By: Claire Tran and Kenimer Highsmith for CTAE Resource Network

1. Infant Feeding By: Claire Tran and Kenimer Highsmith for CTAE Resource Network

2. Timeline for Feeding • 0-3 months • The baby should be eating breast milk at least 8 times a day or 18-40 ounces of iron fortified formula a day. • 4-5 months • The baby should be eating breast milk every 2-4 hours or 24-45 ounces of iron fortified formula. Your baby may also need 1-4 Tbsp. of dry cereal mixed with breast milk or formula. You can tell if your baby is ready for cereal if she's between 4-6 months old, holds her head up, can sit with support, acts interested in foods you're eating, doesn't push food out with her tongue, and can give you satiety cues. • 6-8 months • The baby should be eating breast milk at least 5 times a day or 24-37 ounces of iron fortified formula a day. Also included in their diet should be iron fortified infant cereal, fruit juices, vegetables and fruits, and small servings of finger foods. • 9-12 months • The baby should be eating breast milk at least 4 times a day or 24-31 ounces of iron fortified infant formula. The baby should also experience a number of other foods such as: iron fortified infant cereal, fruit juices, vegetables and fruits, finger foods, legumes, egg yolks, meat, dairy foods.

3. Foods Not Allowed • Low iron formulas • Enzymes, herbs, spices, or botanicals • Oral dehydration fluids or electrolyte solutions • Flavoring or thickening agents • Sports or breakfast drinks • Infant cereal with added infant formula, milk, fruit, or other non-cereal ingredients • Peanuts • Fruit-nut mixtures • Sodas, salt, sugar, honey, fish, raw eggs. • Goats' and sheep's milk (under a year old)

4. How to Feed a Baby • Hold the baby close while feeding. • Hold the baby's head higher than the body keeping it supported, to make swallowing easier. • Hold the bottle so that most of the artificial nipple is in your baby's mouth and the formula fills the nipple. This will prevent the baby from swallowing air. • The baby will not be able to support the bottle alone during the first year. • Let the baby set the pace. Do not rush feeding. • Burp the baby after each feeding. If the baby has a lot of gas, burp halfway through the feeding. • Never prop the bottle in baby's mouth. This could cause choking or tooth decay.

5. Weaning • The process of gradually introducing infants to an adult diet and withdrawing the supply of their mother's milk. • Weaning should start when the baby is 6 months old. • Never put solids food in the baby's bottle. • The first recommended solid food is fortified rice cereal. • Infant rice cereal is easy to digest and unlikely to trigger an allergic reaction. • Introduce fruits after the baby gets used to vegetables. • At 10-12 months, the baby's diet will begin to resemble that of the rest of the family’s, with 3 meals and 2 snacks a day along with 3-4 feedings of breast milk or formula.

6. Breast Milk • Colostrum: thin, watery and yellowish fluid that contains antibiotics. • Nutrients: • Vitamins and minerals: calcium, iron, phosphorous • High quality protein • High quality fatty acids: linoleic and linolenic • Hormones and enzymes

7. Advantages of Breastfeeding • Antibodies passed from a nursing mother to her baby can help lower the occurrence of many conditions such as infections and allergies. • Breast milk is easily digested by a newborn's immature system. • Breast milk also naturally contains many of the vitamins and minerals that a newborn requires. • Free • Convenient • May help prevent obesity. • Lowers the risk of breast cancer, high blood pressure, diabetes, cardiovascular disease, and may also decrease the risk of uterine and ovarian cancer.

8. Disadvantages of Breastfeeding • Breastfed babies need to eat more often. • Requires a substantial time commitment from mothers. • Women who are breastfeeding need to be careful about what they eat and drink, since things can be passed to the baby through the breast milk. • Medical conditions such as HIV or AIDS or those that involve chemotherapy or treatment with certain medications may make breastfeeding unsafe.

9. How to Breastfeed • Position the baby on her side so she is directly facing you, with her belly touching yours. Next, prop up the baby with a pillow if necessary, and hold her up to your breast; don't lean over toward her. • Place your thumb and fingers around your areola. • Tilt your baby's head back slightly and tickle her lips with your nipple until she opens her mouth wide. • Help her "scoop" the breast into her mouth by placing her lower jaw on first, well below the nipple. • Tilt her head forward, placing her upper jaw deeply on the breast. Make sure she takes the entire nipple and at least 1 1/2 inches of the areola in her mouth.

10. Formula Types • Different types of formulas: • Regular iron fortified infant formulas are made with lactose and cow's milk based proteins. Most infants who are not breastfeeding exclusively should be given a cow's milk based iron fortified formula. • Examples: Similac Advance, Enfamil Lipil, and Nestle Good Start Supreme • Soy formulas are made with soy protein and are lactose free. They are good for children who don't tolerate lactose or milk proteins. • Examples: Enfamil ProSobee, Similac Isomil, and Nestle Good Start Supreme Soy • Elemental formulas are also lactose free and are made with hydrolysate proteins which are easy to digest for infants with protein allergies. • Examples: Nutramigen, Pregestamil and Alimentum.

11. Why not low-iron: • The infant suffers an increased risk of iron deficiency anemia. Anemia, or reduction of oxygen-transporting red blood cells, reduces the delivery of oxygen to the developing infant, especially the brain and nervous system. Iron-deficiency anemia is associated with problems in cognitive, behavioral, and physical development in infants and children.

12. Advantages and Disadvantages of Formula Advantages: • Commercially prepared infant formulas are a nutritious alternative to breast milk, and contain some vitamins and nutrients that are not found in breast milk. • Allows the mother to share the feeding duties and helps her partner to feel more involved in the crucial feeding process and the bonding that often comes with it. • Women who opt for formula don't have to worry about what they eat or drink and how it could affect their babies. Disadvantages: • Lack of antibodies • Formula can be costly • Possibility of producing gas and constipation

13. How to Mix Formula 1) Pour the desired amount of water into a bottle. Only use purified, distilled water. 2) Add unpacked, level scoops of powder to the water in the bottle; 1 scoop for every 2 ounces of water 3) Place a finger over the nipple of the bottle and shake it until all the powder has dissolved.

14. Nursing Bottle Syndrome • Caused when children, generally under the age of 3, are put to bed with a baby bottle filled with fruit juice or sweetened milk. • The result is severe decay of the front top teeth.