And it is generally recommended that all juice be given in a cup, not a bottle.

I'd give two meals at daycare - ones that are "solid" in terms of nutrition. By 8-9 months she'll likely be able to eat soft solids (instead of mush!), but even if she isn't any of this can be mashed or put in the food processor! So, let's assume 3 bottles of BM (2-4 oz each unless you pump more!) and one cup of juice mixed with water (it is important to mix with water so that baby doesn't develop a sweet tooth!) will be old enough for a sippy, probably, by that age. Start introducing the sippy EARLY in her high chair with just plain water.

Here is a sample schedule - assuming baby is eating foods on her own - this would need to change if she can't "chew or mash" foods on her own yet. Offer breakfast at daycare at 8ish and lunch at noonish, snack at 10ish and 2ish. Make sure to offer protein or "hardy" foods at lunch and breakfast.

Nursing AM (7:00 am) - nurse baby one last time before daycare at home!

Breakfast (8:30 am) 1/2 avocado spooned out to baby, 1/4 cup scoop of cheerios, spoonful of pears, 2-4 oz BM

Snack (10:00 am) - 1/4 cup cubed cheese or cut up cheese sticks, handful grapes cut in half (choking hazard here if left whole, and must be cut in half until child is 3 or 4), couple goldfish crackers or cheerios for texture OR small cup yogurt w/ fruit, 3 oz juice/water mix in a SIPPY CUP or plain water if you prefer to give the mix as a 6 oz cup later in the day.

Lunch (12:00 pm) - 1/4 cup black beans rinsed, well cooked spiral noodles (can be cold that is ok), banana chunks 2-4 oz BM

Snack (2:00 pm) - handful of diced turkey, cheerios or crackers or rice (some sort of carb) 2-4 oz BM

Nursing PM (4:30 pm) - nurse at daycare when you pick up baby or right when you get home. If it is going to be a long time before you can get home then ask daycare to offer baby another very small snack at around 4:00 pm, so baby won't melt down in the car! Nurse immediately when you get home.

Then, nurse on demand throughout the evening and night. You can offer baby a small dinner. But, when you are with baby always nurse FIRST before meals so that baby takes in more milk and stimulates your supply. A baby that is 8-9 months old still needs to have BM or formula be the MAIN source of nutrition. Thus, baby should be nursing/getting BM about 6-7 times a day MINIMUM at this age. So, nursing 2-3x a home in the evening will do the trick! If baby cues more or wants to eat at night, well, that is pretty normal and you should let baby nurse.

If baby is still needing to do mushy foods at this point and is on regular baby food, just use what you can that makes sense. You can EASILY make your own jars or containers of beans pureed in the food processor for her to take with her. Grinding up some turkey and rice is easy, too - use a bit of chicken broth if it is too dry.

IF you pump enough so that you can do all FOUR bottles/cups with BM with no problem, I'd do that INSTEAD of the juice. Also, tell daycare that if at anytime baby drinks it all and wants more, to offer baby some water in a cup and allow them to give an extra small snack - like beans. If you have no history of allergies in your family, something like just a tad of peanut butter on a bagel can also be a good snack. Amounts above are ballpark and baby may not eat it all. So, that is ok. Some babies may do fine with smaller amounts.

Avocado - can be sliced in half, pit removed and spooned out to baby. She can eat it "raw" as long as it is ripe (and somewhat soft) - if it is "hard", it isn't ripe enough. If she likes to feed herself you can dice it (I'd go with the firmer ones to do that - but it is messy, so spoon it if at all possible).

Beans - any kind will do. My DD loved black beans. If baby isn't yet really eating anything with "form" to it yet, I'd mash them or put them in the food processor for a few and spoon them to her. A bean dip consistency is good - and babies LOVE these. Once they can eat them on their own they are the easiest thing to they are easy to pick up and put in the mouth. I recommend for black beans to rinse them first to avoid a big black gooey mess, lol. Well cooked green beans, limas, navy beans, black eyed peas, etc, etc...are also just fine. And, you can start them at any age. People in cultures that are "bean heavy" usually serve mashed beans as a first food.

Noodles - tossed with a bit of olive oil or plain. Well cooked...for once baby can mash foods with her teeth or gums. IF baby can't eat on her own and is still on "regular" baby food, then you'll need to go with one of those options. Always watch for choking and make sure that baby really can mash/chew before you throw lots of these down!

Meat - diced. Turkey or ham from the deli section in the store does great for this ...get them to cut you one 1/4 inch "slab" and then you dice it at home for baby. Again, baby needs to be at the point that she can mash/chew such before then. You can also put this in the food processor if you want to give baby non-processed meat you cook at home.

Soft cheeses - diced...even some harder ones like cheddar can be cut into tiny little cubes for baby. Cheese sticks are a fav, too.

Yogurt - my kids both loved yogurt. As long as your little one doesn't have milk protein issues, then yogurt can be a great choice.

Whole fruits - like banana, strawberries, grapes cut in half, etc can be good choices, too.

Most of the items above CAN BE CHOKING HAZARDS if baby isn't watched and/or if baby isn't doing "harder" solids yet. But, by 8-9 months she'll probably be into these. Never let baby eat unassisted.

Let me know if you think this sample schedule might work for you! Our daycare also had some standard foods there once baby was one year old and they would also feed baby at one year old off of the regular daycare menu...

Please note that this is all based on you nursing baby on demand when she is with you so that she can make up for any deficits. Make sure to nurse FIRST before you give solids each time as BM needs to remain her primary source of food until she is one year old - at which point you can start a slow transition. But, if she nurses when she gets up, again when you get home with her, again at 7 or 8 when she goes to bed, and once during the night, then that is helping to make sure baby gets enough servings of BM a day for her ...she may still need more at this age, some babies do and a few take in less. If needs more, you might have to fit in an extra pump at home or work to do that. Most moms pump at work during the normal time baby would nurse.

I hope this helps give you all some ideas for older babies. Sometimes we think we need 5-6 eight oz bottles to get baby through the day! But, if we increase the QUALITY of food given (meaning, skip the no-nutrition puffs!) and give baby food with good sources of protein, calories, and fat, then we can support their nursing routine and not have to supplement with formula. For moms who can't then formula is a fine option!

As always, your feedback on this post and how helpful it was to you is greatly appreciated!

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