The cornerstone of infant nutrition is milk. There are two excellent methods of supplying this basic source of nutrition. One is breast feeding, the other bottle feeding with formula. We feel that the optimal milk is mother’s milk and urge you to breast feed. However, there are many good reasons a parent may elect to use formula. Infant formulas fulfill all your baby’s nutritional needs.
Well visits, especially from infancy through the pre-school years are important! They allow frequent assessment of your child’s growth and development, and regular immunization. More importantly, however, they provide a time to discuss your questions and concerns and help prepare you for future developmental stages and routine illnesses.
Scheduling physical exam appointments in advance will allow you to choose the physician and appointment time which is most convenient for you.
As a rule, we will only schedule two physical exam appointments per family per day. However, if you have triplets less than 18 months old, we will see them together.
As a courtesy, our offices will confirm physical exam appointments 3 days in advance and again 2 hours before your scheduled appointment time. If you must cancel your appointment, you must call at least 24 hours in advance, or you will be assessed a $75 missed appointment fee.
For a complete list of the Well Child physical exam schedule as well as lots of information and tips, please refer to our “Baby Book” which is now available “on line”. The updated vaccine schedule in available in the Medical Web Site section. Regular well-child exams are routinely scheduled at two weeks, four weeks, then at 2, 4, 6, 9, 12, 15, 18, and 24 months. Thereafter exams are scheduled yearly. Well-child exams at 21 and 30 months are optional and may not be covered by your insurance company. Please note, the 2 month, 6 month, 12 month, 4 year and 11 year visits must be on or after the child’s birthday due to immunization schedules.
Breast feeding is the most natural, least expensive, and most convenient way to feed your baby. In addition to being a food well-suited for your baby’s nutritional needs, it also provides some protection against infection. Breast milk has a thin bluish-white color compared to cow’s milk. This causes some mothers to worry that their milk isn’t “rich enough,” but it has the same number of calories as formula. The breast milk secreted during the first 2 to 3 days of nursing, colostrum, is different in quality and less in quantity than that thereafter. Babies are born with extra fluid which tides them over during this period.
During the first several weeks of breast feeding, your breasts may initially feel engorged and tender. A hot shower or warm compresses followed by expressing excess milk may help reduce the discomfort. Ice packs (or cold compresses) on the breasts will help to decrease the swelling. Your nipples may become sore and cracked. This can be prevented by proper positioning of the baby. There is frequently leakage of milk between nursing periods which is a nuisance. Nevertheless, all of this unpleasantness is temporary. The milk ducts stretch and adjust to the presence of milk, and even though you are producing twice as much milk, the engorged feeling disappears. Likewise, the nipples toughen, the leakage stops, and the pain is replaced by a pleasant sensation.
First, find a place where you can relax and assume a position in which you are comfortable. There is no single best position for breast feeding. It is only important that the baby be held in such a way that he can grasp the nipple without straining, and that you are comfortable. Take the breast in your free hand and touch the nipple to the baby’s face next to his mouth. He will nuzzle for the nipple. His gums should press on the areola (the darker skin), not the nipple itself. Thus, the nipple should be well back in the baby’s mouth and he should not be sucking just on the tip.
Both breasts should be used at each feeding. At the next feeding, start with the breast where the last feeding was completed. The baby gets most of the milk from one breast in the first five minutes of good strong nursing. In the next five to ten minutes, he gets the hind milk which contains essential fat, so it is important to breast feed ten to fifteen minutes on each side. After breast feeding, dry your breast nipples off. If the nipples are sore, express breast milk and rub it into the nipples. A blow dryer on the low setting will hasten drying.
If you are experiencing problems with breast feeding, lactation consultants are available at the hospital where you delivered.
A normal, well balanced diet will supply all the needed nourishment for you and your baby. There are no foods that are essential. Likewise, there are no foods which must be avoided. Occasionally, a mother may find that ingestion of a certain food upsets the baby. It makes sense to avoid these foods when recognized. Many drugs are secreted in breast milk; therefore, check with us prior to taking any medications. Alcohol should be avoided.
After several weeks, when nursing is well established, a supplemental bottle of formula may be given for your convenience. Some mothers prefer to use their own milk rather than formula. Breast milk can be expressed manually or with a pump and then stored in a clean plastic container (antibodies in the breast milk adhere to glass). It can be stored in the refrigerator for 24 hours or frozen for periods up to six months. When using frozen milk, it must be thawed quickly and fed immediately to prevent curdling of the milk.
If your baby is to be bottle fed, we recommend using one of the prepared infant formulas with iron. Your baby should continue on this formula for the first year. These formulas come in 3 forms: (1) READY TO FEED formula comes in small disposable bottles and quart cans. It is most convenient but also the most expensive. It needs no preparation prior to giving it to the baby. (2) POWDERED formula is mixed like instant coffee. Follow the instructions on the can: two ounces of warm water to one packed scoop of powdered formula. This form is usually the most economical. (3) CONCENTRATED LIQUID formula comes in 13 ounce cans and is prepared by adding equal quantities of water and concentrated liquid formula. A convenient way to use it is to open a can daily, filling each of six clean bottles with two ounces of concentrated liquid and placing them in the refrigerator. When the baby is ready for a bottle, run two ounces of hot water from the tap into one of the bottles and you have 4 ounces of warm formula ready for use. Be sure to carefully clean the tops of the cans, and unused formula should always be refrigerated. It will keep for approximately three days. Do not re-refrigerate a previously warmed bottle just because it was not completely used by the baby. Bacteria grow rapidly in warm milk and it is not worth the risk. As you have noticed, you do not need to sterilize anything. Bottles and nipples simply need to be washed thoroughly either by hand or a dishwasher. With modern sanitation, the extreme sterilization measures of past years are no longer necessary. Water is tested regularly and is chemically treated. It does not need to be boiled prior to use. If you have well water, we recommend boiling the water for a five-minute period to kill any bacteria. This is only necessary for the first two months of the infant’s life.
When feeding your baby, keep the bottle tilted so that he does not swallow extra air. Never prop the bottle. Formula may be fed at room temperature. If warming is desired, place the filled bottle in a pan of warm water for a few minutes. Always test the warm formula by shaking a few drops on your wrist. It should feel neither cool nor warm. The nipple hole should be large enough that when the bottle is held upside down, about one drop per second comes out. To enlarge holes, insert a red hot needle. If the milk drops out rapidly, then the hole is too large and the nipple should be discarded. After a few days, most full term babies will be taking from two to four ounces of formula per feeding. Don’t force formula on the baby; he will take as much as he needs. He will gradually take more and more as he gets older.
The prepared formulas have vitamins added. City water is fluoridated; therefore, if your baby is taking one of the commercial formulas mixed with city water, no vitamin or fluoride supplementation is necessary. If you are nursing exclusively, we will prescribe a liquid vitamin preparation. If you are using well water or a community water supply, we will can give you a kit to test your water for fluoride, and prescribe fluoride for your baby if it is lacking in your water supply.
When a baby is either nursing well or drinking well from the bottle, he is receiving an adequate amount of fluid, and extra water is not necessary.
We do not feel there is any single ideal time to start solid foods. From a nutritional point of view, infants do not need solid food for the first 6 months. Most babies, however, do as well whether they are started on solids at 4 months or at 6 months. We will talk with you about how and when to introduce solid foods to your baby during your well child checkups. Contrary to popular belief, babies who receive solid foods early do not sleep through the night any sooner than those who are fed milk alone.
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