The baby – Nutrition

Human mothers, like all other mammals, are equipped to feed their newborn babies on milk. (The words mammal and mammary are both derived from the Latin mamma, meaning breast.) Since evolution has had millions of years to perfect the formula of breast milk, we should assume that breast is best for our babies. However, modern techniques that are used to make a substitute out of cows’ milk mean that, for the mother who is unable (or does not want) to breastfeed, there is a very satisfactory alternative. Even premature babies benefit from their mothers’ milk, or at least banked milk donated by other breastfeeding women. Human milk differs from formula feeds based on cow’s milk by containing less protein and being more easily digested. It also contains antibodies that help to protect the baby against infection. There is some evidence that breastfeeding helps prevent or delay the development of allergies in babies.

One potential disadvantage of breastfeeding is that toxic substances – whether eaten or inhaled by the mother – may get into her milk and are thus passed to the baby. A breastfeeding woman must, as far as possible, avoid all drugs and any food contaminated with toxic chemicals. Some drugs are safe to take while breastfeeding, but this should always be checked with a doctor.

Breastfeeding has few other disadvantages, although it demands commitment. A breastfeeding woman is likely to have a bigger appetite, and she will need to eat slightly more food. She is unlikely to put on weight, however, unless she overeats; in fact she may lose the extra weight gained during pregnancy more quickly.

Some woman experience a few problems, particularly during the first weeks. Sore nipples, if neglected, may lead to cracks in the skin. These can be avoided by making sure the baby is ‘latched on’ properly with all of the nipple and at least part of the areola in his mouth. This prevents undue tension on the base of the nipple, where cracks usually occur. To treat sore and cracked nipples, the woman should expose them to the air whenever possible; change the position of the baby at the breast (for instance, feeding him lying down, or on the woman’s lap with his legs tucked under her arm); avoid the use of soap; and dry the nipples carefully after a feed. Frequent feeding is less likely to lead to nipple soreness than are infrequent feeds.

A blocked milk duct in the breast causes pain, redness and a lump. This should be treated with frequent feeds plus careful massage and expression of the area. Hot baths are also helpful. The woman should consider what caused the blockage: does she always feed the baby in the same position or is her bra too tight? Also in this respect it is advisable to feed the baby frequently, as this prevents retention of milk. Occasionally, a woman may develop mastitis or a breast abscess. Medical treatment is required for these conditions but there is rarely need to stop breastfeeding. It is even beneficial if breastfeeding is continued because emptying of the milk ducts hampers an infection. If antibiotics are administered, the effect for the baby is that he may have slightly diarrhoeic stools.

A breastfed baby may be fed ‘on demand’. Some babies do not ask for enough feeds and need to be offered the breast more often. Sucking stimulates the production of milk, so a very hungry baby who needs feeding every two hours or more is building up the supply for subsequent feeds. Often a baby who feeds frequently one day will need fewer feeds a day or so later because there is then more milk available. A few breastfed babies eventually fall into a four-hourly feeding pattern and sleep through the night, but it is just as normal for a baby to go on having night-time feeds for months or even years. The length of feeds may also vary. Some babies will have taken all the milk they want after about ten minutes at each breast. Then they may stay gently sucking for longer. Other babies finish feeding more quickly, whereas yet others take very much longer. Many babies like to suck and nap on and off for several hours, especially in the evenings.

Bottle-feeding

Although formula milks are not as ideally suited as breast milk to the needs of a young baby, most thrive on a formula. The chosen formula should be as much like human milk as possible. It should contain small amounts of phosphorus and sodium. Unmodified cows’ milk contains much more of these elements than human milk, and a newborn baby’s kidneys cannot always cope with them. Most babies, however, can drink unmodified cows’ milk from about six months. When making up formula feeds, follow the manufacturer’s instructions strictly. The water used to make up the feeds should be boiled first to sterilize it, and all bottles and teats kept in sterilizing solution before use. A whole day’s supply of feeds may be prepared in advance and the bottles stored in the refrigerator until needed. A bottle-fed baby, on average, takes about 160ml of formula per day for each kg of body weight, but his needs vary from feed to feed and from day to day. Because formula milk takes longer than breast milk to digest, he is more likely than a breastfed baby to settle into a four-hourly routine. Nevertheless, the mother may offer him the bottle if he seems hungry: forcing him to wait until his next feed is due may make him miserable and mother tense. The main advantage of bottle-feeding is that it gives the mother more independence. However, with modern hand-operated breast pumps the breastfeeding mother can easily express some of her milk, to be given to the baby while she is away from home. Bottle-fed babies are more likely than breastfed babies to get infections. They may also need drinks of plain water, as well as formula feeding, to prevent constipation.

Digestion

Food is a young baby’s main interest in life, but it is also the source of most of a young baby’s problems. Vomiting is common but attacks can range from the very mild to the more severe. All babies bring up a little food after meals, especially when they are being burped. This is called posseting. Both breastfed and bottle-fed babies swallow air with their feeds, some more than others. If the baby’s stomach contains a large amount of air, it becomes distended and he will be unable to drink more milk until he has brought up wind. Babies normally do this automatically. Mothers need not worry if their baby does not bring up wind at every feed, or even if he never seems to. Nor should they try to make him do so; if he needs to, he will.

There exist a number of ways of reducing the amount of air swallowed. If the intervals between feeding are too long, the baby will tend to gulp greedily at his food, thus taking in more air. This can be remedied by making shorter intervals between feeds, for example, and feeding baby before he starts to cry. If baby continues to take in air, he may be ready to try a little solid food. A bottle-fed baby may be taking in more wind than necessary because the hole in the teat of the bottle is too small. When the bottle is held upside down, the milk should drip out of the bottle so fast that it is almost running.

Any baby may suddenly begin to suffer from colic -the painful result of retention of wind. This commonly occurs around the age of three months, and shortly after the early evening feed. This type of attack is not normally caused by breast milk, or by a particular brand of approved milk not suiting the baby, although changing the method of feeding may be to blame, or perhaps the eating of food such as rhubarb, cabbage. Turnips, grapes or sprouts by the mother.

Bowel movements

A young baby is quite often constipated. This can, however, be remedied by giving the baby solids such as stewed prunes which are high in fibre content, and by giving the baby plenty of liquids, especially in hot weather. It is also possible that underfeeding may cause constipation. Laxatives should be avoided; it is far better to correct the problem through diet.

Vitamins

All of us, including small babies, need vitamins in our diet. The most important are: vitamin A, which keeps skin and mucous membranes healthy and protects against infection; the B vitamins, which have several functions including the maintenance of red blood cells, skin and nerves; vitamin C, necessary for healthy gums, skin and blood vessels and for resistance to infection; and vitamin D, which helps to maintain the body’s calcium balance, essential for healthy bones and teeth.

Both breast and cows’ milk contain sufficient vitamins A and B, and formula feeds are fortified with vitamin D. Some specialists advise that breastfed babies need vitamin D supplements from about six weeks, but modern evidence suggests that breast milk usually contains enough of this vitamin. Bottle-fed babies need extra vitamin C from about one month of age. It is also important not to forget the dietary requirements of the mother, particularly if she is breast feeding. Looking after a young baby is a demanding task, usually punctuated by broken sleep, and the mother should ensure that she is getting her full quota of protein, vitamins and minerals. Vitamin supplements, however, are usually unnecessary as long as a balanced diet is followed.

Introducing solids

Milk is the only food babies need for at least the first three months. After that age or when they reach about 5.5kg in weight bottle-fed babies may begin to need something more. If a bottle-fed baby is consistently drinking about 200ml at each feed and still seems hungry, solid foods should be introduced gradually. Some babies do well on milk alone until they are six months old; but mixed feeding should not be delayed after this, because the baby will by then require more iron than formula milk can provide. If he is not given iron-rich foods such as green veget- ables, meat, liver and egg yolk, or cereals with added iron, he may develop anaemia. The breastfed baby often does well on breast milk alone for six months and sometimes even longer. A mother should give a hungry four-month-old more milk by feeding more frequently throughout the day and night. Mixed feeding can be introduced from four to six months onwards, although an adequate supply of breast milk can meet the baby’s needs for much longer if necessary.

A baby starting on solids still needs large amounts of milk, and still needs to suck. At first, therefore, solids should be limited to once a day. The baby is unlikely to accept new tastes if he is desperately hungry, so let him suck for a short time on the bottle or breast before offering a spoonful of food. A baby’s first solid food should be something bland and smooth, such as banana or cereal mixed with milk or boiled water. He may enjoy strained or sieved stewed fruit or vegetables but no salt should be added, because a young baby’s kidneys are not mature enough to deal with too much salt properly. Also, avoid added sugar where possible, so as not to encourage a sweet tooth. As he becomes more adventurous, the baby can be offered some of the family’s meals – in puree form. One point that should be emphasized is that on feeding the child with spinach this should never be reheated. Processed spinach especially contains much nitrate which on reheating is practically all turned into nitrite. Nitrite poisoning causes methaemoglobi-naemia which endangers the life of the baby. Letting the baby share family meals is an excellent way of getting him used to a wide variety of tastes, although it does not necessarily follow that when he is older he will eat everything on his plate. Many children are naturally quite conservative eaters. Mothers who like preparing their babies’ food may choose not to buy commercial processed baby-foods, except perhaps when it is inconvenient to cook for the baby, such as when travelling. Processed baby-foods are just as nutritious as those prepared at home; however, many contain quantities of refined cereal, and a baby may become too fat if he is fed on them exclusively. So offer processed foods at some meals only and supplement the diet with plenty of fresh stewed fruit and vegetables. Even before he cuts his first tooth, a baby needs something to chew on. Initially, he will not be able to swallow lumpy foods, but he can be given pieces of carrot, celery or apple to hold and chew. Early ‘chewing practice’ helps to prepare him for more adult foods; if he is allowed to ‘feed’ himself in this way he will enjoy the business of eating more. He needs to be watched carefully, though, in case he bites off a large piece, tries to swallow it and chokes. A baby who seems in difficulties should be tipped forward in order to remove the offending bit of food gently with a finger.