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Can Formula Help Breast-Feeding Moms?

Many a new mother has struggled with whether to breast-feed or give her newborn formula. A recent study, published in the journal Pediatrics,  says the best approach might be both.  In fact, the study suggests that giving newborns a little bit of formula may actually help new mothers, who choose to breast-feed, continue feeding longer.

The lead author of the study, Dr. Valerie Flaherman, an assistant professor of pediatrics and epidemiology and biostatistics at UCSF, and her team followed 40 newborns that had lost at least 5 percent of their birth weight by the time they were 36 hours old. The American Academy of Pediatrics (AAP) notes that it is normal for babies to lose weight during their first days as they become accustomed to feeding. However, if infants drop 10 percent of their birth weight, pediatricians become concerned that babies will be at risk for other heath problems.

For the small trial, Flaherman and her colleagues assigned half the babies a couple days of birth to receive two teaspoons of formula after each breast-feeding, via a syringe so as not to encourage nipple confusion, a condition in which a baby has trouble transitioning between breast and bottle. Mothers were instructed to discontinue the formula supplementation once their milk supply appeared, which generally takes two to five days. The other were exclusively breast-fed unless the doctor ordered formula.

When the babies were one week of age, 10% of the moms in the formula group were still using formula in some way as part of their feeding strategy compared with 47% of the group originally assigned to breast-feed but who added formula. And when the babies were three months old, 79% of the formula-group moms were exclusively breast-feeding, significantly more than the 42% of moms in the group originally instructed to breast-feed.

Flaherman suspects that adding a little formula early in the feeding process, then withdrawing it, helped moms feel more secure that their babies were getting enough to eat. That may have also given them the confidence to continue breast-feeding until it was exclusively how their babies were fed. 

Using that little bit of formula earlier really seems to have had a big effect on whether babies are getting formula at one week, Flaherman says. We wanted to try to find an early intervention we could do with these babies and moms to help them continue breast-feeding. I was surprised the effect was this big.

The AAP recommends that moms breast-feed for 6 months at a minimum. In the United States however, most new mothers start by breast-feeding their infants but only 40 percent continue to 6 months. 20 percent make it to one year.

Some breast-feeding experts take issue with the studys findings. They worry that the results may undermine the public-heath messages that breast milk alone is best for babies.

This study goes against everything thats been published for several years now from very reliable clinicians and researchers about the potential hazards of supplementing exclusively breast-feeding babies with formula, says Dr. Kathleen Marinelli, an associate professor of pediatrics at the University of Connecticut School of Medicine and the chair-elect of the U.S. Breastfeeding Committee. Theyre flying in the face of years of research here and doing so rather glibly, stating that this is the new way to look at things.

Tanya Lieberman, a lactation consultant who writes about scientific research for breast-feeding advocacy organization Best for Babes, says shes a little confused by the results. We know what works to increase breast-feeding exclusivity and duration and weve known it for 20 years. That includes no supplementation unless medically necessary.

Lieberman believes the findings may have been affected by the attitude of the women who were open to the idea of adding formula to their breast-feeding routine.

She believes its possible that the mothers may have misunderstood how much milk newborns need.  Babies dont need large volumes of milk in the first few days, she says. They are fine until their mothers milk comes in.

Flaherman, on the other hand, says the studys results are not necessarily applicable to all babies. "This isnt something we think all people should do, she says. It is just a potential tool for moms to consider using if they think it might be helpful.

She also says that the ultimate goal of the study was to find a way to help more mothers breast-feed, and to do so for as long as possible to help their babies. Its kind of crazy that only 20% of people reach the recommended duration of breast-feeding, says Flaherman. Different approaches to supporting breast-feeding may work better for different people.

If youre interested in the idea of adding formula to your breast-feeding routine, its a good idea to talk with your pediatrician first. If youre having trouble adjusting to breast-feeding, there are experts your doctor or pediatrician can recommend that can answer any questions you have.  You may just decide that adding a little formula in the beginning is helpful as you and your baby adjust to breast-feeding and a new life together.

Source: Bonnie Rochman, http://healthland.time.com/2013/05/13/can-giving-newborns-formula-increase-breast-feeding-rates/#ixzz2TKJaxygx

Life Changing Words

What are the words that a child first speaks that changes everything??  Can you guess?   The first word that a child learns that is truly life changing for a parent is the word NO!  I have so many parents that have told me they are not going to use the word.....well how do you think you can go through parenting without saying NO?   

There are a lot of words that connote the same meaning, such as, I would prefer that you didn't do that, or that was not a good choice.  But the word NO is powerful and necessary as a parent, and a child quickly learns the power of the word as well. 

It is really cute when your child first kind of understands the power of NO.  Think about how many times a day a baby/toddler shakes their head NO. It really doesn't matter what you ask them, their first inclination is to shake their heads NO. Do you want ice cream? NO.  Do you want to go to the zoo? NO.  The list is endless.  But, it is very cute as they start to figure out the difference between NO and YES.

The next life changing word, MINE!!  Suddenly a child learns about being possessive and they have a word for it. No longer are they just tugging at the toy they want, or holding their favorite stuffed animal or pacifier. When you try to take it away they say... MINE.  WOW... another powerful word.

Now, pause for a moment in development. What comes next?  Your child learns to link two words together (which is very important during the toddler years) and suddenly they blurt out...NO MINE.

Life is never the same again!!!! 

Let me know if you agree....and if your baby is under one...watch out this phase is coming. 

Learning to Crawl

Back to more funny office stories - they really keep my job interesting and always a little bit of fun. 

Many of my new young parents worry (haven't we all?) and one of the new comments I have started to hear is why is my baby not crawling? Well, for one reason, they are only 6 months old!  I know we are expecting children to achieve some milestones at younger and younger ages, an example of this is reading.  But while not all children are ready to read at 4-5 years, MOST children do not crawl until they are around 9 months of age. 

I am suddenly having moms and a few dads ask me how to teach their baby to crawl?   What???  This is new to me.  I wish I could remember   each of my own children as they learned to crawl. It is just a foggy memory now, but I do remember that suddenly they were mobile, and that changes everything! 

Babies instinctively want to move and explore their environment. For most babies, if you have been doing tummy time, which is followed by your baby learning to sit, they suddenly figure out how to go from the sitting position back to their tummy.   Why?  That maneuver is the precursor to learning to crawl.  They just do it!  You need to put them on the floor and let them figure it out. You DO NOT need to crawl around the house.  

While you will have to help teach your child to walk, in a manner of speaking, they WILL just crawl if given the opportunity.  That means putting them down and letting them figure out how to move. I had one mother who asked me if her baby could sit in the grass? She was afraid to even let the child touch the ground. Other parents are worried that it is too dirty for their child to sit on the floor and crawl.  The world is full of dirt, grass and who knows what else, but children have to spend some time on the floor to learn to crawl.   

Take home message....no instructions for a baby to crawl, they just figure it out, and we parents figure out that some of the things our wonderful children accomplish are despite us!

Fussy Baby: Walking or Rocking Most Calming?

When your baby cries should you pick him or her up and walk or find a good rocking chair and rock back and forth? A new study from Japan says that infants respond best when mom (or any caregiver) picks them up and walks around.

Researchers said that the babies rapidly beating hearts also slowed down, proving that they felt calmer.

"Infants become calm and relaxed when they are carried by their mother said study researcher Dr. Kumi Kuroda, who investigates social behavior at the RIKEN Brain Science Institute in Saitama, Japan. Interestingly, the study also observed the same response in baby mice.

For the study, researchers monitored the responses of 12 healthy infants ages 1 month to 6 months. The scientists wanted to discover the most effective way for mothers to calm a crying baby over a 30-second period " simply holding the baby or carrying the infant while walking.

Results showed that infants carried by walking mothers were the most relaxed and soothed compared to babies whose mothers sat in a chair and held them. As a mother stood up with her cradled her baby and started to walk, scientists observed an automatic change in the baby's behavior.  

These results held even after the researchers took into account other factors, such as the child's age and sex, and the mother's age and walking speed.

Kuroda said she was surprised by the strength of the calming effect. Researchers noted that the rhythm of walking might be more effective in soothing infants than any other rhythmic motion, including rocking.

Babies cry for a variety of reasons. If an infant is hungry or in pain, they'll most likely start crying again when they are laid back down. But sometimes a baby just feels a little anxious or unsure about their environment and will relax when held close and comforted. Kuroda acknowledged carrying might not completely stop the crying, but it may prevent parents from becoming frustrated by a crying infant.

The findings may also have implications for the parenting technique of letting babies cry in order to help them learn how to soothe themselves.

"Our study suggests why some babies do not respond well to the 'cry-it-out' parenting method," Kuroda said.

Babies crying during separation and maternal carrying are both built-in mechanisms for infant survival. These behaviors have been hard-wired for millions of years. "Changing these reactions would be possible as infants are flexible, but it may take time," she said.

While the study looked at a baby's response to its mother, Kudro said the calming effect was not specific to moms. Dads, grandparents and caregivers were able to provide the same calming effect by carrying the baby and walking

Many moms and dads instinctively know to pick up a baby that's crying, hold them close, pace around while gently patting baby on the back. This study just points out that if your baby is really upset, walking about may have a faster calming effect than rocking or sitting in a chair.  Plus it adds more evidence that simply ignoring a baby while he or she cries isn't going to teach them how to soothe themselves. We all need a hug and a gentle pat on the back when we're upset. Babies need it maybe even a little more.

The study was published online in the journal Current Biology.

Source: Carl Nierenberg, http://www.today.com/moms/carry-study-finds-its-good-

Best Baby Age?

How much fun is a 4-6 month old baby?  I just love this age, and if you have a baby of your own, you probably know what I mean.  I call this age a chia baby!  They are just perfect and low maintenance like the chia pet. 

Think about it, this precious aged baby only requires watering, i.e. they just drink - no real food yet, so no meal planning or mess to clean up.  They don't move , so you know where they are at all times, no looking for them under foot, or worrying if they will be home on time. They sleep for at least 6-8 hours at night (those early months were much more exhausting) and typically wake up with a smile on their face.  

When you talk to this age baby they smile, babble and laugh at whatever you say.  They think you are funny and clever (not always the case during their teen years), even when you might not be.  A 4 month old baby packs up easily and can travel, just like moving a chia pet from one window sill to another.  (wait till toddlerhood and trying to convince the same child to sit still on a plane).   

I am always ready to take a 4 month old baby home with me for a few days.  I tell the parents at the 4 month check up that I will gladly babysit . I just wish I could keep a 4-6 month old baby around at all times.  I do believe that this stage of infancy is God's gift to parenting.   

Don't worry, there are many different stages in a child's life that are also special and perfect, but this is just the first one. This stage is well worth the first months of sleep deprivation and exhaustion!  If you have a younger baby, hang in there, it's getting ready to get really fun!

Starting Baby on Solid Food

Did you read the latest study from the CDC about the number of infants who are starting solid foods too soon?  One of the only things that I think has stayed pretty constant since I began practicing medicine (and what I did with my own children), was waiting until they were around 6 months of age to begin solid food.  

Beginning a baby on solid foods is not really momentous, in that it does not make a baby sleep through the night, it does not make them less fussy, or gain weight faster, but it certainly is a little more work.  A baby really does just fine on breast milk or formula for the first 6 months of life.  It is wonderful to watch a newborn grow and thrive, and it all happens with milk alone. 

While many new parents are anxious to start solids, there is no rush. Actually, once you are starting baby foods you soon figure out that it is really more work, and you get to fix meals for the next 18 years! Formula or breast milk seems like a great meal when you are too tired to cook one night when they are older.  Milk for dinner just doesnt work for a 10 year old. 

Early introduction of solid foods may be linked to obesity, diabetes, eczema and celiac disease. While the studies on these issues continue, why risk any of these problems when your baby is doing well on breast milk or formula alone for 6 months?  

When beginning solid foods your baby should be able to sit up in their high chair and open their mouths when the spoon is introduced.  There is no magic as to how much a baby will even eat when you start baby foods. For some babies, eating solid foods is cosmic and they may love it and continue to eat more and more.  

For others, the spoon and baby food just doesnt hold the same excitement, and they push the spoon out of their mouth and are less than thrilled.  Experiment with pureed foods for your 6 month old, but dont be worried if it takes some time...let your baby lead this dance. 

I typically have parents puree as many different foods as they can, and introduce a different one every 2 to 3 days.  The more different foods the better.  At this age your baby will like all sorts of things that might surprise you.....broccoli, asparagus, black eyed peas,kale, beets.  Same thing for fruits...try kiwi, melon, avocado, papaya, grapefruit and mango.   

Even as your child is beginning solid food they are still getting the majority of their calories from breast milk or formula.  It will be several months before they are eating enough solid food to change their milk intake. 

No rush....solid foods have nothing to do with sleeping through the night either. That too comes with time.

No Link Between Vaccines and Autism

A new study slated to appear in the Journal of Pediatrics, says that there is no association between the amount of vaccines a young child receives and autism. Some parents have worried that there may be a link and have opted out of having their child vaccinated or reduced the number of vaccines recommended.

The percentage of children diagnosed with autism spectrum disorder (ASD) has increased by 72% since 2007. Some experts believe that changes in the diagnostic criteria may account for some of the increase as well as better screening tools and rating scales.

According to a statement released from the journal, researchers from the Centers for Disease Control and Prevention and Abt Associates analyzed data from children with and without ASD.

Researchers examined each child's cumulative exposure to antigens, the substances in vaccines that cause the body's immune system to produce antibodies to fight disease, and the maximum number of antigens each child received in a single day of vaccination, the journal's statement said.

The antigen totals were the same for children with and without ASD, researchers found.

Scientists believe genetics play a fundamental role in the risk for a child developing autism (80-90%), but recent studies also suggests that the fathers age at the time of conception may also be a contributor by increasing risks for genetic mistakes in the sperm that could be passed along to offspring.

Parents have worried about a link between vaccines and autism for decades despite the growing body of scientific evidence disproving such an association.

Source: Luciana Lopez, http://www.reuters.com/article/2013/03/29/us-usa-health-autism-idUSBRE92S0GO20130329

40% of Parents Start Baby on Solid Foods Too Early

When should babies be introduced to solid foods? Many physician groups and the American Academy of Pediatrics (AAP) recommend waiting till your infant is at least 6 months old before solid foods are introduced into his or her diet.

But a new study from the U.S. Centers for Disease Control and Prevention (CDC), reports that 4 in 10 parents start feeding their babies solid foods before their four-month birthday.

Why should parents wait? According to the AAP, its partly because early solid foods have been linked to obesity and other chronic conditions. Public health experts also agree that a mothers breast milk or nutritionally fortified formula is best fed exclusively till the baby is about 6 months old.

"Introducing solid foods early means that the baby gets less breast milk over the course of their infancy, and that decreases the ability to get optimal benefits, like protection against infection," said Dr. Alice Kuo, from the UCLA Center for Healthier Children, Families and Communities.

Choking on solid foods is another concern experts have noted.

"Infants should be able to sit up (and) take food off the spoon," said the CDC's Kelley Scanlon, who worked on the research." Sometimes if they're not ready, if they get presented with the food, they might not open their mouth or they might spit it back up."

The teams research included 1,334 new moms who filled out questionnaires each month about what their baby had eaten in the past week. The surveys were conducted between 2005 and 2007, when AAP recommendations called for starting solid foods no earlier than four months of age. Just over 40 percent of parents reported their babies were eating solids, such as cereals and purees, before that point.

Why were the mothers feeding solid foods so early? They gave several answers. They thought their baby was old enough, their infant seemed hungry " even after being breastfed or given a bottle, and surprisingly many reported that their doctor or nurse had recommended they start introducing solid foods.

"There's not clear communication of the recommendations or the potential health impacts of early introduction," Scanlon told Reuters Health.

9% said they had actually introduced baby solid food before their child was one-month old according to findings published in the journal Pediatrics.

Women who reported exclusive breastfeeding during their baby's first couple of months were less likely to introduce solid foods earlier than recommended compared to formula-feeding mothers, the CDC researchers found.

Mayoclinic.com says that between 4 and 6 months old, babies begin to develop the coordination needed to close their lips around a spoon as well as move solid foods from the back of the their mouths for swallowing.

Starting solid food too early can:

- Pose a risk of aspiration " or sucking food into the airway " since most babies don't have the oral motor skills to safely swallow foods before age 4 months.

- Cause a baby to get too much or not enough calories or nutrients.

- Increase a baby's risk of obesity.

Kuo said the new findings are further evidence that pediatricians should tailor their messages about breastfeeding and solid foods to each particular parent and child - rather than always giving "the same spiel" about introducing solids at the four-month visit.

"The decision to start solid foods in babies has to be a compromise between what makes sense for the baby and what makes sense for the mom, who most likely is working," she said.

And what about the old wives tale of feeding a little solid food at night will help baby sleep better? Research has shown that it doesn't.

Genevra Pittman, http://news.yahoo.com/many-parents-introduce-solids-4-months-cdc-195553198.html

http://www.mayoclinic.com/health/starting-solids/AN02145