• Rooting (where the baby turns its head to anything that touches its cheek)
• Sucking on its fists
• The late sign of crying

• Having 4 or more wet diapers a day after the 3rd day of life, and 6 or more after the 5th day
• Having 3 or more bowel movements a day
• Hearing swallowing during the feeding
• Seeing milk in the baby’s mouth or on its lips after/during the feeding
• Feeling the breast soften during feeding
• Baby is content after the feeding
• Usually there is no need to supplement breast feeding with formula, unless your doctor tells you to. By solely breast feeding, you encourage your body to produce an adequate milk supply and maintain your infant’s preference for the breast rather than a bottle.

Breastfed infants do not require water supplementation in the newborn period, and water bottles are not routinely recommended until the baby is at least 4 months old. 

Techniques for the Breast Feeding Mother

When you nurse in the sitting position, hold your baby on his or her side facing your breast, with the baby’s lower arm tucked around your waist. Hold your breast with your thumb above the areola (the dark skin around the nipple) and your other fingers below. Support your breast well back from the areola to avoid interfering with your baby’s latch. Your baby’s face, tummy, and knees should be facing you.Gently touch the baby’s lips with your nipple and the baby will open her/his mouth to attach to your breast. Bring the baby to you (not the other way around), making sure your nipple and as much of the areola as possible are in the baby’s mouth. Pull the baby in close to a snug tummy-to-tummy position. If necessary, gently pull the breast away from the baby’s nose with your thumb.

Offer both breasts at each feeding. Your baby will empty most of the milk in your breast after 5 to 10 minutes of vigorous sucking, so nurse at least that long on the first breast. Your baby may wish to nurse longer—possibly as long as 30 minutes or more. As long as he/she is properly positioned and is not hurting you, this is fine. When the baby loses interest in the first breast, stop and burp the baby. Then offer the second breast for as long as you both want. Be aware that some babies will only nurse on one side each feeding. To change breasts, put your finger into the corner of the baby’s mouth between the gums, and the baby will open his or her mouth.  However, most babies let go on their own when finished.

Let your breasts completely air dry after nursing. Start with a different breast each time. Put a diaper pin or safety pin on your clothing to remind you which breast to begin with at the next feeding. Following breastfeeding guidelines carefully prevents or minimizes sore nipples. A mother who develops sore nipples should call the office.

If you need to be separated from your baby at feeding time, you can leave behind a bottle of milk that you expressed (pressed out) from your breasts by hand. Or you can express milk with the aid of a breast pump. Manual, battery operated, and electric pumps are available, each with advantages and disadvantages. Our staff will be happy to discuss this with you. Try to avoid supplemental feedings before 2 weeks of age unless we have specifically recommended you to do so.

If breast milk is not available, you can leave behind a bottle of prepared infant formula. Any feeding that a breastfed infant receives in place of a feeding at the breast is called a supplemental feeding. Should you need to supplement with formula, discuss the options with the baby’s doctor.

Bottle Feeding - Formula

Infant formula provides all the nutrients that a baby needs to grow well for the first year of life and offers an excellent alternative to breast milk. Formula comes in many convenient forms:

• Ready To Feed (If you decide to use ready to feed formula, you will have to give a fluoride supplement after the baby is six months old.)
• Liquid concentrate (To use you mix equal parts of water and formula.)
• Powder (To use you add water as instructed on the can.)

We recommend iron-fortified formula Similac Advance® with Iron or Enfamil. We do not recommend any off label brand formulas.  If you have any other specific formula or feeding questions please discuss with one of our providers. Cow’s milk is not recommended for babies less than 12 months of age because it contains excess minerals, has proteins not easily digested by some babies, and may cause allergies or anemia.

Most formula fed infants will take 2 to 3 ounces every 3 to 4 hours for the first few weeks of life and gradually increase to 4 to 8 ounces by 1 to 2 months of age. After 10 or 11 p.m. let the baby awaken you for feedings at night.

Sterilization

It is not necessary to sterilize bottles or nipples if they are carefully washed and thoroughly rinsed. A dishwasher is quite satisfactory. You do not need to boil city water. If you use well water, it should be boiled and your baby will need fluoride supplements after 6 months of age.

Introduction of Solid Foods

For the first 4 to 6 months of life your baby can get all of the nutrients he/she needs from breast milk or formula. Solid foods are not necessary before 4 months.

At 4 to 6 months you may start rice cereal. Use dry fortified baby cereal and mix it with formula, expressed breast milk, or water to a mushy consistency. Start with one tablespoon and increase as tolerated. Cereal should not be put in your baby’s bottle, because he/she will not learn how to eat from a spoon. After cereals, you can begin fruits and vegetables. Introduce one new food at a time. Feed the new food for 3 to 4 days and watch for any intolerance. After your baby has tolerated foods individually you may give mixed food (i.e. peas and carrots together). Most babies will spit out a new food the first time it is fed because they are not familiar with the taste and texture, so do not assume your baby does not like it. On average it can take five to six feedings of a new food before the baby readily eats it.

As your baby grows his/her need for solid foods will too. By 9 months of age most babies are eating three solid meals a day. At 9 months you may introduce meats. Keep in mind that the breast milk and/or formula is still the most important source of nutrition in the first year of life.

Spitup

Almost all babies will spit up some, usually right after feeding and especially if not burped enough. A few teaspoons can appear to be several ounces when spread out on a cloth or the floor. The spit up does not bother most babies, and as long as the baby is gaining weight and is happy, it is nothing to worry about. If your baby seems to spit up frequently, try keeping him/ her upright after a feeding for at least half an hour and try not to bounce him/ her around too much. In addition, you can put the baby to sleep at a 45 degree angle by placing a wedge or layering a towel under the mattress (the baby should always sleep on a firm mattress). Occasionally, your doctor might recommend a formula change if intolerance is suspected, but always check with your doctor first.

If your baby’s spit up is very forceful, increasing in frequency or green in color they need to be seen as soon as possible by their doctor.

Bowel Movements

Most parents will be able to tell when their baby is having a bowel movement, because he/she will typically be a little fussy, turn red in the face, and may grunt and cry and draw up their legs. If the stool is soft, the baby is not constipated. All newborn babies pass gas, more than most parents expect.

All babies will pass very dark black or brown meconium stools that are very sticky in the first few days of life. Lighter colored soft mushy stools will then follow these.

Most breast fed babies will stool several times a day. The stools usually are a yellow mustard color with some seed-like material mixed in.

Nevertheless, in some breast fed babies, the stool may be a variety of colors such as fluorescent green and they may not stool every day. Around 2 months of age stooling patterns may change to much less frequent and larger volume stools.

Formula fed babies tend not to stool as often as breast fed babies. It is quite normal for a formula fed baby not to stool for three to four days at a time. As long as the stool is soft and not hard pellets, the baby is not constipated. The iron in the formula does not cause constipation, therefore we do not recommend the use of low iron formulas. The color and consistency of formula fed infants’ stool can also vary considerably.

Call the pediatrician’s office if you see any blood in the stool.