Smoking while nursing
It’s best for your baby that you stop smoking; and if you gave up cigarettes during pregnancy, you should stay off them. Smoke in your lungs, on your clothes, and in the air can affect your baby’s respiratory health and can make him more vulnerable to colds and other respiratory infections, and even to sudden infant death syndrome (SIDS). Smoking can also affect your milk volume. But, if you find you can’t give up smoking, we have these suggestions:
• Formula isn’t safer. It’s better not to smoke if you’re breastfeeding, because your baby will be exposed to nicotine in your milk. But, don’t stop breastfeeding in the belief that formula feeding is somehow safer for your baby. Doing so will deprive your baby of the valuable health benefits of human milk. Breastfed babies whose mothers don’t smoke are less likely to have acute respiratory illnesses and are at a lower risk of dying from SIDS than babies whose mothers smoke and feed their babies formula.
• Smoke less and step outside. Your baby is very vulnerable to passive, secondhand smoke. Direct exposure to cigarette smoke, whether from you or from someone else in your home, increases your baby’s chances of getting pneumonia and bronchitis, and dying from SIDS. Step outside to smoke, snuff the cigarette out after an inch or less, and cut down on the number of cigarettes you smoke each day. Keep a picture of your baby in your cigarette pack to remind yourself.
• Smoke after (instead of before) feeding. It takes approximately an hour and 15 minutes for nicotine to leave your body, so try to limit your smoking to immediately following a feeding to allow as much time as you can in between smoking and nursing.
• Take iodine. Recent research appears to show that smoking reduces the transport of iodine through breastmilk. Iodine is critical for a baby’s thyroid hormone formation during pregnancy and the first years of life, and insufficient iodine has been associated with developmental brain damage. Using iodized salt on your food and taking vitamins that contain iodine may help. Ask your health-care provider for suggestions and for a referral to an effective smoking-cessation program. It’s a way of helping both of you.
• Use patches only in the daytime. If you’re trying to stop by using a nicotine skin patch, your baby will get less nicotine than if you smoke. Remove the patch at night when you least need it, so your baby will get less nicotine during night feedings.
Breastfeeding while working
Breastfeeding your baby while working can provide a valuable, loving link to your baby. Plus, providing breastmilk for your baby can help to keep him healthier, which could translate into fewer days off for tending to a sick or hospitalized baby.
While many working mothers find themselves holed up in bathroom stalls as they struggle to express milk, some enlightened companies make things easier for them. For example, the CIGNA Corporation, in Nashville, Tennessee, provides a private nursing area where lactating moms can sit back comfortably, put their feet up, and pump milk that can then be stored in an in-room refrigerator.
Some companies even subsidize the cost of breast pump rentals. It’s their way of holding on to valuable employees who would be costly and time-consuming to replace. Plus, keeping employees focused and comfortable results in increased loyalty and productivity.
Some states, such as Minnesota, have enacted laws to protect the rights of nursing mothers, but that’s the exception and not the rule. For many companies, liberal policies are not the case, and you may find yourself judged and possibly ostracized for your twice-a-day jaunts to the restroom to gather milk for your baby. Circumstances such as these make it tempting to quit or to find some other, more family-friendly place to apply your skills.
Pumping tips
• Get the right pump. It helps to rent or buy a truly efficient pump if you want to continue expressing milk after you go back to work. It will save you time and ensure that you maintain your milk supply. A double pump does the job more quickly. (See breast pump buying information on in 4. Gear Guide.)
• Use a good tote bag. Choose a carry bag that has an insulated ice pack for keeping the milk cold while you travel.
• Practice ahead of time. Practice expressing and pumping your milk before you return to work, and try to pump at about the same times each day. This will prepare your body for a regular schedule of expressing.
• Use your imagination. If you feel uptight or worried that someone will see you, it makes it harder to have a letdown. Think about your baby, or use a picture or a piece of clothing with your baby’s scent on it to get your milk going.
• Store it correctly. Date the milk, seal it well, and keep it cool by using a freezer pack until you can get it back home to freeze. Don’t refreeze milk after it’s been defrosted.
• Let your baby practice. Let your partner or child-care provider give your baby the bottle with breastmilk in it so your baby can get used to drinking from it when you’re away.
• Keep your milk supply up. Nurse your baby in the mornings and at night, and let him have full access to nursing on weekends to keep your milk supply up. If you wish, pump the opposite breast to gather milk at the same time as you nurse your baby.
How to wean
It’s not unusual for mothers to feel ambivalent about weaning their babies. You may not want to give up the physical and emotional closeness that breastfeeding has forged between you and your baby, but you may also feel that you can’t continue because of other pressures.
Experts agree that the best weaning strategy is to do it gradually and with gentleness. Abruptly stopping nursing can cause painful engorgement for a few days, and it may be distressing for your baby.
Introducing formula is one way to start slowing down your milk production. Gradually eliminate one daytime feeding at a time while maintaining the early morning and go-to-sleep feeds in the evening. Finally, you can drop the morning feeding and, ultimately, the last feeding of the evening.
Rock and hold your baby and continue the bond of physical closeness even though you’re bottle feeding. Sometimes weaning occurs even if you don’t want it to. Occasionally, babies wean themselves at around nine months as they begin to eat more solids.
Tips for turning off the milk If you choose not to nurse your baby after birth, or you if nurse for a while and then decide to stop, expect to experience some congestion and pain at first. Your breasts will become swollen and hard for two to four days, and you may run a slight fever. The official name for this is engorgement, and the tightness and congestion can be unpleasant, if not painful. Here’s how to help ease your discomfort:
• Bind your breasts for 24 to 48 hours. Use an extra-wide elastic (Ace®) bandage. Wrap it tightly around your breasts three or four times, and pin it in place. This will compress your breasts and slow down milk production.
• Apply ice packs. Or use a towelwrapped bag of frozen vegetables for 15 minutes on, then 45 minutes off. (If you leave the ice pack on for longer than 15 minutes, it may cause your breasts to swell even more.)
• Wear a bra. Wear a supportive bra at all times. A snug sports bra is best, and an underwire bra is the worst. Avoid applying extra pressure anywhere on your breast.
• Don’t take a drug to stop the milk. If you’re offered any drug to suppress lactation, refuse it. In 1990, the FDA recommended that lactation-suppression drugs not be prescribed because they’re no more effective than icing and binding, and they can also cause side effects, such as headaches, dizziness, and stroke. Currently, no drug is approved by the FDA to suppress lactation.
• Keep warmth away. Stand with your back to the shower and use a towel to put a pad between your chest and your baby.
• Apply cabbage leaves. An often-used home remedy for breast swelling is to place raw cabbage leaves under an ice pack on the breast (see above). Cabbage is thought to have anti-inflammatory properties.
• Don’t express milk. Though it will relieve the pain temporarily, it will encourage more milk production.
While breastmilk is ready to serve, bottle feeding requires a good deal of paraphernalia, which may take some getting used to. You need to select the bottles and nipples you want to use, find the formula brand that works best for your baby, and make choices within brands about whether to use powdered, canned, or pre-bottled varieties. You will probably find yourself doing some serious reading of the fine print on formula brands on the shelves of drugstores and grocery stores. You may notice that, although all brands appear to have similar contents, there are some variations.
Some newer formulas advertise that they contain docosahexaenoic acid (DHA) and arachidonic acid (ARA), omega-3 long-chain polyunsaturated fatty acids that are found naturally in breastmilk. While some studies seem to show that these supplements improve a baby’s cognitive and visual development, other studies show no difference at all. It’s important to note that the DHA and ARA found in human breastmilk is structurally different from the plant-and egg-based fatty acids that are manufactured for formula. Some medical professionals question the safety of manufactured DHA and ARA, as the synthesized forms of the ingredients have not been tested by the FDA. As of this writing, the American Academy of Pediatrics has no official stand on these formula additives.
Which baby bottle?
Baby bottles can be found in a variety of shapes and designs. Whatever bottle style you opt for, pick one shape and stick to it. Having a drawer of different-sized bottles and nipples that need to be matched up is enough to drive a parent crazy.
Tip
When it comes to choosing a formula brand for your baby, your baby’s caregiver is the best adviser. Before you start stocking up on formula or cashing in on free coupons, find out what brands your baby’s caregiver recommends and why. Also, wait to see how your baby tolerates the brand before stocking up by the caseload.
Angle-necked bottles are designed to keep the baby from swallowing too much air, which leads to uncomfortable gas. They are more comfortable for parents to hold, especially when a baby’s trying to suck out the last dregs of formula. Their shape helps collect the last of the formula in the nipple so your baby isn’t sucking half air and half liquid.
On the other hand, when it comes to bottle cleaning, the simpler the bottle shape, the better. Bottles should be dishwasher safe and come with easy-to-read ounce markings on the side for measuring. The more transparent the bottle, the easier it is to see what’s going on inside. Glass bottles are the easiest to get squeaky clean, but they’re also breakable. If you decide to use them, make a mental note not to let your toddler walk around with one later.
Another alternative is the disposable bottle system. Usually you can buy the whole system in a box. It contains bottle-sized plastic rings for holding throwaway liners that resemble plastic sandwich bags, and special nipples or nipples and plastic rings for securing the liners inside the holders. Once you’ve used up all the liners in the initial box, you simply buy a roll of replacements. While the system saves dishwashing hassles, it’s a lot more expensive than recycling regular bottles. The bottles aren’t all that easy to set up, measure, and fill. Plus, there’s always the problem of running out of liners.
Bottle-Feeding Supplies
Here’s what you’ll need to have on hand when you bring your baby home:
Formula. A small container of formula (your hospital may supply some free cans of their chosen brand).
Safe water. Water for mixing powdered and concentrated formula. Normal-temperature tap water is fine in most cases, but use bottled water if you have well water.
Cleaning tools. Bottle brush and nipple brush.
Bottles. Three or four bottles. Don’t buy a lot of bottles until you find out what style you and your baby prefer. Then, once you have a favorite, you can never have too many!
Nipples. Several slow-flow, newborn-sized silicone nipples.
Supplies that aren’t necessary but may make bottle feeding easier:
Dishwashing aids. A nipple basket for your dishwasher to hold the small items together. (Nipples and rings put in the silverware basket tend to get lost.)
Ready-to-feed formula. Premixed, liquid formula, which is more expensive than the powdered variety but will save time.
All in all, standard, reusable bottles are the best and most economical solution. In addition to nipples and bottles, you’ll also need a baby-bottle brush and a small, plastic cage for holding nipples in the dishwasher, or a drying rack for the bottles if you plan to hand wash them. If your baby’s bedroom is upstairs and your kitchen is downstairs, you may also want to invest in a small refrigerator and a bottle warmer with a self-monitoring thermostat for middle-of-the-night feedings.
Shopping for bottles
Go for:
• Clear bottles with easy-to-read measurements.
• Bottle sizes compatible with your breast pump.
• An easy-to-clean design.
Avoid:
• “Novelty” bottles in wacky shapes or textures.
• Investing in a single expensive bottle “system” before your baby arrives. Not all nipple and bottle shapes work for all babies (and parents).
Selecting bottle nipples
Nipples, like bottles, come in a variety of shapes, sizes, and materials, and babies seem to have their own preferences about what suits them best. In addition to the standard nipple, other models are available for special uses, such as small and soft for premature babies with sucking problems, and nipples with large or crosshatched holes for pulpy juices and formula thickened with cereal for toddlers.
So-called orthodontic nipples are elongated, almost hourglass-shaped. Advertisers claim that they’re better for a baby’s jaw development, but the center of the nipple is also hard to get clean, and if it’s made of latex, it may rot over time, which will cause it to become sticky and interfere with milk flow.
We suggest starting with standard, newborn-sized nipples, and then experimenting with other versions if your baby seems confused or stressed at feeding time. Always be sure to read the directions for the nipples. Some nipples come with special breathing holes on the base to help adjust the amount of milk flow according to how tightly you screw on the plastic bottle ring. All new nipples should be boiled for about 5 minutes before their first use to be sure that dust and chemical residues are removed.
Most nipples are molded from latex, a form of rubber, or from silicone, a clear, moldable material used widely in the medical world. Both materials have their advantages and disadvantages. Silicone is durable and isn’t likely to cause allergic reactions. Latex, on the other hand, can cause allergy problems in babies. Latex nipples tend to rot over time from exposure to saliva and the acids in milk, but silicone nipples can rupture and tear if your toddler chews on them, and they’re slippery, which may cause difficulty for young babies. Whatever brand and material you choose, inspect nipples closely every few days for tears or abnormalities, and replace old nipples with new ones every 3 months or so.
Burping
Breastfed babies don’t need burping very often, but when babies are bottle fed, air can build up in their bellies and cause them to stop drinking temporarily. If this happens in the middle of a feeding, try removing the bottle and sitting your baby upright while patting him gently on the back. Usually that will bring up a big burp, and your baby will be happy to settle back to drinking. Another way to bring up air is to place your baby up on your shoulder so pressure is put on his tummy. (Be sure to cover your shoulder with a diaper or towel first.) After a few pats, air usually comes up. (For pictures of how to do it, see in 1. Your Baby’s First Half-Year.)
Baby bottle mouth
Never put your baby to bed with a bottle in his crib, since it can cause an unusual form of tooth decay. The acid and sugars in formula and juices pool in the sleeping baby’s mouth and begin to erode tooth surfaces. The problem is usually invisible, because it starts with chalky spots on the inside of a baby’s front teeth, where you’re not likely to look. The teeth eventually begin to break down and crumble.
WARNING! Microwaving Danger!
Never use a microwave to heat a baby’s formula in a bottle. The formula will heat unevenly and could develop hot spots, which can burn a baby’s mouth or cause disposable bottle inserts to boil over and burst, spewing scalding milk on you and your baby. Use a bottle warmer or immerse the bottle in a bowl of warm water, instead.
Some parents think it’s not a problem since preschoolers will lose their baby teeth, anyway. But dentists warn that a baby’s jaw development and the angle at which permanent teeth emerge can be affected by the premature loss of baby teeth.
Research shows that babies who are put to sleep with a bottle are more likely to become entrenched thumb suckers than those who are fed in their parents’ arms. Your baby is less likely to become attached to a baby bottle as a “love object” if you supply lots of love during every feeding.
Buying Formula
Formula comes in three varieties: powdered, premixed, and ready-to-feed (in bottles). Powdered is the least expensive, and the ready-to-feed bottles are the most expensive. Unless your baby’s doctor specifies otherwise, you can use any major brand with confidence. Just make sure that the brand you choose is fortified with iron.
Be careful to follow the formula manufacturer’s instructions to the letter when you mix formula. If you make it too concentrated, it can put a strain on your baby’s kidneys. Sometimes parents are tempted to water down formula to save money or because the can’s almost empty, but that’s not a good idea! Over-diluted formula can deprive the baby of critical nutrients.
Prepare formula only in small batches so that you’re sure it’s fresh. Keep it refrigerated or place an ice pack in your diaper bag so it can’t spoil. A baby’s mouth and saliva can contaminate formula with bacteria, so discard leftover formula rather than serve it a second time.
There’s no medical reason for heating formula, but babies appear to prefer it when it’s at least at body temperature. Most parents opt to twirl the baby’s bottle under warm faucet water for a few minutes until it becomes comfortably lukewarm. You can also buy bottle warmers for the same purpose. (Note: Adult fingers and hands aren’t sensitive enough to test the temperature of formula. Always sprinkle a little of the milk on your wrist to make sure it’s not too hot.)
If you use powdered formula, and your tap water comes from a well, be sure to have your well tested periodically, especially during hot weather, for the presence of E. coli and other contaminants. You may want to consider investing in a water-filtration system if you suspect that your water contains nitrates, lead, or other contaminants.
Money-saving tips for formula
If you want to save money, it helps to let formula companies know that you’d like to be put on their mailing lists for samples and money-saving coupons. Sign up by calling their toll-free customer service numbers. Another way to save on formula is to buy it by the carton from baby-discount stores. Just be careful to examine the labels on the cans to be sure that the formula’s fresh and that it won’t expire before your baby is able to consume all the containers.
If you’re on a low income, you may want to investigate the federally sponsored Women Infants and Children’s program, called WIC. Find your local WIC program through your local department of social services or check www.fns.usda.gov/wic for toll-free phone numbers in each state. If you qualify, you may be able to get formula for free or at reduced prices.
Allergic reactions
In rare instances, a baby may have an allergic reaction to the proteins or sugars in the cow’s milk portion of a formula. Rarely, a baby’s allergic reaction to formula can be so serious as to be life-threatening. Symptoms may include: vomiting, hives, and breathing problems. But, more often, allergic symptoms are much milder—a constantly runny nose with clear mucus, diarrhea, a tendency toward ear infections, or unexplained bouts of fussiness (colic). (See symptoms below.)
If a baby is allergic to formula proteins, there are alternative formulas made with soy protein (not the soy milk found in health food stores), and more refined, predigested formulas, called protein hydrolysates. Your baby’s physician may prescribe one of these formulas if your baby shows symptoms of being allergic to regular formulas. These alternative formulas are very expensive, but your health insurance policy may help to foot the bill. If your physician suggests switching your baby to a soy-based formula, ask about recent research that suggests it could affect your baby’s ability to process certain minerals and that links soy formulas with an increase in vulnerability to peanut allergy.
Signs Your Baby Is Reacting to Formula
Sometimes babies’ bodies react to a particular brand of formula, and you may need to experiment with different brands to find the one that is the most readily digested by your baby. Here are some signs that you may need to shift from powder to liquid or from one brand to another. (Always consult with your baby’s physician first for recommendations, since these symptoms can also signal other physical problems.):
Runny nose. Your baby has a clear mucous discharge from his nose and is vulnerable to frequent colds and ear infections.
Crying after eating. Your baby is fussy soon after feeding.
Vomiting. Your baby vomits after almost every feeding.
Bowel problems. Your baby has persistent diarrhea or constipation (hard pellets) and gas.
Skin rash. Your baby has a red, rough rash on his face or around his anus.
Irritability. Your baby is often fussy or suffers from colic with a distended, tense, painful belly after feeding.