Infant Care

Introduction of Solid Food | Helping Baby Sleep Through the Night | Jaundice and Your Newborn

Introduction of Solid Food to Baby's Diet

When to Begin Solids

Your baby's appetite, behavior and readiness for solid food (not the calendar) will be your best guide to help determine an appropriate time to introduce solid food to him/her. Each infant is unique and it is not wise to judge or take action based on another infant's feeding pattern.

If your baby shows an interest in food at mealtime and seems less satisfied with his/her milk (Breast or bottle), he/she may be ready to try solid food. Some babies may show signs of readiness for solids at 6 months of age, many babies begin to teethe around this time and the urge to bite or chew may develop. This urge may be satisfied with teething toys.

Some babies are not interested in solid foods for several more months. There is NO advantage to your child by an early, rapid introduction of solid food. From a nutritional viewpoint, all of baby's needs for the first 4 to 6 months of life are supplied by milk (formula or breast). Solids are not necessary during this time. Some of the disadvantages of the early introduction of solids include excessive weight gain, inclusion in the diet of undesirable additives, adverse reactions, and increased cost and inconvenience of preparation.

What to Feed

There is no "right" or "wrong" way to introduce solid foods to your baby. Our guidelines are suggestions to help you do so in a simple, organized manner. We suggest the following progression:

Iron fortified cereals
These are usually pleasant tasting, easy to prepare, to feed and to digest; there is a low incidence of allergic response. Start with rice cereal, then 1 to 2 weeks' later barley and oatmeal may be tried. A mixed cereal should be added only after each kind of cereal has been separately introduced.

Vegetables
Yellow carrots, sweet potatoes, squash, green beans, spinach, and peas are recommended.

Meats
Chicken and Veal are usually tolerated well.

Fruits
Apples and bananas are usually introduced last because their sweetness almost always appeals to babies and they take to them readily.

Juices
May be offered (including citrus, however, limited quantity).

Introduce one food at a time, no more than one food per week. This is easy to follow and helps in identifying any allergic response to new foods. Your baby's diet should eventually include foods from all of the basic food groups.

  • Dairy products
  • Meat, fish, and egg yolk
  • Vegetables and fruits
  • Cereals and breads

Important nutrients in foods are proteins, carbohydrates, minerals, vitamins, and fats. Limit foods which are "sugars" and "calorie only" foods and foods which are low in nutritional quality. Remember that no purpose is served by early, rapid introduction of solid food.

Milk will continue to be a mainstay in your baby's diet until around one year of age. Milk continues to be important throughout childhood, however, your child will take in more solids as he/she develops and will depend less on milk to meet his/her nutritional requirements. As the amount of solids in the diet increases, the demand for milk supply decreases.

You may use commercially prepared baby foods or you may serve home prepared foods. If using commercial preparations, read labels for contents. Select foods that are prepared without added salt or sugar and which are high in nutritional quality i.e., all meats, all green vegetables, etc. The combination foods are usually high in starch. Also combination foods can include a new food which may cause an unwanted response.

Food from a can or jar can be resealed and kept in the refrigerator for up to 2 days as long as it has not been heated or baby hasn't been fed from the jar. Remove the desired portion to a small dish or cup and heat as directed.

If you elect to prepare your baby foods at home, prepare his/her portions without added spices, salts, and sugar. Seasoning should be kept to a minimum. You may find a "baby food grinder", "food mill", or a blender helpful to puree your baby's first foods. Later, mashing, mincing or chopping may be sufficient. You may find the attached book list a helpful resource to you in preparing baby's foods at home.

What to Feed

At about 8-12 months of age, finger foods will become enjoyable for your baby. Start at 8-12 months. Crust of toasted whole grain bread, slices of fruit such as apples and bananas, cheese, carrot sticks, and neat sticks are some of the foods he/she may enjoy.

Foods to Avoid

  • Egg white - until one year of age to decrease the possibility of allergic response.
  • Chocolate - until age 2, no nutritional value and possibility of allergic response.
  • Nuts, berries or other small hand foods that may be aspirated into the lungs.
  • Honey before 1 year of age (associated with certain infant illnesses).
  • Sugar and salt additives indefinitely.

How to Begin

  1. Introduce one new food at a time, no faster than one food per week.
  2. 2. Begin with small portions and increase according to your baby's appetite.
  3. At mealtime, you may give your baby his/her milk first and then offer the solid food.
  4. Solid food may be offered at a time of day when it is convenient for you to do so.
  5. At your discretion, you may increase the number of feedings at which you offer solid foods until your baby is on a dietary pattern similar to the rest of your family.
  6. Offer small amounts of food on a teaspoon placed over baby's tongue. He/she may fuss the first few feedings offered.
  7. When your baby shows he/she's ready to begin feeding him/herself, allow him/her to proceed. It's a lengthy and messy process but important for development that he/she is permitted to do so. You may find that your baby will enjoy finger foods. /li>

Reminders

  • Introduce solid foods gradually with patience.
  • Be guided by your baby's interest and readiness for food when deciding to begin solid foods.
  • Introduce one new food at a time.
  • Quality is more important than quantity.

Suggested Reading

  1. The Healthy Family Cookbook by J.U. Marquiles. Discusses basic nutrition. Presents recipes with information pertinent to age at which food can be introduced to the diet.
  2. Making Your Own Baby Food by Mary Dustin Turner and James Turner. Strong criticisms of the baby food industry. Contains guidelines for buying, preparing and serving your own baby food as well as recipes.
  3. Instant Baby Food by Linda McDonald. Easy to read, basic information.
  4. Feed Me! I'm Yours by Vicky Lansky. Full of recipe ideas for children. Contains fun ideas for children's parties, kitchen crafts, and safety.
  5. Let's Cook it Right by Adele Davis. Emphasis on nutrition and preparation of food for simplicity and maximum food value. Lots of recipes.

Our public library has an excellent nutrition section!

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Helping Your Baby Sleep Through the Night

Approximately 10% to 15% of children between 4 months and 24 months of age have problems sleeping at night. They wake up and cry on more times during the night in order to be fed or receive attention from their parents. These incidents usually occur every night. In most instances the baby has had the behavior since birth. If your child fits this description, the information presented here will help you understand the problem and take steps to establish a normal nighttime sleeping pattern.

What Causes Nighttime Awakening?

All children, especially during the first year of life, may awaken several times each night following dreams, but most can put themselves back to sleep. The ones who have not learned how to do this cry for a parent. If you provide too much attention (constant rocking, for example), the infant becomes dependent on you for returning them to sleep. If you play with the baby at these hours, the child may decide to have this kind of entertainment every night. These infants are known as trained night criers. The infants who demand to be fed as well as held are called trained night feeders. After 6 months of age, the normal separation fears of many infants are accentuated at bedtime and during the night. These children become fearful night criers. Changing diapers during the night, allowing excessive daytime naps, and sleeping in the same room with the baby can contribute to all three types of sleep problems.

Trained Night Feeders

If your baby is fed during the night, deal with this problem first. From birth to 2 months of age, most babies normally awaken twice a night for feedings. Between 2 and 3 months, most need one middle-of-the-night feeding. By 4 months of age, about 90% of infants can sleep more than eight consecutive hours without feeding. The remainder can learn to sleep through the night if you take the following steps.

  1. Increase the daytime feeding intervals to four hours or more.Nighttime feeding intervals cannot be extended if the daytime intervals remain short. The baby's stomach is conditioned to expect frequent feedings and complains if they are delayed. Gradually postpone feeding times until they are more normal for the child's age. Your goal is four meals per day by 4 months of age and three meals per day by one year. The infant's demands for unnecessary feedings can be met with extra holding, attention, or a pacifier.
  2. Discontinue any bottle in bed immediately. Feed your child at bedtime, but don't let him hold or keep the bottle. If he has increased sucking needs, offer him a pacifier or help him find his thumb.
  3. Phase out night feedings. Keep in mind that normal babies over 4 months old (and premature babies who have reached 11 pounds) do not need any calories during the night for health reasons. Once the daytime intervals are normal, nighttime awakening will probably decrease or disappear spontaneously. In the meantime, when your baby awakens at night and appears hungry, feed him but leave him slightly hungry. For bottle-fed babies, the amount can be decreased by one ounce every few nights until your infant no longer has a craving for food at night. For bottle-fed babies, the amount can be decreased by one ounce every few nights until your infant no longer has a craving for food at night. For breast-fed babies, nurse him on just one side.

With these measures, improvements should occur in about two weeks. It is important to start correcting the problem as early as possible. The older the child is, the harder he is to treat.

Trained Night Criers

If your baby does not awaken for food but still has nighttime crying, respond briefly or not at all. Crying is not harmful, and infants cannot get over this problem without some crying. When your baby awakens and cries, wait at least five minutes before going in the room. Infants should be taught to use their own resources to get back to sleep.

If the crying continues, you go in, but don't stay longer than one minute. Act sleepy, whisper "Shh, be quiet, everyone's sleeping," add a few reassuring comments, and give some gentle pats. Do not turn on the lights or remove him from the crib. Absolutely avoid rocking or playing with the baby, bringing him to your bed, or staying in the room for more than one minute. Most young infants will cry for 30 to 60 minutes and then fall asleep. If the crying persists, you may recheck your baby every 15 to 20 minutes, for one minute or less each visit, if you feel it is necessary.

Fearful Night Criers

If your child sounds fearful, panics when you leave, cries until he vomits, or by past experience will cry nonstop for hours, go in immediately and reassure him. Stay as long as it takes to calm him, but don't lift him out of the crib. At the most sit in a chair next to the crib with your hand on his body. Don't talk much and leave the lights out. Leave for a few minutes every now and then to teach your child that separation is tolerable. Do the same thing at naptime and bedtime.

For separation fears, using the night-light (to offset fear of the dark) and leaving the bedroom door open (to offset the fear of the parent being gone) are always important. During the day, respond to the child's fears with lots of hugs and comforting. Young babies may need more time being carried about in front sling or backpack.

Children of working mothers especially need undivided time and cuddling in the evenings. Also practice separation games like peek-a-boo, hide-and-seek, or chase me.

Steps to Take For All Types of Sleep Problems
Whether your baby's problem is trained night feeding, trained night crying, or fearful night crying, the following measures should be helpful.

Put your baby to bed when he is awake. Many trained night feeders and criers are rarely ever placed in their cribs awake. If your baby goes to sleep in your arms occasionally, that's fine. But try to place him in the crib awake for bedtime and all naps. His last memory should be of the crib, not you or the bottle.

Move the crib to another room. If the crib is in your bedroom move it to a separate room so you aren't awakened by your baby's normal tossing and turning. If this is impossible, cover one of the side rails with a blanket so your baby can't see you when he awakens.

Eliminate long daytime naps. If your baby has napped for more than three hours, awaken him. If he is in the habit of taking three naps per day, try to convert him to two.

Don't change diapers during the night. Babies can survive until morning with a wet diaper. The diaper can be changed if soiled, although this is uncommon. It also may be changed if you are treating a bad diaper rash. If you must change your child, use a flashlight, do it quietly, and don't provide any entertainment.

When to Call for Help
Call this office during regular office hours if you feel the crying has a physical cause, if your child acts sick, if someone in your family cannot tolerate the crying, or if the steps outlined here do not produce improvement in sleep habits within two weeks. Feel free to contact us if you need additional information on sleep problems.

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Jaundice and your Newborn

Congratulations on the birth of your new baby! To make sure your baby’s first week is safe and healthy, it is important that:

  1. Your baby is checked for jaundice in the hospital.
  2. If you are breastfeeding, you get the help you need to make sure it is going well.
  3. Your baby is seen by a doctor or nurse at 3 to 5 days of age

Q: What is jaundice?
A: Jaundice is the yellow color in the skin of many newborns. It happens when a chemical called bilirubin builds up in the baby’s blood. Jaundice can occur in babies of any race or color.

Q: Why is jaundice common in newborns?
A: Everyone’s blood contains bilirubin, which is removed by the liver. Before birth, the mother’s liver does this for the baby. Most babies develop jaundice in the first few days after birth because it takes a few days for the baby’s liver to get better at removing bilirubin.

Q: How can I tell if my baby is jaundiced?
A: The skin of a baby with jaundice usually appears yellow. The best way to see jaundice is in good light, such as daylight or under fluorescent lights. Jaundice usually appears first in the face and then moves to the chest, abdomen, arms and legs as the bilirubin level increases. The whites of the eyes may also be yellow. Jaundice may be harder to see in babies with darker skin color.

Q: Can jaundice hurt my baby?
A: Most infants have mild jaundice that is harmless, but in unusual situations, the bilirubin level can get very high and might cause brain damage. This is why newborns should be checked carefully for jaundice and treated to prevent a high bilirubin level.

Q: How should my baby be checked for jaundice?
A: If your baby looks jaundiced in the first few days after birth, your baby’s doctor or nurse may use a skin test or blood test to check your baby’s bilirubin level. A bilirubin level is always needed if jaundice develops before the baby is 24 hours old. Whether a test is needed after that depends on the baby’s age, the amount of jaundice and whether the baby has other factors that make jaundice more likely or harder to see.

Q: Does breastfeeding affect jaundice?
A: Jaundice is more common in babies who are breastfed than babies who are formula-fed, but this occurs mainly in infants who are not nursing well. If you are breastfeeding, you should nurse your baby at least 8 to 12 times a day for the first few days. This will help you produce enough milk and will help to keep the baby’s bilirubin level down. If you are having trouble breastfeeding, ask your baby’s doctor or nurse or a lactation specialist for help. Breast milk is the ideal food for your baby.

Q: When should my newborn get checked after leaving the hospital?
A: It is important for your baby to be seen by a nurse or doctor when the baby is between 3 and 5 days old, because this is usually when a baby’s bilirubin level is highest. The timing of this visit may vary depending on your baby’s age when released from the hospital and other factors.

Q: Which babies require more attention for jaundice?
A: Some babies have a greater risk for high levels of bilirubin and may need to be seen sooner after discharge from the hospital. Ask your doctor about an early follow-up visit if your baby has any of the following:

  • A high bilirubin level before leaving the hospital
  • Early birth (more that 2 weeks before the due date)
  • Jaundice in the first 24 hours after birth
  • Breastfeeding that is not going well
  • A lot of bruising or bleeding under the scalp related to labor and delivery
  • A parent or brother or sister who had high bilirubin and received light therapy

Q: When should I call my baby’s doctor?
A: Call your baby’s doctor if:

  • Your baby’s skin turns more yellow.
  • Your baby’s abdomen, arms or legs are yellow.
  • The whites of your baby’s eyes are yellow.
  • Your baby is jaundiced and is hard to wake, fussy or not nursing or taking formula well.

Q: How is harmful jaundice prevented?
A: Most jaundice requires no treatment. When treatment is necessary, placing your baby under special lights while he or she is undressed will lower the bilirubin level. Depending on your baby’s bilirubin level, this can be done in the hospital or at home. Jaundice is treated at levels that are much lower than those at which brain damage is a concern. Treatment can prevent the harmful effects of jaundice. Putting your baby in sunlight is not recommended as a safe way of treating jaundice. Exposing your baby to sunlight might help lower the bilirubin level, but this will only work if the baby is completely undressed. This cannot be done safely inside your home because your baby will get cold, and newborns should never be put in direct sunlight outside because they might get sunburned.

Q: When does jaundice go away?
A: In breastfed infants, jaundice often lasts for more than 2 to 3 weeks. In formula-fed infants, most jaundice goes away by 2 weeks. If your baby is jaundiced for more than 3 weeks, see your baby’s doctor.

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Texting and Driving Statistics:

  • National Safety Council reports 2 out of 3 teens admit they use apps while driving and 27% say they text and drive.
  • National Safety Council estimates that at least 1.6 million crashes each year involve drivers using cell phones and texting.
  • 56% of teenagers admit to talking on their cell phones while behind the wheel, while 13% admit to texting while driving.
  • Each year, 21% of fatal car crashes involving teenagers between the ages of 16 and 19 were the result of cell phone usage. This results has been expected to grow as much as 4% every year.
  • For every 6 seconds of drive time, a driver sending or receiving a text message spends 4.6 of those seconds with their eyes off the road. This makes texting the most distracting of all cell phone related tasks.

 

  
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