Spitting up (also known as reflux) in babies is very common and a frequent cause is over feeding. It may occur during the burping, during the feeding, and frequently will occur following the feeding. Sometimes it appears to be an entire feeding that has been spit up, but it very seldom is. These babies usually take much more than their stomachs can handle and will spit up the excess. They are characteristic in that they tend to gain weight more rapidly than the average infant despite the spitting up. As a “rule of thumb” any infant who is able to go two and a half to three and a half hours between feedings and who is gaining weight well is likely spitting up because of excessive feeding. However, if vomiting becomes forceful, if the child is not gaining weight properly, or if he does not seem to be satisfied between feedings, this should be evaluated. If spitting up seems to become quite painful for the infant, an evaluation is necessary as well.

When you were an infant, babies were fed formula for a short period of time, frequently only four to five months. Today, because of increasing evidence that babies do better on formula for a longer period of time (preferably twelve months), we recommend you continue formula through the first birthday. As this first birthday approaches, we will decide together whether to continue formula, switch to another formula preparation, or to whole milk.

Your friends or relatives may suggest that you change your baby to cow’s milk during the first year. This is not appropriate. Cow’s milk is low in iron, vitamin C, vitamin E, and essential fatty acids. It also has more salt than he/she needs which results in the need for additional water for the kidneys to excrete the salt and other wastes. Finally, cow’s milk contains more protein than he/she needs and this places additional unnecessary burdens on the kidneys. It can even cause intestinal bleeding and anemia. Please, do not use regular cowʼs milk during the first 12 months.

Most babies will be able to take one of the “common” baby formulas, such as Similac. Similac Advance is the formula we recommend for most infants, as it is closest to breast milk in composition. If excessive gassiness and fussiness occur, Similac Sensitive formula may be used. It is lactose free, and may be useful to reduce gas. Occasionally, a child will not be able to tolerate the formulas made from cow’s milk, and for those children there are milk substitutes such as soy formulas (Isomil, or Similac Sensitive Soy, would be recommended), and hypoallergenic formulas (Alimentum would be recommended).

Sterilization is no longer a necessity with today’s improved sanitation standards, refrigeration, and purification of city water supplies. However, it is essential that you wash and rinse both bottles and nipples well. Washing in a dishwasher is preferred. It is fine to use one of the common home sterilizers as an alternative. Always keep prepared formula refrigerated.

Many families use powdered formulas because they are generally the least expensive. Powdered formula can also be more convenient than even ready to feed formula. This convenience results from your ability to store the dry powdered milk in a dry bottle, adding water only when ready to feed your infant as follows: clean the bottle carefully and allow it to dry thoroughly. Add the desired amount of powdered milk to each bottle, then cap the bottle and place it on a shelf. When it is time to feed your infant, simply add the proper amount of bottled water, shake, and you are “ready to go”.

We recommend the use of an iron fortified formula only. Iron does not cause constipation, as was once believed, and is essential for brain development. The temperature of the formula is of no real consequence. It may be given at refrigerator temperature, room temperature, or body temperature. In the hospital formula fed babies are given the formula at room temperature. Since breast milk is given at body temperature, most mothers are most comfortable warming the formula to approximately 95 degrees to 98 degrees.

At first most infants want to be fed at approximately two to four hour intervals, day and night. This is, however, quite variable from baby to baby, and will also vary from one feeding to the next. Do not try to set up a rigid feeding schedule for your child. All that your baby knows is that he is hungry and that it is time to eat. He does not know how to tell time.

A healthy baby will always let you know when he is hungry. Therefore, unless it is for your own convenience, it is best not to awaken a child for feeding. Most babies will take all the milk that they want within 15 to 30 minutes, whether this is one and a half ounces when he first comes home, or six ounces when he is three months old. If he is taking longer than 30 minutes to feed, it may be because the nipple holes are not large enough, or because he needs a different type of feeding system (such as rigid bottle vs. plastic collapsible bags).

The average age at which a baby will sleep through the night is approximately three months. It is not related to the amount of feeding or whether or not he is on solid foods.

Whether breast feeding or bottle feeding, hold your baby comfortably close to you. He derives a great deal of pleasure and security when fed and cuddled properly. Allowing an infant to take formula by propping or by allowing him/her to “feed himself” will result in an increased risk for middle ear infections and will significantly retard his/her emotional and social development. We strongly recommend that you never “prop a bottle” for feedings.

All current research indicates that breast feeding is superior to formula feeding. Breast milk offers a degree of protection from intestinal diseases and is much less likely to result in gastrointestinal upsets. However, with modern formulas, adequate hygiene, and a concerned, loving mother, these advantages are small. They are far outweighed by mother’s own desires concerning breast feeding. Thus, for the mother who wants to breast feed, nothing is better. For the mother who does not wish to breast feed, formula feeding is adequate and nutritious.

There are two general considerations that you should appreciate about breast feeding: (1) The biggest single difficulty in nursing a baby successfully is lack of confidence in yourself. (2) The first two to three weeks of breast feeding always take more time and are harder than bottle feeding. However, this increased trouble is worthwhile because after three weeks or so, breast feeding is easier.

If you are planning to breast feed, approach it with a feeling of confidence in yourself and with an acceptance of the fact that breast milk does not come in fully for 3 to 5 days. It frequently can take 5 to 10 days for the supply to build up. Overall, the first 2 to 3 weeks may take a little more time and effort than bottle feeding. Once the supply is established, breast feeding is easier, less expensive, and offers many health benefits for your baby.

Your baby, when first given a chance to nurse, may settle down right away as if he/she had been doing it for weeks, or he/she may just act sleepy and only mildly interested. It doesn’t really make a great deal of difference at this point, because the infant will primarily be getting colostrum until your milk “comes in”. In addition he/she has excess fluid from which to draw until your milk does “come in”. He/she will have several nursing periods during which he/she can learn the “knack” of nursing and become interested before he/she really needs the nourishment. The important thing during this time is to learn how to make yourself comfortable while nursing and how to hold the baby and to offer him/her the breast. It is most important to be gentle and patient. If your baby is slow to nurse at first, do not feel the least bit discouraged.

Initially you may nurse your baby for 10 to 15 minutes at a feeding. If your nipples are unusually sore, you may want to hold down the feeding time until they become less tender. If the baby is satisfied and content after the first breast, you do not need to offer the second breast. If your other breast is very full and engorged or the baby is unsatisfied, you may offer that breast or use a breast pump to pump that breast and freeze the milk for future use. Frequently babies are sleepy and quite content with shorter feedings for the first 2 to 3 days and they become hungry and interested in nursing by the second to fifth day when the milk comes in.

During the first week, do not let anyone tell you that you don’t have enough milk to nurse the baby. Your milk supply will build up gradually over the first week or two as the baby nurses and stimulates the milk production. Once you do have milk, it is important to nurse your baby at each of his/her hungry periods, both day and night. It is not wise to give supplementary formula during the first three weeks to a breast fed baby unless he is unusually hungry and seems to require the breast too frequently for your comfort. Formula at this period satisfies him/her too quickly and gives him/her less incentive to nurse. This also results in a poor supply of breast milk.

During the first few weeks, your milk supply is very much influenced by your fatigue, anxiety, and the possible use of a supplemental bottle. Having a hungry baby nurse often is the best way to increase your milk supply. Relax and try to get all the rest that you can. Use your energy and time to get adjusted to the baby and to take care of your growing family. Let everything else go for the time being. Doing this for the first two weeks will pay dividends in having a satisfied baby and an easier feeding time.

Your diet should include an abundance of liquids, meats, fruits and vegetables; that is, well balanced meals. Avoid excessive chocolate, caffeine, spices, nuts, shellfish, and other highly seasoned foods, or any other foods which appear to cause discomfort in your infant. Do not use laxatives or other drugs without the knowledge of your pediatrician while you are breast feeding (Stool softeners such as bran, mineral oil, or Metamucil may be used without worry).