They were doing great, breastfeeding or taking a bottle and eating some solids but now what?!??! You're expected to change everything. First off, remember that if you plan to continue to breastfeed (which is awesome if that’s your choice!), some of this won’t apply to you but some of it will.

With everything else going on, I’m here to tell you it doesn’t have to be that complicated.

Here are my 5 simple rules for transitioning to milk at 1 year of age (and only two low-stress choices for you to make):

1. Remember that there’s nothing magical about milk.

Cow’s milk is an easy source of calcium, calories, and protein but if they are eating those things then they actually don’t have to drink milk at all. Especially keep that in mind when you make the change if their milk intake falls off. It’s OK. I generally recommend 18-24 ounces per day. This should be enough to get your baby some extra calories, but not be so much that it can lead to constipation. Also remember that yogurt and cheese have similar nutritional content so they can be included in the total as well.

2. Transition to a cup before 15 months.

The closer to 1 year that you can transition to a cup, the better. Hopefully you’ve been offering some water at meal times with a cup for a while. Don’t buy any large quantities of a cup until you find out what your baby likes. Put the cup in front of them, they’ll eventually drink.

3. Decide on a milk. You have some choices.

Remembering rule  No. 1, it’s OK to give yourself some flexibility in the milk that you choose. I’m not worried about cow’s milk or dairy intake as a general rule. Depending on baby’s weight, I am Ok with either whole milk or 2% milk. Talk to your doctor about which might work for your child. There are a few milk alternatives that closely resemble cow’s milk in nutritional content (pea and soy milk are examples) but there are others that are basically water (almond milk). I don’t routinely recommend toddler formula unless medical indicated or recommended by your doctor.

4. Decide on a plan for your transition.

I’ve seen families make the change cold turkey the first day it was possible. I’ve seen families slowly transition by adding in milk alternating bottles with formula. I’ve also seen families mix some formula and some milk in individual cups. I haven’t seen any one particular strategy work better than another. I think most babies would do fine with a quick transition or cold turkey swap…but every baby is different.

5. Try not to stress too much about this.

There are plenty of things to worry about in parenting. Deciding what to give them to eat and drink shouldn’t add to your stress. Provide them plenty of fruits and vegetables. Decide on your milk choice and your method of transition and don’t stress the rest.

They will have good days and bad days (just like us).

But, I promise everything is going to be OK in the end.

But I hear from my patient families all the time that it's anything but relaxing.

The American Academy of Pediatrics recommends doctors ask parents three questions about mealtime:

1. How anxious are you about your child’s eating?

2. How would you describe what happens during mealtime?

3. What do you do when your child won’t eat?

When offered a healthy, well balanced meal with fresh fruits, vegetables, and lean proteins, kids will stop eating when they are full. Children will naturally refuse to eat when they are not hungry. We often describe these as normal appetite slumps. We can disturb children’s natural satiety cues by either forcing them to eat or by offering foods high in added sugar or salt when they won’t eat. This results in a child who will “only eat chicken nuggets.”

Parents are most successful in feeding their children more fruits and vegetables when they model healthy eating, set appropriate limits, and have a positive attitude at mealtime. “The parent determines where, when, and what the child is fed; the child determines what to eat.” ⁽¹⁾ In other words, “parents provide and kids decide”. ⁽²⁾ 

Here are some tips on eating mindfully and encouraging your kids to eat in a manner that gives them more energy and helps them avoid chronic disease. These are easy ways to change your lifestyle that don’t involve a ton of work and expensive supplements.

1.Drink more water. Kids should not drink juice or soda except on special occasions.

2.Drink milk with meals. Children from age 1-2 should be on whole milk. After the age of 2, low fat or skim milk is recommended.

3.Vitamin supplements are not needed unless your child does not drink milk. Vitamin D is essential for bone health and immune function and may play a role in prevention of chronic disease.

4.Serve 5-9 servings of fruits and vegetables daily. Encourage your children to at least take a bite of everything you serve. Remember that children will need to taste a food 10-15 times before they decide they like it. Lean protein like fish and baked chicken might be better accepted if you add ketchup as a condiment.

5.Add healthy protein likes nuts (for older children) and legumes. Peanut butter is fine for younger children and new allergy immunology guidelines suggest that early introduction of peanut may actually decrease the risk of peanut allergy.

6.Eat more meals at home. Keep staples such as eggs, whole grain pasta, pasta sauce, yogurt, carrots, frozen vegetables, chicken breasts, and fruit stocked at all times so that in a pinch you could throw together a simple meal.

7.Double your recipes and freeze 1 meal at the same time that you cook the other meal. This will save you from making a trip to a fast food restaurant when you have that go to meal in your freezer.

8.Serve only whole grain breads and pastas.

9.Avoid buying, eating, or serving processed foods (chips, cookies, cakes).

10.Avoid fried foods and fast foods.

To read more about nutrition needs of children at different ages, I highly recommend the book “Nutrition: What Every Parent Needs to Know" available on the American Academy of Pediatrics (AAP) online bookstore.

See choosemyplate.gov for more information about how your child’s plate should look at meal time.

Realize that children’s tastes will change over time. They will sometimes refuse foods they readily accepted in the past, and they will readily accept foods that they refused in the past. Involve your children in shopping and meal planning. Let them help in the kitchen! Take them to a local farmer’s market and let them choose something new for everyone to try.

Take a matter of fact and pleasant approach to meal times and ENJOY YOUR FAMILY! Create wonderful childhood memories.

References:

1. “A Practical Approach to Classifying and Managing Feeding Difficulties” Pediatrics Volume 135, number 2, February 2015

2.Nutrition: What Every Parent Needs to Know. AAP

Most mothers eat a varied diet with fortified foods (usually milk) containing Vitamin D, take prenatal vitamins, and have some exposure to sunlight while pregnant and have plenty of Vitamin D to pass on to their babies.

However, due to an increase in vitamin D deficient babies, the American Academy of Pediatrics published guidelines in 2003, recommending that all breastfed babies receive 400 mgs IU of Vitamin D drops each day.

The increased number of vitamin D deficient babies is likely due to the less amount of time today’s moms and babies spend in the sun. Darker skin tones, vegan diets, babies born in northern regions and those who cover completely (like religious veils) are at a higher risk for deficiency.

Talk with your child’s health care provider about vitamin D options for your child.

Related Topic:

• How Much Calcium and Vitamin D Does My Child Need?
• Do Your Kids Need Vitamins or Supplements?
• Let's Learn About ... Giving Your Kids Vitamins
• The life-saving reason your baby needs vitamin K

Often, moms perceive that they do not make enough milk because they do not make “extra” milk.

Other times they think the baby is eating too often, or the breasts feel too soft, or the baby is fussy at certain times of the day, or they are unable to pump much milk.

Many complain they do not leak, that their baby nurses quicker than he or she once did, or that they are unable to feel a letdown.

Reality is, that none of these things mean that a mom has inadequate supply.

As the virtual lacation consult at Cook Children's, I ask questions like:

• Is the baby is growing?
• Are they having plentiful output (poops and urine diapers) each day?
• Are they waking often to feed and seeming satisfied after?

Since breastmilk is easily digested, breastfed babies may eat more often than bottlefed babies at somewhere between 8-12 times in a 24 hour period. The baby will be described as alert and active, and seems satisfied after feedings; often times with relaxed hands. Mom will also report hearing swallows during the feed.

The greatest indicator of sufficient milk intake is weight gain, though an initial loss is normal and expected as they shed the extra fluid in their tissues. Once the milk supply is in, we expect most babies to gain close to an ounce per day. After 3-4 months, the number will gradually slow down.

Another reliable indicator is output. By day 6 we expect to have 6 pale and mild smelling wet diapers and >4 bowel movements that have transitioned to the yellow, mustard, seedy stools. Over time, the number of stools will fluctuate and breastfed babies may go many days without a BM as their body is absorbing all of the nutrients. Even then, we expect soft and profuse stools.

The older the baby gets, the more adequate they feed, therefor spend less time at the breast and since many mothers do not feel their letdowns, that nor the firmness of the breast tell us how well the infant is being fed.

Virtual Lacation Consultation Program

Connect to an International Board Certified Lactation Consultant (IBLC) from the comfort of your own home. When caring for a newborn, it is important to have support for successful breastfeeding and nutrition. Cook Children's now offers that to you and your baby when and where you need it: in the comfort of your home. Click here to learn more about the program.

Schedule an appointment now

Consultation topics include:

• Correct latching
• Milk supply
• Feeding schedules
• Pump options and supplies
• Pumping routines/schedules
• Return to work planning
• Nutrition and skin care
• Newborn positioning
• Milk storage
• Pain or possible infection

Meet our Lacation Consultant

 

Holly Erwin, LVN, IBCLC, is a mom of three boys and has worked as a pediatric nurse for over 11 years within the Cook Children's Health Care System. When not working, she spends her time running to and from sports for her boys, being outside with her family and dreaming of traveling with her husband of 10 years. For now, she settles for their bi-annual date-night!

Through her own children and the thousands of moms that she has helped over the years, Holly found a special interest in infants and breastfeeding. In 2015, she became internationally board certified as a lactation consultant and now works as an IBCLC virtually through the Cook Children's telemedicine department.

But does it really do any of those things? And what are the risks?

The opposite of raw milk is milk that has been through the pasteurization process. Pasteurization is the process where milk is heated to a high temperature and maintained there for a period of time to kill off harmful bacteria. Bacteria such as Listeria, Salmonella and E. coli can be present in unpasteurized (raw) milk. These bacteria are potentially dangerous in anyone but are especially concerning in young children, pregnant women, and people with weakened immune systems.

But, unfortunately the myths about raw milk and pasteurization are out there … here are some of the worst:

1. If your supplier is careful, they can prevent infection. This is categorically not true. Outbreaks happen as a result of drinking raw milk, even in the most careful and frequently tested suppliers. Raw milk is 150 times more likely to cause foodborne illness.

2. The bacteria that could be in raw milk are no big deal. Unfortunately, serious illness, hospitalization and death occur during outbreaks of E. coli, Listeria and Salmonella. Raw milk causes 13 times more hospitalizations than pasteurized dairy.

3. Drinking raw milk will protect you from allergies. The only studies that show any benefit in allergic symptoms from drinking raw milk looked at families who live in rural areas and on dairy farms. There are so many other possible factors, it’s impossible to know.

4. Milk has natural mechanisms which prevent bacterial contamination. Unfortunately not. Outbreaks from raw milk prove this.

5. Grass fed animals produce clean milk. Outbreaks have been tied back to both grain and grass fed animals.

6. Pasteurization increases the risk of lactose intolerance. No again.

7. Pasteurization decreases the nutritional value of milk. Pasteurization changes the taste of milk and that’s about it. Vitamin B12 and E were lower in pasteurized milk but milk is not considered an important source of either vitamin anyway.

8. Isn’t natural always better? Many of the advances we have had in science and medicine are related to improvement or changes over substances in their natural state.

Despite all the myths out there (and even if the claims were true), it’s clear that the risk of drinking raw milk at any age far outweighs the benefits.

Yes, according to a new study from the American Journal of Clinical Nutrition. Researchers say children who consumed milk from alternative sources, such as almond, rice and soy milk grew less than children who consumed cow’s milk.

For every cup of non-cow’s milk a child drank, they grew 0.4 centimeters (0.15 inches) less in height than average for a child’s age. The decreased growth was dependent upon the amount of non-cow’s milk that the child drank, thus a child who drank 3 cups of non-cow’s milk was 1.5 centimeters shorter.

There could be several reasons for this finding:

• Alternative milks have less calories and protein than cow’s milk. They also have less vitamins and minerals.
• Children who drank alternative milks also drank less than those who drank cow’s milk. (Further analysis showed that this only accounted for part of the difference in height.)

So, what should your family do?

You should know that there is nothing magical about milk, but it’s an easy way to get your child’s calories, protein and calcium. If they’re getting those nutrients from other sources, I’m not concerned about how much cow’s milk they drink.

For children who are allergic to cow’s milk and families who decide to drink milk alternatives for various reasons, talk to your pediatrician about how to adjust your child’s diet to make sure they are receiving the proper amount of calories and protein.

Focusing on a balanced diet is the most important thing you can do.

About the Source

Justin Smith, M.D., is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles.Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

ENOUGH MILK ON DAY ONE?

Many parents worry their baby is not getting enough milk. Did you know a baby’s stomach is the size of a cherry when first born? And the drops of milk you are making the first day or two are normal! The milk you make these first days is called “colostrum” and is highly concentrated, yellow, and sticky, full of easy to digest carbohydrates and proteins that help your baby fight off infections.

SUPPLY AND DEMAND:

The more you breastfeed, the more your brain will make hormones that increase your milk supply and switch it over from drops of colostrum to larger volumes of mature milk. The larger the “demand” for milk, the larger the supply you will make. That is why frequent breastfeeding in those first days after birth are crucial! A general goal is 8-12 feeds during a 24 hour period. Watch the baby for hunger cues like opening their mouth, putting their hands to their face, sucking on their hands, or moving their head around as if they are searching for something. Your baby might even begin to cluster feed, where the baby will want to feed seemingly right after you just fed them! This is their way of getting your milk supply to come in. They cannot overfeed at this stage. Sometimes pumping during this stage can be beneficial to the supply/demand effect. The more you stimulate the breasts, by direct breastfeeding with the baby, and by using a pump, the more milk you will produce. To get an idea of what amount is typical, see the chart below for average volumes of milk intake.

MILK COMING IN

Mature milk usually will come in around day 3-4 of life and will be creamy, fatty, and white. Your breasts will likely feel firm, warm, tender, and full. But remember it can take up to four days for this to happen. If your milk has not come in by day 4, see your pediatrician and your OBGYN in addition to optimizing breastfeeding techniques with a lactation consultant.

LOSING WEIGHT (For baby, not mom!)

Some weight loss in the first days of life is normal. Your pediatrician will check the baby every day in the hospital and again a few days after leaving the hospital to make sure the baby’s weight loss is in a safe range. It is normal to lose up to 10 percent of birthweight in the first week, so for a 7 pound baby that means losing up to 11 ounces. Once the milk is in, the weight should start going up, and babies are expected to be back up to original birthweight when they are 2 weeks old. In addition to weighing, a good way to gauge if the baby is hydrated and getting enough from feeds is to check the number of wet diapers. Lots of full wet diapers means your baby is staying hydrated from feeds. If weight loss is beyond the normal range, your pediatrician will guide you through ways to help, which can include supplementing and/or pumping.

IT HURTS!

The most common cause of discomfort with breastfeeding is not having the right latch onto the breast. Try to make sure that the baby is opening up wide to get the entire areola and not just the nipple. You may need to take the baby off the breast and try again if the latch is not right. Both lips should be open wide and curled outwards if the latch is ideal. Lactation consultants in the hospital can help you each day to make sure you and your baby have a good latch. You can also try to use Lanolin creams to help soothe your nipples after feedings. With the proper latch onto the breast, your discomfort should be a temporary issue that gets better with time.

PACIFIER USE

Sleep deprivation combined with a crying infant can make pacifiers a tempting choice in the first days of life. However, studies show that pacifiers are best introduced AFTER breastfeeding is “established” meaning it is going very well, typically at 3 weeks of life, to prevent the baby from being confused between the pacifier and the nipple. Many parents don’t know this, but pacifiers are actually recommended because in the long run they reduce the risk of sudden infant death syndrome. So DO use a pacifier, but try to wait until feedings are going well first.

PRACTICE MAKES PERFECT

I always grew up hearing my dad say “practice makes perfect!” I wonder if that’s why I ended up becoming a doctor. I got used to practicing new things over and over again until it felt like second nature. The same can be said about breastfeeding. It is a skill, and it takes practice and most importantly, patience, but sleep deprivation added into the mix can make this easier said than done! If you are looking for further breastfeeding support from other parents, more resources, lactation consultant recommendations, or free breastfeeding classes, check out the following resources:

• Breastfeeding Tarrant County Coalition website
• Mobile app LatchMe
• Mobile app LactMed - information about safety of medications and their effect on babies through breastmilk

Happy feeding!

Dr. Rachel Hamilton

About the author

Rachel Hamilton, M.D., is a pediatrician at the Henderson Clinic. To make an appointment, call 817-783-4109. Dr. Henderson grew up in the Dallas/Fort Worth area. She obtained her bachelor’s degrees in chemistry and biology and graduated as a president scholar from Southern Methodist University. She completed medical school at the University of Texas – Southwestern Medical Center in Dallas and pediatric residency at the University of Texas at Austin – Dell Medical School. She is a member of the medical honor society Alpha Omega Alpha, and has been recognized for humanism in medicine. She is married to David Hamilton and enjoys traveling, SCUBA diving, bass fishing and other outdoor activities. Her favorite aspects of being a doctor include life-long learning and the joy of helping children live fulfilled, healthy and happy lives.

“Is it GERD?”

Or, as I frequently see it spelled, “Is it gurd?”

Every baby spits up ... there is definitely a spectrum from the babies that spit up once in their whole life all the way to the babies that spit up every single time they eat.

It can be hard to understand what a doctor or patient means when they use the terms spitting up, reflux or GERD because people use them in different ways.

I try to keep it simple and only use the terms reflux and GERD when I think that the spitting up might be causing a problem:

So, if every baby spits up, how do I decide what is normal? When is it spitting up vs. reflux vs. gastro-esophageal reflux disease (GERD)?

The answer to this is tricky but I’m hopeful that I can help you decide.

Studies have been done where they watch how many times a baby regurgitates milk and stomach acid by placing a probe down his or her esophagus (this is reflux). The answer ... on average, 30 times per day. Most, but not all, of these episodes were associated with milk at least making it into the mouth.

Why does this happen?

There's a muscle that sits on top of the stomach that is meant to properly relax and squeeze to allow milk into, but not out of the stomach. Unfortunately, in most young infants, this muscle is both weak and dumb. It's not strong enough to override the pressure of the stomach pressing on it and it frequently relaxes when it is supposed to be contracting, letting stomach acid run back up into the esophagus.

So, reflux is, for the most part, a mechanical problem that's based on the pressure of the stomach and the strength of the muscle that sits on top of it. That is why, I think, that the most common cause of spitting up is overfeeding.

Often a family of a 2 month old will come in for their checkup and have questions about why their baby (who eats 6 ounces per feed) is spitting up. The issue is that the stomach is only a few ounces big at this age and everything else that you try to squeeze into it just raises the pressure and causes the baby to spit up.

So, if it’s so common what makes it abnormal?

There’s really only 2 reasons why I will treat babies for reflux: poor weight gain or associated pain/fussiness. So, the most common thing I will do to treat reflux is check the baby’s weight and if weight gain is good, reassure the family that they have a “happy spitter.”

I also see babies who are consistently fussy with their spitting up or that have fussiness predictably during feeds or in the 30 minutes following each feed with or without spitting up. Some people have termed this “silent reflux,” but I don’t really like that term because the screaming associated with it is anything but “silent.” Babies can also arch their backs which is sometimes confused for seizures but is, in fact, reflux.

What do we do about it?

Many babies can be helped by just cutting back on the amount of milk they are ingesting ... most babies need about 2-3 ounces per feed at 2 months and this goes up about 1 ounce per month of age after (6 ounces at 6 months).

I still commonly discuss with families that they can slightly elevate the head of the crib although it looks like review of the literature questions whether this is actually helpful,  so I may have to rethink this.

Studies have shown varying percentages about babies with reflux who have an allergy or sensitivity to cow’s milk protein (some studies show it as high as 40 percent). Thus it might be reasonable to try a short trial of a hypo-allergenic formula (Neutramigen or Alimentum). Many babies who are sensitive to cow’s milk will also be sensitive to soy. Many publications don't recommend a trial of soy, but because of the expense of the hypo-allergenic formulas I will sometimes have families do a trial of soy formula first.

Finally, in those babies who aren't gaining weight well or who are fussy with their GERD or following feeds, a short trial of an antacid medicine can be attempted to help with symptoms. There are two types of medicines that can be used: H2-blockers (ex Zantac) and PPI (ex Prevacid). I try to remind families that neither of these medicines are meant to help keep milk in the stomach. They only change the acidity of the contents that are coming up. So, it's likely that the baby will continue to spit.

Summary

1. Most babies with reflux have a laundry problem and not a medical problem (think happy spitter).

2. Limiting overfeeding is the major non-medical treatment for spit up.

3. Medicines for reflux can be used in babies with poor weight gain or fussiness but should be used sparingly and with appropriate expectations.

Here are 4 reasons goat's milk is dangerous and could even be deadly:

1. It is usually not pasteurized which can lead to all kinds of bad infections (listeria most commonly).
2. It has more protein so baby's kidneys can't handle it well. This along with high sodium level can lead to strokes.
3. It doesn't have enough folate which can lead to anemia.
4. It doesn't have the same electrolytes which can lead to extra acids building up in the baby's body. This causes multiple downstream problems.

Breast is best. Modern formula is really, really good too.

Goat's milk is nothing to kid around with.

Some choose to stop breastfeeding. Some move on from spending all their extra money on formula. Everyone is wondering what milk to move to next.

The standard answer used to be ... whole cow’s milk. Now 2 percent seems reasonable; even soy in those who have had issues with cow’s milk before. Let’s start off by saying that there’s nothing magical about milk. I like to think of it as an easy way to get your child calories, protein and calcium. But, if they are getting those nutrients from other sources, I am not too concerned about how much milk they drink.

What about almond milk?

Almond milk sales have gone through the roof over the past decade. As more adults identify as lactose intolerant and are turning to plant-based alternatives, it’s no surprise that they are starting to consider it an alternative to cow’s milk for their children.

Let’s start by comparing the nutritional information:

Almond milk is made by crushing up some almonds and mixing them with some water. It’s not fancy. In commercially available products, 1 cup has the equivalent of about 4 almonds worth of nutrition in it.

Given that I consider the primary benefits of milk to be a source of calories (35 in almond compared vs 160 in whole cow’s milk), protein (1 vs 9 grams) and calcium (2% RDA vs 30%), almond milk doesn’t exactly measure up. This could be a problem with a picky eater whom the family is relying on almond milk, thinking it will help supplement when they do not eat well.

Could almond milk be harmful?

A case study published online for Pediatrics (February 2016) describes a case where a child fed predominately almond milk and almond flour from 2.5-10 months of age resulted in the child having scurvy. Scurvy is a disease that is the result of having too little vitamin C and can result in bone thinning and fractures. Of course, the improper use of cow’s milk over this time could also cause a number of health problems as well, including anemia.

Prolonged use of almond based milk has been linked to low chloride levels and failure to gain weight in other patients. I believe these are both also related to poor intake of other foods, as a child can grow just fine without nutritional deficiencies with a balanced diet and water.

What’s the bottom line?

Is almond milk the most terrible thing in the world? No.

Is it a good alternative to cow’s milk for your child? No.

It just doesn’t have the same nutritional value. Your child might as well just drink water. Focusing on a balanced diet is key no matter what.

If you don’t know her name, you more than likely have seen her photo because she has blown up the Internet with a photo of her breastfeeding her own son and the son of a friend.

For some it’s a beautiful expression of what’s perfectly natural. For others, it’s caused a range of emotion from “yuck” to outrage.

And for our lactation experts at Cook Children’s, well, they look at it as an opportunity to educate the public.

The lactation nurses at Cook Children’s have been busy working and had not seen the photo making the Internet rounds until called for this story. They realize that it makes many of us uncomfortable in the United States to see such a bold expression of a natural process. But they say it’s a common practice in many other countries around the world and accepted and sometimes expected culturally.

From a medical aspect, the lactation experts say milk sharing is becoming a more common practice but not without risks. There are numerous transmittable diseases that can be passed on through a mother's milk as well as many medications that will be passed on through milk too. As milk sharing is becoming more common there are even websites out there where people can share breastmilk with one another. Again, caution must be used when sharing breast milk.

To be perfectly safe, for those babies that have a medical need and prescription for breastmilk, they recommend a place like Mothers’ Milk Bank of North Texas, which allows moms to donate breastmilk. The mothers go through a screening process and is then the milk is pasteurized to make sure there’s no harmful bacteria.

The consultants hope that people don’t focus on the photo as much as they do the benefits of breastfeeding.

And for those of you wondering, “Aren’t those kids a little old to be breastfeeding?” Come on. We know a lot of you are. The World Health Organization recommends breastfeeding babies until at least 2 years of age.

The lactation nurses aren’t willing to weigh in as far as the emotional aspect of the picture or how it impacts them developmentally. Breastfeeding in a personal choice and one that we hope every mother will attempt. How long to feed your baby is personal and will be very different for each mother. At the end of the day, breastfeeding is supported by the World Health Organization, Center for Disease Control, the American Academy of Pediatrics just to name a few.

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life, “followed by breastfeeding in combination with the introduction of complimentary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.”

About the source

Because research shows that breast feeding helps improve babies' health and helps moms bond with their little ones, Cook Children's has full-time lactation specialists on staff to assist mothers with pumping and breastfeeding. We offer breast pumps in every room and have an on-site milk bank available for safety and storage. There are numerous resources available through lactation services for moms that are having difficulty with nursing/pumping. While other nurses are focusing on the baby's care, the lactation consultant can provide extra attention to mom.

The numerous health benefits of breastfeeding cannot be denied. Some of them might be overstated at times but, all in all, I believe that breastfeeding is best.

I know there are times when, for whatever reason, moms cannot or choose not to breastfeed. Fortunately, we have come a long way from the old days of evaporated milk formulas of the 1920s to where formula feeding is a very reasonable alternative for those moms. I believe that families should be properly educated and supported in their feeding decision no matter what it is.

If you chose to formula feed or plan to, you can stop reading now. This is not one of those articles meant to shame someone for their choice. This post is a message in support of moms and families who choose to breastfeed and need a little help to determine if everything is going OK.

“Seven percent is average, over 10 percent I start to get worried.”

Most moms know (or read or were taught) that babies lose weight in their first few days of life. If not, that one week checkup is pretty emotional when they place their babies on the scale and the number is lower than their birth weight. Think about it, a 10-pound baby can drop to as low as 9 pounds and still be considered normal weight loss, but you would certainly worry from the time the baby was weighed until I came in the room to tell you everything is OK.

I have been quoting this 7 percent/10 percent mantra since I started practice. It’s partially wrong, at least for breast fed babies. Why? They can actually lose more and still be normal.

A study released in Pediatrics in December showed that breastfed babies could lose more than 10 percent and still be normal, especially babies born via caesarean section. The graphs enable a pediatrician to look at a baby’s weight loss day-by-day and determine if the weight loss is excessive. The bottoms of the weight loss peak occur on day six for both vaginal and c-section but the peaks occur at 11 percent and 12 percent respectively.

Why does this matter?

Any mom who has had trouble getting their baby to grow on breastmilk knows the pressure to start formula that can be applied by doctor, nurses or family members. While, I don’t believe that having mom give formula when appropriate ruins her chances of breastfeeding, I certainly don’t want to be pushing families to supplement when it isn’t necessary. Therefore, I plan to start implementing these guidelines into my practice so that I can best support breastfeeding moms in their effort to breastfeed.

If you are having a baby and are planning to breastfeed, it might be helpful for you to be aware of them as well.

"We try and try, but he won't burp."

Oh, the magical burp. It's that often elusive sound that would be offensive for you to let loose at the dinner table, but everyone celebrates when it comes from your newborn.

So, what's the point? Easy, to get some of the air that's trapped in the stomach below the milk … out. Some babies are easy to burp. They can suck down eight ounces of milk in five minutes and you barely get them upright before your hear a big, manly burp. There are other babies who, no matter what you do: pat, bounce, dance or turn them upside down … they are not going to burp.

I actually don't think it matters. I think the biggest benefit of the process of burping is simply that you aren't immediately laying them down flat right after they feed. Keeping them upright helps the milk settle lower in their stomach and provides some protection from spitting up, but actually obtaining the precious belch is probably not all that important.

Do you have more questions about newborns? Check out Dr. Smith’s program, Newborn University, including 20 posts about newborn care and classes or consultation at his office in Lewisville.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.