Feeding Your Newborn

How you feed your newborn is the first nutrition decision you make for your child. These guidelines on breastfeeding and bottle feeding can help you know what's right for you and your baby.

Breast or Bottle?

The American Academy of Pediatrics (AAP) recommends that babies be breastfed exclusively for about the first 6 months. Following the introduction of solid foods, breastfeeding should continue through the first year of life and even beyond, if desired.

But breastfeeding isn't possible or preferable for all new moms. Deciding to breastfeed or bottle feed a baby is usually based on the mother's comfort level with breastfeeding and her lifestyle. In some cases, breastfeeding may not be recommended for a mom and her baby. If you have any questions about whether to breastfeed or formula feed, talk to your pediatrician.

Remember, your baby's nutritional and emotional needs will be met whether you choose to breastfeed or formula feed.

About Breastfeeding

Breastfeeding your newborn has many advantages. Perhaps most important, breast milk is the perfect food for a baby's digestive system. It has the nutrients that a newborn needs, and all of its components — lactose, protein (whey and casein), and fat — are easily digested. Commercial formulas try to imitate breast milk, and come close, but cannot match its exact composition.

Also, breast milk has antibodies that help protect babies from many infectious illnesses, including diarrhea and respiratory infections. Studies suggest that breastfed babies are less likely to develop medical problems such as diabetes, high cholesterol, asthma, and allergies. Breastfeeding also may decrease the chances that a child will become overweight or obese.

Breastfeeding is great for moms too. It burns calories, so nursing moms get back in shape quicker. Breastfeeding also may protect mom from breast cancer and ovarian cancer.

Some moms find breastfeeding easier and quicker than formula feeding — it needs no preparation and you don't run out of breast milk in the middle of the night. Also, breastfeeding costs little. Nursing mothers do need to eat more and may want to buy nursing bras and pads, a breast pump, or other equipment. But these expenses are generally less than the cost of formula.

Breastfeeding meets a variety of emotional needs for both moms and babies — the skin-to-skin contact can enhance the emotional connection, and providing complete nourishment can help a new mother feel confident in her ability to care for her newborn.

Limitations of Breastfeeding

With all the good things known about breastfeeding, why doesn't every mother choose to breastfeed?

Breastfeeding requires a big commitment from a mother. Some new moms feel tied down by the demands of a nursing newborn. Because breast milk is easily digested, breastfed babies tend to eat more often than babies who are fed formula. This means mom may find herself in demand as often as every 2 or 3 hours in the first few weeks. This can be tiring, but it's not long before babies feed less frequently and sleep longer at night.

Some new mothers need to get back to work outside the home or separate from their babies from time to time for other reasons. Some of these moms opt for formula feeding so other caregivers can give the baby a bottle. Mothers who want to continue breastfeeding can use a breast pump to collect breast milk to be given in a bottle so their babies still get its benefits even when mom isn't available to breastfeed.

Other family members (dads most of all) may want to share in feeding the baby. When mom is breastfeeding, dad or siblings may want to stay close by. Helping mom get comfortable, or providing a burp cloth when needed, will let them be part of the experience.

When breastfeeding is established, other family members can help out by giving the baby pumped breast milk in a bottle when mom needs a break.

Sometimes a woman may feel embarrassed or worried about breastfeeding. These feelings usually disappear once a successful breastfeeding process is set. It's often helpful to seek advice from those who've gone through the experience. Most hospitals and birthing centers can provide in-depth instruction on breastfeeding techniques to new mothers.

Your pediatrician, nurse practitioner, or nurse can answer questions or put you in touch with a lactation consultant or a breastfeeding support group.

In some cases, a mother's health may affect her ability to breastfeed. For example, mothers undergoing chemotherapy for cancer and moms who are infected with human immunodeficiency virus (HIV, the virus that causes AIDS) should not breastfeed.

If you have a medical condition or take any medicines regularly, or if you or your baby gets sick, talk with your doctor about whether it's OK to breastfeed. If you have to stop nursing temporarily, continue to pump breast milk to maintain milk production.

In some situations, it may not possible to breastfeed, such as when a baby is sick or born prematurely. Mothers should talk with their baby's doctor about expressing and storing milk. Even if the infant cannot breastfeed, breast milk may be given via a feeding tube or bottle.

Sometimes mothers who have inverted nipples may have trouble breastfeeding, but with the help of a lactation consultant this usually can be overcome. Likewise, women who have had plastic surgery on their breasts should be able to successfully breastfeed. Talk with your doctor if you have any concerns.

Avoid using pacifiers or bottles until breastfeeding is established, usually after the first month of life. Introducing them before breastfeeding might cause "nipple confusion," and can lead to an infant giving up the breast.

About Formula Feeding

Commercially prepared infant formula is a nutritious alternative to breast milk. Bottle feeding can offer more freedom and flexibility for moms, and it makes it easier to know how much the baby is getting.

Because babies digest formula more slowly than breast milk, a baby who is getting formula may need fewer feedings than one who breastfeeds. Formula feeding also can make it easier to feed the baby in public, and lets the father and other family members help feed the baby, which can enhance bonding.

Limitations of Formula Feeding

Just as breastfeeding has its unique demands, so does bottle feeding. Bottle feeding requires organization and preparation, especially if you want to take your baby out. Also, formula can be pretty expensive.

It's important to make sure that you have enough formula on hand, and bottles that are clean and ready to be used.

Here are a few guidelines for formula feeding:

• Carefully follow directions on the label when preparing formula.
• Bottles left out of the refrigerator longer than 1 hour and any formula left in the bottle that a baby doesn't finish should be discarded.
• Prepared bottles of formula should be stored in the refrigerator up to 24 hours and can be carefully warmed just before feeding. You don't have to warm formula, but most babies prefer it.
• A bottle of formula can be warmed by holding it in running warm water or setting it in a pan of warm water. A bottle of formula (or breast milk) should never be warmed in a microwave. The bottle can heat unevenly and leave "hot spots" that can burn a baby's mouth.

How Often Do Newborns Eat?

Your newborn will nurse about 8 to 12 times per day during the first weeks of life. In the beginning, mothers may want to try nursing 10–15 minutes on each breast, then adjust the time as necessary.

Breastfeeding should be on demand (when your baby is hungry), which is generally every 1–3 hours. As newborns get older, they'll nurse less often and have longer stretches between feedings. Newborn babies who are getting formula will likely take about 2–3 ounces every 2–4 hours. Newborns should not go more than about 4–5 hours without feeding.

Signs that babies are hungry include:

• moving their heads from side to side
• opening their mouths
• sticking out their tongues
• placing their hands and fists to their mouths
• puckering their lips as if to suck
• nuzzling again their mothers' breasts
• crying

A feeding schedule is not necessary; you and your baby will eventually establish your routine. Babies know (and will let their parents know) when they're hungry and when they've had enough. Watch for signs that your baby is full (slowing down, spitting out the bottle or unlatching from breast, closing the mouth, turning away from the breast or bottle) and stop the feeding when these signs appear.

As babies grow, they begin to eat more at each feeding and can go longer between feedings. There may be other times when your infant seems hungrier than usual. Continue to nurse or feed on demand. Nursing mothers need not worry — breastfeeding stimulates milk production and your supply of breast milk will adjust to your baby's demand for it.

Is My Newborn Getting Enough to Eat?

New moms often worry about whether their babies are getting enough to eat. It's important for all infants to be seen by their pediatrician 48 to 72 hours after a mother and newborn leave the hospital. During this visit, the baby will be weighed and examined, and feeding questions and concerns can be addressed.

You can be assured that your baby is getting enough to eat if he or she seems satisfied, produces about six to eight wet diapers a day, has regular bowel movements, sleeps well, is alert when awake, and is gaining weight. A baby who is fussing, crying, seems hungry, and does not appear satisfied after feeding may not be getting enough to eat. If you're concerned that your baby isn't getting enough to eat, call your doctor.

Many infants "spit up" a small amount after eating or during burping, but a baby should not vomit after feeding. Vomiting after every feeding might be a sign of an allergy, digestive problem, or other problem that needs medical attention. If you have concerns that your baby is spitting up too much, call your doctor.

Should Newborns Get Nutritional Supplements?

Breast milk has the right combination of vitamins and easily absorbed iron for newborns. A healthy infant being nursed by a healthy mother does not need any additional vitamins or nutritional supplements, with the exception of vitamin D.

The AAP recommends that all breastfed babies begin getting vitamin D supplements within the first few days of life, continuing until they get enough vitamin D-fortified formula or milk (after 1 year of age).

Iron-fortified formula contains the right blend of vitamins and minerals for a baby, so supplements usually aren't necessary. Infants drinking less than 1 liter, or about a quart, of formula a day may need a vitamin D supplement.

Water, juice, and other foods usually aren't necessary during a baby's first 6 months. Breast milk or formula provides everything babies need nutritionally until they start eating solid foods. Talk to your doctor if you have any questions about feeding your newborn.