What to Know
Lactose itself is the sugar found in dairy products. Lactose intolerance is a digestive problem that can cause discomfort such as bloating, cramping, diarrhea, and gas. Because of a deficiency of an enzyme in the body called lactase, people who are lactose intolerant are unable to digest this milk sugar. The best treatment is avoiding dairy products and choosing lactose-free products. Lactose intolerance is not very common in babies and typically shows up in children after the age of 3.
While lactose intolerance is rare in babies and tots, some little ones with dairy sensitivities may actually have an intolerance or allergy to the milk proteins whey and casein (versus the milk sugar with lactose intolerance.)
A milk allergy or intolerance could potentially cause a wide range of symptoms from a rash, hives, itching, and swelling to a more life-threatening reaction such as anaphylaxis. Babies who have a milk allergy may also experience frequent loose stools that may possibly contain blood or mucus, frequent spitting up, vomiting, and discomfort. A cow’s milk allergy is the most common food allergy in infants and young children with approximately 2.5 percent of children younger than 3 years being allergic to milk. Fortunately, most children will eventually outgrow this as they get older and their digestive systems mature.
Your pediatrician may ask for a stool sample to check for blood, as sometimes the blood is not visible to the eye. Breastfeeding moms must eliminate dairy in their diet since the milk proteins pass through breastmilk, while formula feeding moms will likely need to switch to a specialized formula.
When eliminating dairy in your own diet or trying to figure out what foods to offer your tot, reading labels is critical. The following words will indicate the presence of milk in the product:
- Milk by-products (like butter)
- Dry milk solids
- Nonfat dry milk powder
You may wonder how you or your child’s nutritional status may be impacted when foregoing dairy products. Fortunately, there are many foods that can supply the important nutrients that dairy provides, such as protein, calcium, magnesium, and vitamin D. All whole fruits, vegetables, legumes, nuts, seeds, meat, poultry, fish, grains, and eggs are dairy free. There are also many non-dairy substitutes on the market, such as soy yogurt or coconut milk so you can still cook and bake dairy-free with ease. When it comes to meeting your and your baby’s nutritional needs, choose a variety of these non-dairy containing foods.
What to Do
- Observe the symptoms: Does your baby have gas and bloating? Loose stool with blood in it? Eczema or skin rash? This will help determine the problem.
- Consult with your pediatrician if you suspect your baby may have a milk allergy or lactose intolerance.
- Read food labels’ ingredient lists for sources of lactose or milk protein that need to be avoided.
- Seek out non-dairy alternatives to use in cooking and baking as needed, such as non-dairy margarine and soy milk in baked goods, or canned coconut milk in creamy soups.
- Eliminate dairy in your own diet if your breastfed baby develops a milk allergy.
- Seek out non-dairy sources of protein such as meat, eggs, fish, tofu, and beans.
- Seek out non-dairy sources of calcium, such as dark leafy greens, tofu, legumes, and calcium fortified non-dairy beverages.
- Seek out non-dairy sources of vitamin D, such as salmon, egg yolks, and some fortified cereals and non-dairy beverages.
The primary goal is to be your own detective, read labels, and make inquiries at restaurants or other events involving food. Allergens can be hidden in coatings, thickeners, spices, natural flavors, and other ingredients found in fresh, frozen, refrigerated, and shelf-stable foods. Preparing meals and snacks at home can help you maintain control over food sources and help prevent cross-contamination.
This meal plan is created for women who are truly allergic, or who are breastfeeding and need to undergo an elimination diet to determine what foods their infant may have an intolerance or allergy to. Taking these foods out during pregnancy or breastfeeding, if not warranted, may actually promote intolerance in your infant as complete avoidance will prevent the immune system from learning that these foods are not actually harmful. If you are breastfeeding and your infant is showing symptoms of allergy or intolerance, and you have discussed the issue with your and/or your infant’s healthcare provider (HCP), this meal plan may be used to eliminate the major allergens.
This diet can be tricky. Make sure to work closely with your HCP as he or she knows what is best for you and your baby. To determine which foods were not tolerated by your baby, your HCP may have you add these foods back into your diet one at a time after they have been eliminated for 2-4 weeks, or until your infant stops having symptoms.
Choosing meals and snacks from the below listed options will help eliminate major allergens (dairy, soy, eggs, gluten, and peanuts) while helping you maintain adequate nutrient intake.
The first decision concerns timing: when should you begin feeding your baby? Research points to six months as the ideal time for introduction of solids because your little one’s intestines are mostly developed. Other important signs of readiness for food include ensuring your baby can sit up with minimal support, keep her head up and steady, and show interest in the foods you’re eating. (For more information on when to start solids, please see Introducing Solids: Signs of Readiness)
Introduction of food is complementary to breastmilk and/or formula feeding, which should remain the primary source of nutrients and calories up through the first year. Think of eating as a way for your baby to explore food, tastes, and textures; rather than a way for them to get most of their nutrients. This will allow you and your baby to set aside frustration and have more fun with the process.
There are different methods that parents may choose when it comes to baby’s first bites. Below reviews the traditional as well as alternative approaches to feeding, including their pros and cons.
Traditional: Purees to Start
This technique has been around longest and is the one recommended by most pediatricians. It begins with spoon-feeding purees, graduating to lumpy mixtures, soft solids, and soft table foods; progressively advancing textures as the baby matures and shows readiness.
While many pediatricians still recommend fortified single grains mixed with breastmilk or formula as the first food, followed by pureed vegetables and fruit, there is no medical evidence indicating that solids should be introduced in any specific order. This includes the theory that vegetables should be introduced before fruit. Babies have a natural preference for sweet tastes regardless of which foods come first. Rather than worry about the order of produce introduced, the primary goal is to introduce many flavors to set your infant up for successful eating both now and in the future.
The traditional method also suggests adding one new food every 2 to 3 days to check for intolerance or possible allergic reactions, although this recommendation is becoming less frequently used by professional organizations such as the AAP. After each new food, watch for symptoms such as diarrhea, rash, or vomiting. If these occur, consult with your infant’s health care provider to discuss the next steps. Vegetables and proteins are high in nutrients per serving, so having them as a consistent part of your baby’s diet alongside fruits and grains, will ensure a variety of quality nutrients are offered.
Another older recommendation is to wait until between 7 to 8 months to introduce proteins such as chicken, turkey, fish, beef, and dairy foods (excluding cow’s milk, which should be introduced at 1 year). Research indicates this may not be necessary, and in fact introducing meat early, particularly to breastfed babies, will help them meet their increasing iron and zinc needs. Simply ensure the proteins are a texture your baby is able to tolerate. This might mean introducing ground beef, pureed chicken, or mashed fish initially until he is able to chew (or ‘gum’) advancing textures. (See: What’s the Deal with Seafood for more information on which fish are high in mercury and should be avoided for infants).
Though some health care providers counsel to hold off on offering fish, eggs, and other potential allergens until your infant is one year or older, new research indicates earlier introduction may actually help prevent allergies. (To learn more, please see: Introducing Major Allergens)
When your baby is able to bring her hands to her mouth, typically between 8 and 10 months, finger foods may be introduced. During this time she is developing her ability to ‘gum’ foods, as well as developing pincer and fine motor skills needed for self-feeding. Very soft foods cut into small pieces are still needed as baby does not have enough teeth to break up hard foods.
Baby Led Weaning (BLW)
This progressive technique discourages spoon feeding and supports infants to self-feed from the beginning. The theory behind this method is that infants should be in control of what and how much they eat. Proponents also say BLW helps to better develop infants’ chewing skills and hand-eye coordination. Because infants have more control of their ability to grasp and swallow at 6 months, BLW is recommended to start around this age and not sooner.
Per Baby Led Weaning, first foods should be soft enough to ‘smush’ between the fingers and cut into a ‘strip’ for the baby to grasp. Advocates for this technique advise adults to never put food in the baby’s mouth. This allows the infant to be in control of the entire feeding experience. Example first foods include: Banana, avocado, mango; steamed sweet potato, carrots, broccoli, asparagus; steamed apple and pear; well-cooked fish and scrambled eggs; over-cooked pasta, etc. Foods that are choking hazards should be avoided, as with any feeding method. (See: Preventing Choking for more information).
Some proponents also promote feeding baby what the family is eating (“table food”); however, these foods may be too high in salt and sugar. Feeding family foods may be acceptable so long as a separate dish is prepared without these added ingredients.
Potential advantages: Greater acceptance of foods, weight management, promotion of oral motor and chewing skills. It should be noted that some of these benefits are contested.
Potential disadvantages include: Not meeting infant’s increasing iron needs, not meeting calorie needs, too much added sodium or sugar, risk of choking.
For more information on the potential benefits and disadvantages of Baby Led Weaning, please read Introducing Solids: Baby Led Weaning.
Feed Almost Anything, Anytime
This method is similar to the traditional method in that you may choose to start with pureed foods and advance textures as appropriate; but it differs in that a much wider variety of foods are offered from the start. This includes: fruits, vegetables, eggs, fish, chicken, meat, combination foods, mixed grains, beans, dairy (still not cow’s milk to drink though), etc. Another difference is that this method does not require waiting 2 to 3 days to introduce a new food, but rather new foods are introduced anytime and in any combination – not just one at a time. As long as the food is a consistency that your baby can handle, the food is within the realm of possibility.
As with any feeding strategy, avoiding foods with added salt and sugar is key to your infant’s health as well as the foundation to building healthy taste preferences. Should you decide to follow this more relaxed strategy, it may be important to keep a food log of what your infant eats so that if symptoms of a possible food intolerance or allergy pop up, you can see what items it may be linked to.
How do you decide?
Baby feeding is exciting, yet can also be riddled with questions of how to proceed and progress. Speak with your infant’s pediatrician to gather more information and ensure they support the method you choose. This will allow for better care of your infant as you introduce solids.
If you’re unsure of how to start, begin with what you are most comfortable with and progress as you see best and safest for you and your baby. If you begin using one method and it doesn’t feel right, there is no harm in switching to another. But most of all, enjoy the journey!
Tips and information on introduction of solids
- Feed baby when she is not overly hungry and is in a good mood to avoid frustration on both her and your part.
- Diaper rash may be due to changes in the digestive process after foods are introduced and does not necessarily indicate an allergy or intolerance.
- Stool will become more solid, will vary in color, and may change in odor as foods are introduced. If foods are mashed and not strained, you may find undigested pieces of food, which is not of concern.
- Research does not support introducing vegetables before fruit. Offering a variety of both in any order is adequate.
- Stop feeding your baby once she shows signs of being finished: turning her head, crying, not opening her mouth. Wait to offer more until she is ready at the next feeding, rather than force feed.
- Iron is important for infants to consume starting at 6 months. This can come from fortified infant cereal or meats such as chicken, turkey, beef, and fish.
- Your infant may reach for your spoon! Provide her with her own to play with and explore.
- Have fun!
What to Do
No matter which feeding style you choose, make sure that the first foods you introduce are very soft. Infants do not have teeth so what you offer must be soft enough for your baby to mash with their tongue or gums. Examples:
- Steamed or pureed vegetables: broccoli, peas, sweet potato, butternut squash, cauliflower, asparagus, carrots, etc.
- Steamed, pureed, or mashed fruit, no skin: Apples, pears, banana, avocado, mango,
- Infant cereal or over-cooked pasta
- Well-cooked pureed or finely chopped ground beef, chicken, turkey, or fish.
- Well-cooked scrambled eggs
- Whole milk yogurt blended with pumpkin puree, banana, avocado, or blueberries.
Avoid adding salt or sugar to your infant’s food. Advance textures when your baby is ready.
Read Introducing Solids: First Foods and Advancing Textures for information on introducing solids to your infant.
2. Finger Foods
When your baby is ready to feed herself, or if you choose the Baby Led Weaning method, here are some finger foods to try. Place four to five pieces of food on your infant’s tray to start, adding more as she feeds herself (or attempts to!).
Soft Finger foods:
- Steamed strips (for baby to grasp if pincer skills still need development) or bite-sized piece of sweet potato, winter squash, and carrot.
- Ripe banana, avocado, mango, peaches, watermelon, plum, cantaloupe, honeydew melon.
- Scrambled egg
- Toast strips or pieces (smeared with a thin layer of avocado or small amount of nut butter if you like)
- Small cubes of tofu
- Over-cooked pasta, cut into pieces
Once your baby becomes better at ‘gumming’ foods well before swallowing, slightly firmer foods may be tried in addition to the above foods.
- Small pieces of cheese
- Roasted or cooked beans and sweet peas (If you notice these coming out whole on the other end, slightly smush them with your finger to break the skin and allow for better digestion).
- Steamed broccoli or cauliflower ‘trees’
- O-shaped toasted cereal
- Chopped hard-boiled egg
- Pea-sized pieces of cooked chicken, ground beef, turkey, or fish.
3. Foods to avoid
Some foods pose choking risks for infants and toddlers due to their shape or hard texture. Here are some foods that should be avoided:
- Hot dogs and sausages
- Nuts and seeds
- Whole grapes
- Hard, gooey, or sticky candy, such as marshmallows and caramels
- Chunks of peanut butter (if you are introducing nut butters, spread it very thin on a slice of toast)
- Raw vegetables, such as carrots and celery
- Chunks of cheese and meats
- Chewing gum
- Small foods with pits such as cherries and olives
- Large pieces of bread
- Added salt and sugar
To learn more, please read our article on Preventing Choking
4. Go with the method that feels right to you
Know that there are no studies showing any one feeding method as superior to another, so go with the one that is right for you and your family. Whether you choose the traditional, Baby Led Weaning, or the ‘anything’ approach, how your baby reacts to it – and how comfortable you are – is the best indicator that it is working… or not! Taking into account the benefits and disadvantages of each will help you feed your baby what they need both for health and exploration. For additional support, speak with your pediatrician about your decision. And remember that you can switch techniques at any point!
5. Meet your baby’s iron needs
Iron needs increase after 6 months of age, so including foods with iron is an important part of feeding. Note that iron from vegetables and beans is better absorbed when eaten with vitamin C. Pair these foods with some citrus fruit to accomplish this.
Food high in iron:
- Iron-fortified cereals and grains, such as oatmeal and pasta
- Red meat (ground beef)
- Dark green leafy vegetables such as: spinach, Swiss chard, beet and collard greens, Bok choy, and kale
- Lentils and beans
General Timeline of Feeding Guidelines and Tips for Babies under 12 months
6 months: Exploration
- Continue to breast and/or formula feed.
- You can introduce new foods every 2-3 days to allow baby to acclimate to new textures and flavors, as well as to watch for adverse reactions.
- Amount of food consumed may be minimal as your baby discovers food, plays with spoons and bowls, and learns to swallow rather than reflexively push food out of his mouth.
- Food order of introduction is not critical.
- Include iron-rich or iron-fortified foods.
- Feed once or twice per day, about 1 to 2 tablespoons at a time. Graduate up to 2 to 3 small meals per day, of 2 to 4 tablespoons once baby is ready.
- Feed when baby is slightly hunger, but not ravenous. 60 to 90 minutes after breastmilk/ formula may work well.
- No need to add salt and sugar to your baby’s food.
- Stop feeding when baby indicates she is finished.
7 to 8 months: Exploration and Flavor immersion
- Continue to breast or formula feed.
- Offer a variety of foods, including vegetable, fruit, meat, poultry, fish, egg, small amounts of diluted nut butters*, grains, and unsweetened yogurt and cheese (but no cow’s milk until after 1 year), in a texture and size your baby can handle.
- Continue to repeat foods even if it seems your baby did not enjoy it the first few times. Babies develop a liking for food over time and with multiple exposures.
- Infants are open to many flavors. The wider the variety of foods and flavors offered on a repetitive basis, the increased likelihood of being a less picky eater in the future.
- Advance texture of food as your infant is ready.
- Encourage and explore self-feeding soft foods, such as banana and avocado. Your baby may not be able to self-feed yet, which is absolutely normal.
- Begin teaching how to drink water from a cup. Aim for no more than a couple ounces total for the day.
- Feed 2-3 small meals, the size of baby’s fist, with optional nutritious snacks.
- Continue to avoid adding salt and sugar.
- Stop feeding when baby indicates she is finished.
* If there aren’t any food allergies in baby’s/your immediate family, then your little one is likely low risk for an allergy. The current recommendation is to introduce all foods (including peanut butter, eggs, fish, soy, and other allergens) when your baby is developmentally ready for that texture, as early as 6 months.
8 to 10 months: Flavor immersion and Finger Foods
- Continue breast or formula feeding.
- Lumpy foods and advanced textures should be introduced before 10 months, as your baby is ready, to help prevent difficulty feeding later in childhood.
- Provide soft, baby-size pieces of foods for self-feeding, such as small pieces of: soft cheese, toasted bread, tofu, beans, cooked pasta, steamed broccoli, roasted winter squash, soft cooked eggs, etc. You should be able to ‘smush’ the food between your fingers.
- Avoid foods that are choking hazards (see: Preventing Choking for more information)[
- Include baby in family meals when able.
- Begin offering soft combination table foods around 9 months, such as: casseroles, pasta with sauce, etc.
- Make sure table foods are not laden with salt and sugar.
- Stop feeding when baby indicates she is finished.
10 to 12 months: Finger foods and Family meals
- Continue to breast or formula feed.
- Continue offering a wide variety of foods.
- Begin to structure family meal time (see: Family Meals for more information)
- Begin providing fluids in a cup.
- Continue to offer soft “smush-able” foods to help prevent choking.
- Provide 3 to 4 small meals per day plus nutritious snacks.
- Continue to avoid excessive salt, sugar, and fried foods.
12 + months: Regular eating and Bottle weaning
- Continue to breast and formula feed as needed.
- Wean from the bottle, if your baby takes one.
- Offer water in a cup or sippy cup (see: The Pros and Cons of cups, sippy cups, and straws for babies and toddlers for more information)
- Provide 3 to 4 meals plus nutritious snacks.
- Consider providing whole milk or milk alternative to replace formula. Continue breastfeeding if preferred, no milk or alternative necessary for breastfed babies. (See: Choosing milk and milk alternatives for your baby and toddler for more information on how to introduce and how much).
A mother who was planning on breastfeeding her baby may not know what to do when her baby will be spending days, weeks or even months in the NICU. While pumping for your NICU baby can be time consuming and challenging, it can be an important way for you to be involved with your baby’s care, and breast milk offers significant health benefits to your baby, especially if he is premature or ill. And even if your baby needs supplementation from formula or specialized human milk fortifier, he will still be getting the benefits of your breastmilk in any amount you can provide.
It is important to begin pumping right away for your baby. It typically takes between 2 and 5 days for your milk to come in. Before this happens, your body makes colostrum; the yellow, thick ‘first milk’. This is nutrient-dense, packed with all sorts of good things such as immune factors, and sustains your baby until your milk comes in. You may only get a few drops of colostrum – this is normal!, but every bit is beneficial.
Healthy newborns typically eat 10 to 12 times per 24 hours – that’s every 2-3 hours. This is normal as their bellies are very small, so they need to eat more frequently. Your goal is to mimic the frequency of normal breastfeeding and establish your milk supply with pumping. Milk supply is typically based on a supply and demand relationship, so the more the breasts are stimulated and emptied, the more the body is signaled to make milk. The best way to set up your milk supply for your baby is to pump completely and frequently, at least 8-12 times per day for at least the first 3-4 weeks. Aim to pump at the same time each day so that your body knows to make milk at that time. Even if your baby is unable to eat much or any of your breast milk at the beginning, keep pumping consistently, as the first month is very important for setting up your supply. Establishing milk supply will enable you to be prepared if and when your baby is ready and able to nurse.
After the first month, you may be able to pump eight times per day and maintain an adequate milk supply for your growing baby. If your baby is able to be held while in the NICU, holding your baby skin-to-skin helps stimulate your milk production hormones, and is recommended before pumping. If you are unable to hold your baby, you can pump close by while you’re visiting in the NICU, look at pictures or videos of your baby, or even smell an article of their used clothing for extra stimulation while you pump. While it is normal to feel stressed when your baby is ill or in the NICU, try to find support through family and friends and NICU support staff, as stress can negatively impact milk supply. Also, taking care of yourself through good nutrition and hydration can help support your milk supply.
If your baby was born prematurely, the milk that you express is a little different than what is produced when babies are born at full term. It is much higher in protein and minerals, and contains different types of fat that are easy for him to digest. You will not be getting as much volume because your baby’s tummy is very small (likely the size of a marble!). So if you are not getting a lot, do not fear! That is normal.
The hospital-grade electric breast pump is the most effective type of breast pump, and most moms find they’re able to get more milk when using a hospital grade pump. Electric breast pumps that pump both breasts at the same time are also effective, but for the exclusive pumper – even if your goal is to eventually nurse – a hospital grade pump is recommended and can typically be rented monthly from your hospital.
It is important to practice safely handling the pumped milk when you are transporting it to the hospital. Milk storage guidelines are different for premature or hospitalized babies, as these babies are more at risk for infection. Whenever possible, take your pump to the hospital to pump fresh milk for baby’s next feeding. It is important to discuss storage and transportation guidelines for pumped milk for your premature or ill baby with the NICU medical providers.
You will be spending a lot of time pumping. Try some of these things to make the best of it:
- A hands free pumping bra can be very useful, or you can take an old sports bra and cut two slits in it to slip the flanges through. Then you have your hands free to grab some food, relax, or just pump without needing to hold on.
- Have snacks and water handy wherever you pump so you can stay nourished and fueled while you are sitting down.
- Catch up on your favorite show or podcast while pumping! Enjoying some mindless entertainment can help give your brain a break during a stressful time.
- Reach out to other new moms, especially NICU moms, for support and guidance, whether virtually or over the phone.
- Close your eyes. The humm of the pump isn’t exactly the sound of ocean waves, but getting some rest when you can is important when you’re likely exhausted and not sleeping adequately.
Make sure to let the medical personnel at the hospital know you’d like to provide breastmilk for your baby. Getting their support will be key to helping make your breastfeeding goals work. Many NICU’s have a lactation consultant on staff. Ask your baby’s nurse to meet with that person to help support you in a more personalized way.
Vitamin B12 is a nutrient that helps keep the body’s nerve and blood cells healthy and helps make DNA, the genetic material in all cells. Vitamin B12 also helps prevent a type of anemia called megaloblastic anemia that makes people tired and weak.
During pregnancy, vitamin B12 is believed to combine with folic acid to help prevent spina bifida and other spinal and central nervous system birth defects in your baby.
Vitamin B12 that is found in food needs the acidic environment of the stomach to separate it from the protein that it is bound to. The synthetic B12 found in supplements does not need to be separated, so if you have a low acid level (maybe you are taking medication to treat reflux or peptic ulcer disease for an extended time period) then you may have low blood levels of B12 and a supplement taken by mouth should be just fine.
Vitamin B12 is naturally found in animal products, including fish, meat, poultry, eggs, milk, and milk products. Vitamin B12 is generally not present in plant foods however it is commonly fortified and found in breakfast cereals, soy and other plant-based milks, nutrition bars, meat substitutes, and Red Star Vegetarian Support Nutritional Yeast.
The top food sources of Vitamin B12 are clams, liver, certain fortified breakfast cereals, fish, beef and dairy products.
Supplemental vitamin B12 for vegans and lacto-ovo vegetarians is recommended during both pregnancy and lactation to ensure that enough vitamin B12 is transferred to the fetus and infant. Pregnant and lactating women who follow strict vegetarian or vegan diets should consult with their health care practitioner regarding vitamin B12 supplements for themselves, their babies and their children.
Recommended intakes for vitamin B12 vary. They are as follows:
- Babies 0-6 months require .4 micrograms
- Infants 7-12 months require .5 micrograms
- Children 1-3 years require .9 micrograms
- Children 4-8 years require 1.2 micrograms
- Children 9-13 years require 1.8 micrograms
- Ages over 14 years require 2.4 micrograms
- If you are pregnant you require 2.6 micrograms
- If you are lactating you require 2.8 micrograms
What To Do
Include foods supplemented with vitamin B12 such as breakfast cereals fortified with 100% of vitamin B12.
Include foods that are naturally high in vitamin B12 such as clams, liver, sockeye salmon and rainbow trout.
If you are a vegan or vegetarian, talk to your health care practitioner about a vitamin B12 supplement.
If your diet is low on animal foods such as meat, fish, poultry, milk, cheese and eggs look for fortified vitamin B12 foods. Check nutrition labels because not all fortified foods have the same amounts.
If you are a long time user of certain medications to treat gastroesophageal reflux, peptic ulcer disease or are on metformin, talk to your health care practitioner about checking your vitamin B12 levels or supplementation.
Paced bottle feeding is a method of feeding a baby with breastfeeding difficulties or is temporarily away from mom. It helps “pace” the feed similarly to a breastfeed, where baby controls the flow, and not the caregiver.
It can be very useful in instances of extended latching difficulties, instances when mom and baby are separated temporarily but want the breastfeeding relationship to be maintained, and any other time that a parent and/or lactation consultant or healthcare provider deems it useful.
It’s most useful for babies under 6 months old and can be particularly effective for younger infants.
It’s important to keep in mind that this is just one method that can help feed baby during latching difficulties or mom’s absence. Some lactation providers are fond of a supplemental nursing system, some help moms practice finger feeding, and there are still even more methods than that!
Some of the above methods need to be used and taught by a trained lactation provider, while paced bottle feeding can easily be described.
Steps to paced bottle feeding
- Always feed baby on demand, and never on a schedule.
- Take the bottle and place it at the tip of baby’s lips or stroke the baby’s lips with the bottle. Keep the bottle as horizontal as possible to allow milk to be drawn out but not “drip” into baby’s mouth. The bottle will have to be tipped more and more vertically as the milk is being drunk.
- Allow baby to suck the bottle into her mouth. Some experts recommend a deep latch on a wide-nipple bottle (sometimes called “wide neck”) that resembles a breastfeeding latch, while others says it doesn’t make a difference.
- Frequently pause and tip the nipple down after every few suck/swallow cycles in order to help baby attain a natural rhythm as feeding at the breast is suck/swallows followed by pausing to breathe and swallow.
What to Do
Discuss the various methods of feeding baby with your healthcare provider. Every method doesn’t necessarily work for every mom, and it’s important to see which one works for you – even if that means some experimenting!
If your goal is to get baby to latch, don’t lose sight of it! For moms using this as an intermediate step to get baby to latch, then keep trying to latch and working on it with your lactation consultant.
Educate other family members and care providers about the technique.
Moments after birth your new babe is wiped off and put into your arms. Did you know that this is also an important part of the breastfeeding process? Skin to skin contact is when your naked baby (diaper and head cap only) is placed directly on your bare chest. A blanket covering your baby and you is then placed on top, to keep you both warm. This important first connection is a special time when your baby is first meeting his family. Skin to skin contact promotes bonding between you and your baby, helps lower your baby’s stress levels and is an important first step in your breastfeeding journey.
Evidence shows that babies who have early skin to skin contact, keeping mother and baby together during and after birth, promotes greater breastfeeding outcomes. Babies are born with the instinct to be placed in this position and perform the “breast crawl” to move down to the breast to breastfeed for the first time. It is during this time that your baby’s breastfeeding reflexes come alive; some of which include familiarization with the nipple and breast as well as suckling.
The research also shows that even babies who are born prematurely are more metabolically stable and breathe better if they are skin to skin immediately after birth, if the baby is medically able. The same is true for post cesarean births. Skin to skin contact can begin in the operating room when mom is alert and responsive. It is important that mom be alert and have someone else in the room who is available should any emergency arise.
Skin to skin contact during the weeks and months postpartum, can last as long as mom and baby are comfortable. It stimulates the let down process in breastfeeding and continues the bonding process. Partners can also partake in the skin to skin process to promote bonding and the feeling of comfort and safety between them and your baby. Non breastfeeding moms can also share in this wonderful experience and bond with baby, as well.
What to Do
Make sure your birth plan includes putting baby skin to skin immediately after birth. In most birth circumstances, even c-sections, babies can be put skin to skin without any issue. . If mom is under heavy anesthesia or sedation, you may need to recover a bit before skin to skin, and/or be supervised while doing skin to skin. Dad/partner/birthing coach can do skin to skin while mom is recovering.
Practice proper technique. Make sure mom and baby are truly chest to chest, with no clothing or blanket between skin. A diaper and head cap is fine for baby. Both can be covered with a blanket if the room is cold. If baby is not attempting to breastfeed, make sure his head is turned to the side. If baby is on mom, make sure he is between, not on, mom’s breasts.
If you’re sleepy, make sure that someone is alert and supervising the interaction. In this cozy situation, it’s easy to drift off to sleep, but for safety’s sake, make sure someone is supervising you while you are doing skin to skin with your baby, especially if you are under the influence of any sedatives.
It can certainly be concerning to see your baby expel what appears to be a large amount of liquid from his tiny body; however, spitting up, sometimes called uncomplicated reflux, can be totally common in healthy babies. In fact, about half of babies under three months experience this at least once per day and, more often, several times a day. Normally a muscle, (called the lower esophageal sphincter) between the esophagus and the stomach, keeps the contents of the stomach where they belong. In babies, this muscle isn’t fully developed yet, allowing the food to quickly make its way back up the esophagus and out of the mouth (and all over your clothes!) Since your baby’s stomach is so small, swallowing too much air during a feeding or getting too much milk too fast, such as when mom’s breasts are overfull, can also contribute to some milk being brought back up.
Although it appears that your baby may have spit up his entire feeding, the amount that actually comes back up is usually only a tablespoon or two, as opposed to the several ounces he just consumed. If your baby is happy, not in any obvious discomfort or distress, eating and gaining weight well, having enough wet and dirty diapers daily, then the spitting up is a “laundry” issue (sorry, mom!) and not a medical concern. Spitting up usually peaks around 4 months of age but can continue up to the first birthday. Most babies outgrow or show a significant decrease in the amount they spit up by 7-8 months, once they learn to sit up on their own and have started eating more solid foods.
If your baby is experiencing any of these symptoms in conjunction with spitting up, be sure to contact your pediatrician: refusing feedings, appears to be in pain or discomfort during or after a feeding, isn’t gaining weight, weight loss, spits up very forcefully, spitting up blood or green/yellow fluid, breathing issues like wheezing and arching of the back/neck with apparent pain or distress.
See the What To Do section for tips on how to help manage spitting up in infants.
What to Do
- Create a calm feeding environment- Reduce stimulation, like bright lights and loud sounds, during feedings to avoid distracted eating which can increase the amount of air being swallowed if baby is popping on and off of the breast or bottle.
- Pace Feeds- If you are nursing, feed on demand and allow baby to eat at his own pace. If bottle feeding, avoid tipping the bottle and allowing baby to “chug.” Pace the feeding by holding the bottle more horizontally, allowing the baby to eat more slowly, take breaks and draw the nipple back in when he is ready.
- Burp frequently-Burping your baby more frequently (as opposed to waiting until the end of the feeding) will help eliminate excess air in the stomach. Burp your baby between switching breasts or after every 2 ounces if bottle-feeding.
- Feed upright- Keeping your baby as upright as possible during feedings will help prevent the food from traveling back up into the esophagus.
- Hold upright after feeds- Keep your baby in an upright position for at least 15 minutes after a feeding to help keep the stomach contents where they belong.
- Don’t jostle baby after feedings- Try not to move your baby around too vigorously after a feeding. A full, tiny belly combined with an underdeveloped digestive system will make it easier for the milk to flow back up the esophagus.
- Wait to put baby on his tummy- Placing your baby directly on his tummy after he eats increases pressure, which can increase spitting up. Try waiting about 20-30 minutes after he eats before doing some tummy time.
- Avoid overfeeding- Smaller, more frequent feedings may help reduce spitting up by not allowing the tummy to become overfilled
- Don’t wait until your baby is starving-If your baby is frantically hungry and crying, he will take in more air, making it more likely that he will spit up. Instead, look for early hunger cues like rooting and sucking on fingers and hands.
- Keep burp cloths and bibs handy- Spitting up can be messy for the both of you. Keep the burp cloths and the bibs handy to keep you and your clothes protected!
Two forms of vitamin A are available in the diet. Preformed vitamin A is found in foods from animal sources including dairy products, fish, poultry, and meat. Provitamin A is found in plant products. Beta-carotene is the most common type of Provitamin A (think yellow, orange, red and dark green fruits and vegetables). Provitamin A can be made into vitamin A by the body.
Common food sources of Vitamin A include:
- Orange/red vegetables such as sweet potatoes, carrots, squash, red bell peppers
- Fruit such as cantaloupe, oranges, mango, apricot
- Beef liver and organ meats (high in cholesterol, so go easy)
- Milk with Added vitamin A and D
- Green leafy vegetables and other green vegetables such as broccoli, kale
- Fortified breakfast cereals
Vitamin A listed on food and supplement labels are in international units (IU), however the RDA lists vitamin A in micrograms (mcg) of Retinol Activity Equivalents (RAE) to account for how different forms of vitamin A have different bioactivities (how well your body can use various forms). Converting these is complicated because different forms of vitamin A have different usable amounts for the body. Here are the requirements:
- Babies 0-6 months require 400 mcg RAE
- Infants 7-12 months require 500 mcg RAE
- Children 1-3 years require 300 mcg RAE
- Children 4-8 years require 400 mcg RAE
- Children 9-13 years require 600 mcg RAE
- Adolescent males require 900 mcg RAE
- Adolescent females require 700 mcg RAE (females)
- Adults males require 900 mcg RAE
- Adult females require 700 mcg RAE
- Pregnant Teens require 750 mcg RAE
- Pregnant Adults require 770 mcg RAE
- Breastfeeding teens require 1200 mcg RAE
- Breastfeeding adults require 1300 mcg RAE
Vitamin A deficiency is rare in the United States. Americans are more likely to get too much vitamin A from their diets, than too little. Excessive Vitamin A is mostly a concern from over supplementation. This can cause adverse effects and is of particular concern for women who are pregnant. It would be difficult to consume excessive vitamin A from food sources alone.
What to Do
- Include a variety of fruits and vegetables: A rainbow assortment of fruits and vegetables will help you to meet your requirements for vitamin A, so include the following on a regular basis:
- Sweet potato, spinach, carrots, pumpkin, cantaloupe, red peppers, mangos, dried apricots broccoli, spinach, and kale.
- Dairy products such as ricotta cheese, milk and yogurt can be included in a healthy diet and will help you to meet your requirements for vitamin A.
Preventing Foodborne Illness
There are many ways to prevent foodborne illness in babies and toddlers including:
- Good hygiene- Hand washing is the most effective measure you can take in preventing foodborne illness in your baby or toddler.
- Avoiding at risk foods- Certain foods are more susceptible to bacterial growth and should not be given to your baby. These include:
- Unpasteurized dairy products, including milk
- Raw and undercooked eggs and foods containing raw or undercooked eggs
- Raw and undercooked meat and poultry
- Raw and undercooked fish and shellfish
- Unpasteurized juices (unless freshly squeezed yourself)
- Raw sprouts
- Honey-do not give to children less than 12 months old due to the risk of botulism, a foodborne illness
- Proper cleaning and sterilization of bottles, sippy cups, breast pump parts, and other baby feeding supplies
- Proper handling, storage and reheating of breastmilk (See: Breastmilk pumping: Safe storage)
- Proper handling and preparation of infant formula
Other Food Safety Considerations
Choking– Don’t let those pearly whites fool you. Just because your child has teeth, does not mean he is ready to handle all types of food. Babies and toddlers are at an increased risk of choking, so it’s important to provide age appropriate textures and appropriately sized foods.
Mercury– Certain types of seafood have a high mercury content, including albacore tuna, swordfish, mackerel, and tilefish. Fish is a great source of lean protein and can be included in your baby or toddler’s diet. When choosing fish, opt for low mercury choices like salmon, cod, chunk light tuna (in the can), pollock, tilapia, and catfish.
What to Do
- Practice good hand hygiene– Wash your hands frequently with warm, soapy water for at least 10-20 seconds.
- Avoid high risk foods –Refrain from giving your baby unpasteurized milk, cheese and juice, raw or undercooked meat, poultry, fish or eggs, raw sprouts, and honey if under 12 months old. These foods are more susceptible to bacterial growth.
- Cook foods thoroughly– Cook foods like meats and poultry to recommended internal temperatures (below) to ensure harmful bacteria are killed.
- Beef, pork veal and lamb- 145 degrees
- Ground meats- 160 degrees
- Poultry-165 degrees
- Fish and shellfish-145 degrees
- Don’t “double dip”- Feeding your baby straight from the jar can introduce bacteria from your baby’s mouth from the spoon into the food. Instead, spoon a small amount into a bowl and feed your baby from there. Throw out any food from the bowl that your baby did not eat. You can place whatever is left in the jar (that did not come into contact with your baby’s saliva) back in the refrigerator for later use.
- Timing is key-Be familiar with recommended “safe times” for opened baby food
- Strained fruits or veggies- 2-3 days
- Strained meats- 1 day
- Veggie and meat combos-2 days
- Clean and sterilize- Be sure to wash bottles, sippy cups, feeding utensils, breast pump parts and other feeding supplies in hot, soapy water then rinse thoroughly.
- Follow proper handling, storage and reheating of breastmilk guidelines- (See: Breastmilk pumping: Safe storage.)[
- Follow proper handling and preparation of infant formula
- Mix formula with safe water source
- Prepared formula must be discarded within 1 hour after feeding your baby
- Prepared formula that has not been given to a baby can be stored in the refrigerator for up to 24 hours
- An open container of ready to feed or concentrated formula should be covered, refrigerated and discarded after 48 hours if not used
- Prevent choking-Take these precautions to minimize the risk of your child choking.
- Foods that pose a risk of choking should be avoided. Examples include nuts, whole grapes, hot dogs, raw carrots, raisins, popcorn, and portions of food that are too large.
- Stay close to your baby during meals to make sure he is tolerating the foods appropriately
- Make sure your baby or toddler is in a designated feeding chair like a high chair or booster seat
- Allow baby to eat at his own, comfortable pace
- When it doubt, throw it out – If you can’t remember whether the leftovers are from two days ago or last week, throw it out.