Transcript The skinny on feeding your baby What baby books won’t tell you! Catherine Pound, CHEO Pediatrician.

The skinny on feeding your baby
What baby books won’t tell you!
Catherine Pound, CHEO Pediatrician
Objectives
• Review different stages of feeding between 0 and 1
year
• Briefly discuss breastfeeding and its benefits
• Discuss various breastfeeding issues
• Review how to transition your baby to solid food
• Help you work with your picky eater
• Review transition to an adult diet
Before we start….
• Audience breakdown
• What do you want to know?
Why do babies eat?
• To grow
• To develop oromotor skills
• To learn eating behaviors
Breastfeeding
• Multiple benefits for baby, mom and society
• Easy, convenient
• Almost everyone can
BUT
• Nearly impossible without support
• Often very labor-intensive in first few weeks
A little bit of history!
• Zulu societies: breastfeeding for 12 to 18 months
(circa 2000 BC)
• Aristotle: breastfeeding should continue for 12 to 18
months (384 to 322 BC)
• 19th century: weaning recommended when
canine teeth appeared
– Infant mortality increased at around the same time
– Pediatrics as a specialty emerged
How does it work???
• Baby suckles at breast
• Nerve endings in mom’s nipples
send signal to glands in the brain
• Gland releases hormones
• Hormone in blood causes milk production and letdown
Common problems
• I’m not producing enough
• I’m anemic therefore my baby won’t get enough iron
• Breastfeeding hurts me too much
• I get mastitis and then I take antibiotics
• My baby is too colicky on breast milk
Low milk supply
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Supply and demand mechanism
The art of pumping
Don’t skip feedings!
Engorgement
• Pump to get supply back up
• Then pump wisely thereafter
I’m anemic!
• Baby takes iron he / she needs during 3rd trimester,
then recycles it
• Little from breast milk, but what is in there is very
easy to absorb
• Has no effect on milk production
Aouch, it hurts!
• Then there is something wrong!
• # 1 reason is poor latch
– Clicking sound is a tell-tale sign
– Lip should be flanged
– As much of areola as possible under nipple in mouth
• Yeast
• Raynaud’s
I get mastitis
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Often because of blocked ducts
Poor drainage from breast
Address breastfeeding technique
Most antibiotics are safe!
The dreaded colic
• What is colic???
• What it is almost for sure not:
– Lactose intolerance
– taste issue
• Consider red flags
– Explosive green, mucousy poops, with lots of gas
– Arching, popping off breast, pulling, obvious discomfort
– Poor weight gain
Easy fix
• Baby with explosive green, mucousy poops
• Passes lots of gas, loud burps
– Empty breast fully, then offer the other
– Fix the latch
– Throw out your watch!
NEEDS CLOSER ATTENTION IF
• No improvement
• Weight gain issues
Reflux
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Reflux is a laundry problem
Gastro-esophageal reflux disease is an issue
Arching, discomfort, retching, gas
Feeds better when asleep / drowsy
Interferes with feeding / weight gain
Needs to be treated
Resolves around 1 year
Cow’s milk / soy protein intolerance
• NOT lactose intolerance; can’t take lactose out of
breast milk
• Family history
• Gut immaturity?
• Symptoms vary; blood in stool tell-tale
• Take cow’s milk (casein and whey) and ?soy out of
diet
– Beware of hidden milk (balsamic vinegar, Coca-Cola, etc!)
What about vitamin D
• Yes, for all breastfed babies
• At least 400 IU daily
• May help with gut maturation for those fussy babies
Some helpful resources
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Ottawa Public Health—well baby drop-ins
City of Ottawa – Ottawa Breastfeeding buddies
La Leche League
Ottawa Valley Lactation Consultants
– www.ovlc.net
• www.breastfeedinginc.ca
Solid introduction
• When?
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Current recommendation is 6 months
Able to sit with support
Good head and neck control
Able to tell you they want to eat, or that they’re done
• Why wait?
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May result in aspiration if poor skills
Before 2 months, can be bad for kidneys
Some studies showed increased risk of obesity
Before 3 months, may increase risk of diabetes and celiac in high-risk
Solid introduction
• Don’t wait too long
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Decreased growth; not enough calories
Iron deficiency
Delayed oral and motor function
Feeding aversion
• What?
– Iron, then vitamin C to help with iron!
– Lots of fat; 25% of diet
– Pureed cereal with spoon, not in bottle!
How to advance?
• Traditional way
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Purees
Thicker purees
Textured foods
Finger foods
Self-feeding
•Baby-led weaning
- Not very well studied
- Needs baby’s development
to be on track
What not to give!
• Before 4 months: (all solid food)
– Especially not carrots, turnips, beets, spinach
• Before 1 year
– Foods that can cause choking (hard and round)
• Nuts, whole grapes, raw carrots, round candies
– Honey
– Juice
• “Allergenic” foods are ok!!!
– Eggs, fish, peanuts and tree nuts, shellfish, strawberry, kiwi, etc
My child won’t eat a thing!
Does this child
look familiar????
• First, relax, it’s not your fault!
• Second, the vast majority of children will eat enough
to grow and remain healthy
• Hang in there, it WILL pass…
Rules of the game
• “Play with your food” is the rule
• Messy is good
• Let them feed themselves, even if you need to hose
them down after every meal
A few more rules
• Park the airplane… they are in charge
– Let the child come to the spoon
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No means no
No chasing / running after them
If they don’t like it, offer it again
3 meals, 3 snacks
Make meal time fun
The milk question
• Breast milk / formula until 1 year
• Cow’s milk protein is too big; hurts the gut
• Causes all sorts of problems; anemia, decreased
appetite
• NO MILK AT BEDTIME!!!
• Get rid of bottles as soon
as you possibly can
Transition to adult diet
• By one year, the goal is:
– Adult type diet; no more special meal
• May continue iron-fortified cereal
• Age-appropriate bite-size pieces
– No more than 20 ounces (600 cc) of milk per day
– If no longer breastfeeding, switch to homogenized milk
Helpful resources
• Canadian Pediatric Society Caring for Kids
– https://www.caringforkids.cps.ca
• Ottawa Public Health
– http://www.ottawa.ca/health_safety/pregnancy/baby/index_e
n.html
Questions
 Thank you 