8.0 - Weaning Process

Sources

1. The New Contented Little Baby Book by Gina Ford
2. Your Baby’s First Year by American Academy of Pediatrics
3. Dr Ang Ai Tin’s Talk

(8.0) INTRODUCTION

1. You must wean because baby’s brain grows the fastest in the first 2 years of life. So baby needs more nutrients from other sources of food.
2. Babies rely on the introduction of iron-containing foods at 6 months, as their bodies’ iron stores, with which they are born, become depleted at this age.
3. Iron is essential for healthy red blood cells that transport oxygen around the body.
4. Children who do not take in sufficient amounts of iron, are at risk of developing iron-deficiency anaemia which causes tiredness, irritability and an overall lack of energy and enthusiasm.
5. Iron-containing foods are breakfast cereals, broccoli, lentils and baby foods with iron. You will need to progress quickly through the food groups to include meat or vegetarian alternatives for their iron content.
6. Babies on formula will have their iron supplemented in the milk.

(8.1) When to Wean

1. Golden rule: Baby should not be given food before 17 weeks. It takes up to 4 months for the lining of baby’s gut to develop and for the kidneys to mature enough to cope with the waste products from solid food.
2. If solids are introduced before a baby has the complete set of enzymes required to digest food properly, his digestive system could become damaged.
3. Early introduction of foreign protein may increase the risks of food allergies.
4. If baby is under 6 months (and over 4 months) and showing all signs below, it is vital to discuss things with baby doctor and decide whether to wean early or not.
5. A baby could be ready when:

• Loss of extrusion reflex
• Reduces milk feeds
• Dislikes milk
• Mouthing finger
• Slower weight gain
• Waking for night feeds
• He has been taking a full feed 4-5 times a day and has been happily going for 4 hours between feeds, but now gets irritable and chews his hands long before his next feed is due.
• He has been taking a full feed, and screams for more the minute the feed finishes.
• He usually sleeps well at night and nap times but is starting to wake up earlier and earlier.
• He is chewing his hands excessively, displaying eye-to-hand coordination and trying to put things into his mouth.

1. If you decide to wait until the baby is 6 months before you introduce solids, it is important that his increased hunger is met by introducing further milk feeds.

(8.2) Programming the Future

1. Purpose-driven to prevent:
   1. Food allergy
   2. Fussy eater
   3. Brain starvation
   4. Obesity
   5. Inflammatory diseases
   6. Cancer transformation
   7. Weak immune defence

1. Introduce one food at a time as it makes it easier to identify food intolerance. Offer only a small amount of food (about 1 tsp) and gradually increase the quantity over a few meals.
2. Avoid adding fats such as butter or oil, unless advised by your doctor or dietitian, as they are harder to digest for small babies.
3. Try not to add sugar, use a sweeter fruit or add a little mashed banana, which is sweet. Do not use honey until your child is 12 months old.
4. Never use whole nuts and it is better not to serve smooth or chopped nuts until your child is two, but seek advice from your GP or health visitor.
5. Thin your baby's purees down with breast milk, baby milk or water only.
6. Some foods may cause an allergic reaction, so avoid them until he's six months. These include citrus fruits, well-cooked eggs, wheat-based foods, strawberries and fish. If allergies run in the family, ask your health visitor when to introduce certain foods.
7. To be flexible and have a happy, easy-going attitude towards meal times. It's also vital to praise your baby for eating a little or a lot. Never reward eating with sweets. Instead, give your baby plenty of hugs, kisses and attention.
8. You could give your baby vitamin drops containing vitamins A and D from six months. It's a way of ensuring she has enough of the important vitamins she needs. This is especially important for breastfed babies, and babies who drink less than 500ml of formula milk a day.
9. Give your baby sips of water from a cup or beaker at mealtimes. If you give your baby fruit juice, keep it to mealtimes only, and dilute it well. Add one part juice to 10 parts water.

(8.3a) Foods to be Avoided – To Prevent Choking

1. Small, hard foods like whole nuts, seeds, large pieces of dried fruits with stones and popcorn
2. Slippery foods like whole fish balls, whole grapes, candy and large pieces of meat
3. Sticky foods like peanut butter, which, if offered from a spoon, may get stuck in baby’s throat and cause difficulty in breathing

(8.3b) Foods to be Avoided – SUGAR

1. This refers to any form of table sugar that is added to food, and food items that contain added sugar, e.g. sweet biscuits, sugar-coated breakfast cereals, cakes and soft drinks
2. It provides ‘empty’ calories, i.e. energy (calories) with little or no other nutrients
3. If introduced early, it may cultivate a ‘sweet tooth’ in baby
4. Sugar is best avoided until baby is at least 1 year old
5. Sugar may be listed as dextrose, fructose, glucose or sucrose.
6. Too much sugar in the diet may not only cause baby to refuse savoury food, but can lead to serious problems such as tooth decay and obesity.
7. Because sugar converts very quickly into energy, babies and children who have too much may become hyperactive.
8. Products such as baked beans, spaghetti hoops, cornflakes, fish fingers, jam, tomato ketchup, tinned soups and some yoghurts are just a few of everyday foods that contain hidden sugars, so care should be taken that when baby reaches toddlerhood he does not eat these foods in excess.

(8.3c) Foods to be Avoided – HONEY

1. It can contain spores of a bacterium called Clostridium botulinum. If consumed, may germinate in a yound baby’s immature digestive system thus may result in food poisoning, which can be fatal.
2. Honey is safe for children above 1-year of age and adults.

(8.3d) Foods to be Avoided – SALT

1. Children under 2-year of age should not have salt added to their food – they get all the salt they needed from natural sources such as vegetables.
2. Adding salt to a young baby’s food can be very dangerous, as it may put a strain on his immature kidneys.
3. Research also shows that children with high salt intake may be more prone to heart disease later.
4. When baby reaches the important stage of joining in with family meals, it is important that you do not add salt to the food during cooking. Remove your baby’s portion, then add salt if needed for the rest of the family.

(8.3e) Foods to be Avoided – FRESH MILK

1. It is not recommended by the ESPGHAN and AAP for children under 1-year of age because fresh milk is poor source of iron, vitamin E and essential fatty acids.
2. Fresh milk contains too much protein, sodium and potassium, which may stress baby’s immature kidneys
3. Its protein and fat are more difficult for baby to digest and absorb.

(8.3f) Foods to be Avoided – LOW FAT and SKIMMED MILK

1. These type of milks are not suitable for babies below 12 months of age because they do not provide them with enough calories and fat to grow optimally.
2. Low fat milk can be offered to children aged 2 years and above.
3. Do not give skimmed milk to children under 5 years of age.

(8.3g) Foods to be Avoided – BRAN, WHOLEMEAL BREAD and BROWN RICE

1. They are high in a dietary fiber that may hinder baby’s absorption of iron, calcium and zinc from his diet.
2. They are very filling and may spoil your baby’s appetite for other foods
3. They can be gradually introduced into your baby’s diet when he is 1-year and older.

(8.3h) Foods to be Avoided – HIGHLY ALLERGENIC FOODS

1. These include egg whites, shellfish (e.g. prawns and crab), peanuts and tree nuts (e.g. almonds, cashews, walnuts), wheat, fish (cod, sea bass, flounder), and soy. Avoid also French beans, garden pea, legumes, beans, peas, lentils, long beans.
2. These foods may cause an allergic reaction in some children
3. They are best avoided until a child is at least 12 months old.
4. Foods to avoid until after 12-months to prevent general rash are crustaceans, oyster, tree nuts, squid, cooked white egg and peanut
5. Foods to avoid until after 12-month to prevent oral rash are citrus fruits, green kiwi, pineapple, mango, cantaloupe, dairy produce.

(8.4) Preparing and Cooking food for Baby

1. Always ensure that all surfaces are clean and have been wiped down with an anti-bacterial cleaner. Use kitchen roll for cleaning surfaces and drying, as it is more hygienic than kitchen towels, which may carry bacteria.
2. All fresh fruits and vegetables should be carefully peeled, removing the core, pips and any blemishes. They should then be rinsed thoroughly with filtered water.
3. If you are advised to wean baby early, remember that all fruit and vegetables must be cooked until your baby is 6-month old. This can be done by either steaming or boiling in filtered water. Do not add sugar, salt or honey.
4. During the initial stages all food must be cooked until soft enough to puree to a very smooth consistency. A small amount of the cooking water may need to be added so that the mixture is similar to smooth yoghurt.
5. If using a food processor, check carefully for lumps by using a spoon and pouring into another bowl. Then transfer to ice cube trays or containers for storage in the freezer.
6. ALL FEEDING EQUIPMENT SHOULD BE STERILISED FOR THE FIRST 6 MONTHS, AND BOTTLE AND TEATS FOR AS LONG AS THEY ARE USED.
7. Sterilise ice cube trays or freezer containers by boiling them in a large saucepan of water for 5 minutes.
8. Use a steam sterilizer, for small items such as spoons or serving bowls.
9. Wash cooking utensils as usual in a dishwasher or rinse handwashed items with boiling water from the kettle.

(8.5) Packing food for the freezer

1. Make sure cooked, pureed food is covered as quickly as possible and transfer it to the freezer as soon as it’s cool enough
2. Never put warm food into a refrigerator or freezer
3. Check the temperature of your freezer on a freezer thermometer, it should read - 18°C.
4. If using an ice cube tray, fill with pureed food, open-freeze until solid, then pop the cubes out of the tray and into sterilized plastic box. Non-sterilized items such as plastic bags can be used from 6 months. Seal well and freeze.
5. Label items clearly, adding the date.
6. Use foods within 6 months.
7. Never refreeze cooked food. Food can only be put back into the freezer if it was originally frozen raw and then defrosted and cooked – a raw frozen chicken breast, defrosted, for example, can be frozen as a cooked casserole.

(8.6) Defrosting tips

1. Defrost frozen (covered) food in the fridge overnight or leave at room temperature if you forget, transferring it to the fridge as soon as it has defrosted. Make sure it is covered at all times and stand it on a plate to catch the drips.
2. Never speed up defrosting by putting food into warm or hot water.
3. Always use defrosted foods within 24 hours.

(8.7) Reheating tips

1. Food should be heated thoroughly to ensure that any bacteria are killed. If using jars, always transfer to a dish, never serve straight from the jar. Any food left over should be discarded, never reheated and used again.
2. When batch cooking, take out a portion of food for your baby to eat now and freeze the rest. Don’t be tempted to reheat the entire mixture and then freeze what is left.
3. If baby has only eaten a tiny portion it can be tempting to reheat and serve leftovers later. Please don’t – babies are much more susceptible than adults to food poisoning, so get in the habit of throwing leftovers away immediately.
4. Reheat foods only once.

(8.8) How to Introduce Solids at 6 Months

1.             Don’t add cereals in milk feeds when you start weaning your baby to solids.

2.             Ensure that the first solid feed is watery and is done by parents. Observe that the baby chews his food and rolls it with his tongue.

3.             Start off with small spoonfuls. Ensure that the weaning process into solids is fun and the baby learns to enjoy the feeding, and learns that feeding time is a socializing time. Why not introduce food in a baby bowl with baby seated in her high chair? She will learn valuable lessons like grasping objects, hand-eye coordination and chewing. She will find it fun too!

4.             Avoid big pieces of food which can choke the baby.

5.             Avoid watering the food down by forcing the baby to drink water to wash down the solid. Drinking too much water can cause the baby to regurgitate.

6.             Observe for sensitivity to allergy towards particular foods as allergy can lead to choking if the throat of the baby’s swollen, and may lead to difficulty in breathing.

7.             Sit older children down when introducing them to solids as 6-month-old babies can sit well on high chairs.

8.             Avoid chasing, running and playing while feeding as toddlers can choke on the food. (pg 26)

9.             Once baby is eating solid foods, his need for liquid will increase. Getting your infant used to the taste of plain water is a healthy habit that will last a lifetime. Juice is not recommended; although if you do give your infant juice, make sure your child’s daily juice intake does not exceed 120-180ml. (pg 143)

(8.9) Baby’s First Food

1.             As a toothless baby cannot chew, his first food should be smooth, soft and watery in consistency.

2.             Push food through a sieve, or puree them in a blender or food processor. Dry, lumpy foods can make baby choke and cause asphyxiation.

3.             To start off, fresh fruits such as papaya, banana, or cooked apple may be offered. Scoop, mash and spoon a small amount of these fruits for your baby to try. Avoid acidic fruits such as grapefruit and those with pips (small seeds) such as strawberries and raspberries.

4.             7-9 months: Mashed food in the form of vegetables such as cauliflower, carrot, meat, fish and egg yolk. He can also take porridge. Food can now be coarser and thicker as your baby starts teething. If you use ikan bilis, remember to remove the salt before grinding them into powder. High amounts of sodium chloride can harm baby’s kidneys.

5.             One-year-old: Baby should have enough teeth to chew on small bites of food. The rate of growing varies from baby to baby. The appetite of your baby also fluctuates. He can become fussy and demand for his one favourite food at every meal. In such cases, do not become overly concerned or stressed. Entice him with a variety of new and tempting food.

6.             How to Feed Baby:  Sit baby on your lap. Use a small spoon with a fairly long handle and gently spoon the food to his lips. Avoid pushing it too far into his mouth as this can cause choking. At this stage, baby is learning to use his tongue and throat muscles. Allow baby to enjoy the texture of his food by letting him play with it on his tongue. 2-3 spoonfuls are sufficient for a first feed. Clean and wash his face with a warm towel after feeding.

7.             How to Avoid Meal-Time Misery: All babies have likes and dislikes when it comes to food. Never use force. Always try and be ready to abandon attempts at offering new foods. Be patient and try again a few days later. Avoid giving baby spicy, salty and acidic food. Sit him with the rest of the family at the dinner table at mealtimes so he can come to regard it as a social occasion. (pg 26-28)

8.             Common allergic reactions: Skin (Itchy rash in patches in dense or scattered, eczema, even hives); Swelling (around lips, tongue, mouth, eyes or face in severe allergy); Airways (Inflammation and irritation of the mucosa lining of air passage, may cause breathing problems, wheezing, rhinitis); Digestive system (Abdominal cramp, nausea, diarrhea, vomiting, colic).

9.             Some common allergenic food: Peanuts, eggs, cow’s milk, soy, tree nuts like walnut and cashew, fish, wheat (gluten), Shellfish.(pg 29-30)

(8.10) Choking

1.             What to do: Babies cannot tell us when they are choking. Be alert to signs of the baby turning blue, dusky or visibly struggling in breathing. Tears in the baby’s eyes and his legs and arms are limp and no crying sound is heard. Call for help and act immediately.

1. 2.        How to help: 
2. (1) Check to see if the baby is breathing. Observe the baby’s chest for rising and falling movements, and the sound of breathing. Don’t spend more than 30 seconds here. 
3. (2) Call for help, 995. If you are alone with the baby while calling, try to dislodge the foreign body in your baby’s throat. 
4. (3) Hold the baby in a face-down position, placing him lengthwise on your forearm. Deliver 5 firm blows between the shoulder blades, using the palm of your hand. If the baby does not begin to cry following the back blows, turn him face up in your other arm. Place 3 fingers in the centre of the baby’s chest, raise the finger which is the position in the imaginary line below the nipples. Use the other 2 fingers in a 90-degree angle and administer 5 chest thrusts. Look into the baby’s throat for any foreign body. If it is visible, use your small finger to sweep it out. Repeat until the baby has recovered. (pg 99)

7.0 - Baby’s massage – A Moment of Tenderness and Bonding

(7.0) Baby’s massage – A Moment of Tenderness and Bonding

by Mustela.com

(7.1) Introduction

In the womb, baby is exposed to sensory stimulations coming from the breathing and the moving of his mother during the day.

Today, most health care professionals agree that baby’s massage is a natural activity, which can help him in his self-discovery and exploration of the world. One demonstration of this is that some specialists give massage to accelerate the progress and development of the child.

But for you who just feel like massaging your baby, it is neither a therapeutic gesture nor a tradition. As explained in this brochure, massaging baby can bring you a moment of happy bonding. I wish it to be as beneficial to you as to your baby.

Valentine Marchac, Pediatrician, Necker Hospital, Paris, France.

(7.2) Why massage your baby?

A tradition in Africa, South America and India, the practice of massage is more recent in the western world. In the 70’s, some specialists have showed the importance of early contacts with the mother for the motor development of the baby. Since then, massage has become more popular with mothers who find it ideal to establish an additional communication with their youngster. Giving a massage to a baby is an act of tenderness as essential for his psychological and motor development as his emotional pleasure. Not only a trend, it represents the opportunity to build a real relationship with baby.

(7.3) Why this brochure?

Written with the help of a psychologist*, specializing in the mother/baby relationship, this brochure will help you discover the numerous advantages of a massage: for your baby, for you and for the quality of your relationship with him. You will also find some practical advice, easy to follow, as well as some basic precautions, to make each moment of the massage a moment of shared happiness.

*Mrs. Hubin-Gayte, child psychologist, researcher in maternity

(7.4) Baby shows great sensitivity

Touch is the only fully developed sense in the newborn. The first tool of communication, it establishes immediate contact with the new world around him. This tactile sensibility, acquired during pregnancy, is the true ‘prehistory’ of his emotional relationship with his mother. From birth, this immediate contact helps create a privileged dialogue between mother and child. All the depth of their emotions comes directly from this natural physical contact.

Practical Questions: At what age can a mother give a massage to her baby?

In general, you can start as soon as the umbilical cord has healed right up until the time when your baby becomes more active and experiences difficulty staying immobile for an extended period of time (around 1 year old). However, if your baby agrees, nothing forbids you from continuing beyond that stage.

(7.5) He progressively discovers the ‘the world’

At birth, baby is not aware of his body. He does not know that he is an individual distinct from his mother. In the first weeks, he learns the difference between the world and himself. “The world’ is for him the same as his mother. It is she, by washing him, carrying him and caring for him, who is going to help him build the consciousness of his body. Massage really helps this awakening to individuality.

Precautions: What is the ideal place?

• Bed, sofa, mat directly on the floor… The important point is that you are comfortable and that baby is safe.
• Choose a quiet, warm place (at least 77°F) with diffused light.
• Unplug the phone so as not to be disturbed.

(7.6) You are key to his development

Between the world and baby, his mother comes before all. This privileged relationship favors the development of the little one but also helps dissipate his anxiety and start the first months more peacefully.

Giving him a massage shows him the softness and carefulness of the maternal presence which helps him gain confidence in himself. The physical closeness enables the reassuring maternal presence. As he approaches his first birthday, it will be easier to build his independence.

Massage: a constructive experience for baby

Practical Questions: What time of the day?

The moment when you AND your baby are available. This can happen after the bath or at a time of the day when both are relaxed. Avoid giving a massage after a meal or when baby is sick, tired or fussy.

How long should it last?

Here again, there are no set rules. As long as baby seems to enjoy it and that you are in harmony… A few minutes can be enough. Avoid extended sessions (more than 10 minutes), as your baby could get cold.

Precautions: For yourself

• A massage should not be given with cold hands. In winter, rub your hands together to warm them up or put them under warm water to bring them to the temperature of your baby’s skin.
• Also make sure to remove your jewelry and to cut your nails short.

(7.7) Massage your baby to get to know him

The mother/baby relationship is not only instinctive but also grows with time. The physical contacts evolve during the first weeks. At first, even though it is natural to kiss and cuddle your baby, contacts are primarily ‘utilitarian’ (bathing, dressing, nursing). After a while, mothers have more confidence to use their whole hand: fingers AND palm. A time for discovery is necessary to establish a reciprocal trust. The massage is a privileged time which enables this adaptation.

Practical Questions: How often can you give a massage?

There are no rules or obligations as it should be a moment of happiness and freedom. You can perfectly well go several days between massages, if he is fussy or if your schedule is too busy. And fathers too can share the experience of massage with their babies.

(7.8) Massage is an exchange

Giving a massage is a reciprocal exchange allowing mother and baby to feel good together.A baby is born with the innate need to re-establish the proximity with his mother. A massage helps him feel loved and confident. The physical contact and the cuddles allow the mother to communicate physically and emotionally with her baby. While helping to relax him and to exchange emotions, she feels the rewarding pleasure of reassuring her baby.

Massage: a constructive relationship for the happiness of mother AND baby

Precautions: For baby’s comfort

• Make sure especially that baby’s feet are not cold
• Stop the massage at the first sign of discomfort
• Speak to your baby to put him at ease. For example, explain the movements you are making.
• Wrap him in a towel once the massage is finished and wait a few minutes before lifting him up.

(7.9) A few simple movements

Massaging your baby is an intense moment of exchange and bonding. There is no good or bad technique as the most important thing is to use gentle and tender gestures. As you watch for his reaction, you will soon know what he likes.

Following are a few examples of simple movements:

1)   Baby is on his belly: Gently massage his shoulders starting from the neck. Massage down his back from top to bottom with small strokes. Gently massage the legs from the thigh down to the calf, without forgetting the feet.

2)   Baby is on his back: Massage chest and stomach clockwise in gentle circles. Gently massage arms including the hands and fingers.

3)   Finish with the face: from forehead to temples using fingertips. Then, from the tip of the chin passing along the jawline up to the ears.

Postpone the massage on occasions when the baby’s skin shows signs of surface discomfort.

“A massage is shared with baby, not given to baby”

Precautions

The movements: They must be gentle, especially in the beginning. Avoid the muscled manipulations used in sport massage!

The product: It is very important to use a product which:

• Respects the fragile skin of baby (no essential oil, for example)
• Facilitates the massage without being too greasy
• Is hypoallergenic

6.0 - Bathing Your Baby

Sources

1. Guide to Childcare by Wong Boh Boi
2. Your Baby’s First Year by American Academy of Pediatrics
3.  Baby Must-Haves

(6.1) Bath Time

1. Infant doesn't need much bathing if you wash the diaper area thoroughly during diaper changes.
2. Three times a week during his first year may be enough.
3. Bathing him more frequently may dry out his skin, particularly if soaps are used or moisture is allowed to evaporate from the skin.
4. Patting him dry and applying a fragrance-free, hypoallergenic moisturizing lotion immediately after bathing can help prevent dry skin or worsening the skin condition called eczema.
5. During his first week or two, until the stump of the umbilical cord falls off, your newborn should have only sponge baths. Once the umbilical cord area is healed, you can try placing your baby directly in the water. Same goes for older babies who’ve moved on to the big tub, but once baby can sit up and play in the water, you may want to bathe him every day for the sheer delight of watching him splash and explore.
6. His first baths should be as gentle and brief as possible. He probably will protest a little; if he seems miserable, go back to sponge baths for a week or two, then try the bath again. He will make it clear when he's ready.
7. Toddlers, who can get pretty grimy while eating and playing, may need to be bathed daily as well.
8. If you've forgotten something or need to answer the phone or door during the bath, youMUST TAKE THE BABY WITH YOU, so keep a dry towel within reach. NEVER LEAVE A BABY ALONE IN THE BATH, EVEN FOR AN INSTANT.
9. If your baby enjoys his bath, give him some extra time to splash and explore the water. The more fun your child has in the bath, the less she'll be afraid of the water.
10. As he gets older, the length of the bath will extend until most of it is taken up with play. Bathing should be a very relaxing and soothing experience, so don't rush unless he's unhappy.
11. Bath toys are not really needed for very young babies, as the stimulation of the water and washing is exciting enough.
12. Once a baby is old enough for the bathtub, however, toys become invaluable. Containers, floating toys, even waterproof books make wonderful distractions as you cleanse your baby.
13. The bath is a relaxing way to prepare him for sleep and should be given at a time that's convenient for you.
14. Avoid bathing your baby immediately after feeding as it may cause him to throw up his feed. Baby may also want to nap after his feed.

(6.2) Bathing Your Baby Step-by-Step

1. Room has to be warm, comfortable and well-ventilated room.
2. Supplies: Large bath tub (avoid ergonomic and egg-shape tub, fanciful gadgets like bathing stools, slings or wedges in the bathtub), baby bath, towel, wash cloth, cotton wool, clean cloth, wet wipes, jug or cup, disposable diaper or napkin with liner, lotion and bottom barrier cream if needed – keep all supplies close at hand.
3. Wash your hands 7-step with soap and water at room temperature (20°C).
4. Put cold water into the tub first before adding hot water.
5. Check the temperature of the water with the inside of your wrist (not elbow) or using thermometer (ideal 30-36°C).
6. Undress baby’s shirt and leaving diaper on, and cover him loosely with towel (so he doesn’t get chilled).
7. EYE: Clean each eye with a separate sterilized cotton ball (soaked in the cooled boiled water, do not use contact lenses solution), wiping from the inner corner (near the nose) outwards. If the sticky eyes are inflamed, consult your doctor.
8. FACE: With baby in your arm, on your lap or on the bed, first wash his face with plain water (without soap) using cotton wool. Dap dry with a towel (do not rub his skin).
9. Support baby by his neck with one hand – football hold.
10. Squeeze a few drops of ‘rinse-free’ baby bath into the water.
11. HAIR: For newborns, the baby bath solution alone is enough for cleansing his hair. Rub dry after washing to avoid losing heat (as the head has the biggest area surface. If it is wet, baby may catch a cold). For older baby, you may wash his scalp using a washcloth with baby shampoo. Make sure the washcloth is not too wet or soapy water may get into baby’s eyes. Then rinse the hair clean and dry it. (You can sing – ‘Raindrops fallin' on our heads’ – so baby will know what’s happening)
12. Remove his wrap. If his diaper is soiled, clean baby first then clean your hands again (Always clean baby’s genitalia front to back – do not pull the foreskin that covers baby boy’s penis as it can cause damage. The foreskin retracts after 3-4 years on its own. Then clean the bottom)
13. Hold baby securely by his armpit (thumb on his shoulder and four fingers under his armpit) so that your wrist supports his head. Use another hand to hold his buttocks.
14. Then put him gently into the water, legs first, followed by the buttocks and then the trunk (the water level is under the chin to keep him warm like spa experience). Cover his chest with a washcloth to give him security.
15. NECK: With your free hand, clean the creases of the neck with wet cotton wool.
16. HANDS: Ensure that the creased areas are cleaned thoroughly with cotton wool or a cloth. It is easier to wash with your hands instead of using a cloth. Since his hands are always in a grip, you can rotate 3 times massaging his back palm – he will open his grip automatically. (You can sing ‘Round and round the garden, like a teddy bear, one step, two step, tickle you under there.’) Then wash his fingers one-by-one gently without bending them backward. This will break them (green stick fracture).
17. Make sure that your other hand is gripping his armpits and supporting his neck securely. If you are afraid that baby may slip off your grip when you use soap, soap him on your lap or on the bed first before rinsing him off in the tub. Soap is not recommended as it has a drying effect on a baby’s skin.
18. LEGS: Wash his legs and toes. You can sing ‘This little piggy went to market, This little piggy stayed at home, This little piggy had roast beef, This little piggy had none. And this little piggy went... "Wee wee wee" all the way home... (Challenge you to sing: When he reaches 9-month of age, he can fill up the blanks when you sing, and one fine day, he may crawl to your feet and sing the whole song to overwhelm you with surprise).
19. BONDING: You can turn the baby over to wash his back by supporting at the front with your hand under his armpit – bonding time. Maid can skip this bonding part.
20. GROIN & BUTTOCKS: Wash the areas last.
21. When you have finished, lift baby up with both hands, put him on a stable surface and cover him with a dry towel (Avoid hooded towel because you may ‘wing’ him and make him catch cold).
22. Pat him dry, especially the creases and folds, before dressing him. Avoid rubbing him.
23. Contrary to what you may read in ads for baby products, your infant does not ordinarily need any lotions, oils, or powder. You may apply oil or lotion if baby’s skin is flaky or dry. Ideally, don’t use powder. If you have to, dust the powder away from him with your hand to avoid inhalation of powder particles or dust. Then rub gently. Avoid baby oil, which does not penetrate or lubricate as well as baby lotion or cream.
24. You may also use baby barrier cream (only when baby starts to have them).
25. EARS: Use a dry cotton bud to clean his outer ear after bath. Do not try to clean deep inside as you may cause injury. The earwax is for protection and is not really dirty.
26. NOSE: You can remove any dried mucus from the nose with damp cotton wool rolled into a tip (Avoid poking into baby’s nostril with a cotton bud). Wet the mucus and wipe it out or use a mucus extractor.
27. MOUTH & TONGUE: Baby’s mouth is generally clean and does not require much cleaning during the bath time. There is no need to clean his tongue. If you have to, it is safer to use clean, wet gauze wrapped around your index finger. Insert your finger by the corner of his mouth, rest your finger on his tongue and swipe outwards once only (too much cleaning may cause bulimia – by 3 month, baby may not want his milk again). Avoid rubbing his throat. Always consult your doctor if you have concerns over his tongue. If baby is bottle-fed with formula, a teaspoonful of water can be given to him to cleanse his tongue after each feed.
28. CORD CARE: Clean the cord with cord spirit or sterilized water 3 times a day and leave it to air. There is no need to cover the cord with a bandage. Baby’s diaper should also be positioned below the navel to avoid any irritation in that area. Do not be too alarmed if you notice some discharge or bleeding at the cord stem when it drops off from the part where it was cut at birth. Apply a little pressure with a cotton ball soaked in cord spirit over the bleeding point using 2 fingers (do not poke it in further with one finger). The bleeding should stop. However, if you notice any strange smell and the area surrounding the cord becomes red or swollen, or the navel is shiny and swollen, consult your doctor.
29. FINGER NAILS: Let him wear mittens (After 6 weeks, let him be free to do acrobats/be active with his finger movement.  Rest assured that he wouldn’t scratch his face). Trim his nails when he is a few weeks old.
30. TOENAILS: Baby's toenails grow much more slowly and are usually very soft and pliable. They needn't be kept as short as the fingernails, so you may have to trim them only once or twice a month. Because they are so soft, they sometimes look as if they're in-grown, but there's no cause for concern unless the skin alongside the nail gets red, inflamed, or hard. As baby gets older, his toenails will become harder and better defined.
31. CRADDLE CAP: It occurs as a result of excessive oil around the head, eyebrows and face. It is a common condition that affects babies under the age of one. Causes are thought to be related to hormones transferred or stimulated by the mother’s hormone during the last week of pregnancy. The stimulation leads to over-production of a waxy, oily substance called sebum. The skin around the scalp, eyebrows or even eyelids is covered by flaky, crusty orange-yellowish patches. The skin is reddened and scaly but is usually not itchy. It is also believed to be caused by strong shampoo. Apply some olive oil on the area for 2 hours (or overnight if the condition is bad). If it is on the head, use a fine-toothed comb to comb baby’s hair from front to back to ensure that the olive oil permeates the scalp.

(6.3) TYPES OF TOYS TO LOOK FOR:

1. Toys that will help your baby experiment with the properties of water: things he can fill and pour from, and have sieves that allow water to flow through
2. Boats that really float
3. Aquatic creatures that bob and float in the water
4. Terry cloth bath puppets (these can double as washcloths, meaning your child might be more compliant when it’s time scrub up)
5. Shapes, letters, and numbers that stick to the side of the tub
6. A doll that’s meant to go in the tub; your child will love washing up his own little baby

5.0 - Bottle feeding

Sources

1. Guide to Childcare by Wong Boh Boi
2. The New Contented Little Baby Book by Gina Ford
3. Your Baby’s First Year by American Academy of Pediatrics
4. Successful Breastfeeding by Kang Phaik Gaik

(5.0) Expressing – Few things to take note

(5.1) Preparation for Expressing Breast milk

(5.2) How to Express Using Breast Pump

(5.3) How to Hand Express

(5.4) Storing Expressed Breast Milk

(5.5) Bottle-feeding with Formula

(5.6) Infant Formula

(5.7) Sterilizing Feeding Utensils

(5.8) Preparing a Feed

(5.9) Giving the feed

(5.10) How Much Does Baby Need?

(5.11) Formula: Overfeeding

(5.12) Burping

(5.13) Spitting Up

(5.14) Choking with Milk

(5.15) Weaning to Food

(5.0) Expressing – Few things to take note

1. Majority of mothers are so successful at breastfeeding is because they use electric expressing machine in the very early days.
2. Breast milk is produced on a supply and demand basis. During the early days, most babies will empty the first breast and some may take a small amount from the second breast. Very few will empty both breasts at this stage.
3. By the end of the 2nd week, the milk production balances out and most mothers are producing exactly the amount their baby is demanding.
4. Some time during the 3rd and 4th week, the baby goes through a growth spurt and demands more milk. This is where a problem often sets in if you have followed the current advice of not expressing before six weeks.
5. In order to meet the increased demand for more food, you would more than likely have to go back to feeding two- or three-hourly and often twice in the night. This feeding pattern is repeated each time the baby goes through a growth spurt and often results in the baby being continually fed just prior to sleep time. This can create the problem of the wrong sleep association, making it even more difficult to get the baby back into the routine. (pg 68-69)

(5.1) Preparation for Expressing Breast milk

1. Mothers who express the extra milk they produce in the very early days will always be producing more than their baby needs.
2. The best time to express is in the morning as the breasts are usually fuller. Expressing will also be easier if done at the beginning of a feed.
3. Express one breast prior to feeding your baby, or feed your baby from one breast, then express from the second breast before offering him the remainder of his feed.
4. Some mothers actually find that expressing is easier when done while they are feeding the baby on the other breast.
5. It is also important to note that expressing at the beginning of a feed allows slightly longer for that breast to make more milk for the next feed.
6. Give babies a bottle either last thing in the evening or during the night by someone other than the mother, thereby allowing the mother to sleep for several hours at a stretch.
7. Don’t offer more than one bottle a day as baby may reject the mother’s breast or becoming confused between nipple and tea.
8. It gives you some flexibility and secondly, the problem of later introducing bottles to an exclusively breast-fed baby doesn’t arise.
9. In the early days, you will need to allow at least 15 minutes to express 60-90ml at the morning feeds, and up to 30 minutes at the evening expressing time. By end of first month, the majority can easily express 60-90ml within 10 minutes at the 9.30pm expressing when using a double pumping system.
10. You can cut back on expressing as your milk supply becomes firmly established. (pg 70-71)
11. Hand pump: Slow method but effective.
12. Battery pump: Makes a whirring noise when you pump
13. Electric pump: For speed and breast stimulation, it’s a good investment although it’s the most expensive. But it’s slightly heavier. It can adjust both the speed (cycle per minute) and suction strength (vacuum level) according to your needs.
14. Storage bottles or milk bags
15. Cooler bag: This has insulated linings which you can pack with ice packs to keep your breastmilk cool.
16. Sterilizer: You will need to sterilize equipment like breastshields and bottles after pumping – either by boiling them or steam them.
17. Breastfeeding shawls: Breathable cotton with patterns on a dark background is a good choice because it will not be too hot for you and baby when you are wearing it; and milk stains will be less visible.
18. The right caregiver: If choosing a childcare centre, ask the principal how the Infant Care department handles the preparation of EBM. Arrange to leave your baby with the caregiver for several hours on one or more occasions before you actually start work. Show her how to hold your baby during feeding and how to comfort him when he is upset. Show him how to store, defrost and handle EBM.
19. Weaning from the breast to the bottle:  Once baby’s feeding is established, after 4-6 weeks, you can wean baby onto a bottle filled with EBM. Give one bottle a day for 1-2 weeks, then add another bottle. Increase the number of bottles gradually according to the number of feeds baby will need when you return to the office. Continue to breastfeed baby in the mornings and nights. Tips: Let the caregiver or a family member give him the bottle. Make it fun – tease his mouth with the teat, let her play with the bottle, do not force the teat into his mouth; He does not have to drain the bottle – the purpose is to introduce him to the bottle, not to achieve a full feed. After you start work, continue to breastfeed him before and after working hours. This is important for bonding and stimulating your milk supply. (pg 119-124)
20. It is important to plan the transition properly. You must allow approximately a week to drop each feed. For example, it can take 6 weeks to establish a good milk supply, and if you decide to give up breastfeeding, you should allow, at the very least, a further 5 weeks to drop all breastfeeds and establish bottle-feeding. (pg 74)
21. When to Express: Pump 15 minutes per side after milk starts flowing. Pumping more times for short intervals will generally yield more milk than one or two long sessions. After you start work, you should fit in 2 expressing sessions at around 10am and 2.30pm. If you express any later than this, it is possible that your breasts will not produce enough for the 6pm feed. It is essential that you pay particular attention to your diet and that you rest well in the evening. It would be advisable to continue expressing at 9.30pm to ensure that you maintain a good milk supply. Make sure that you keep a good supply of breast pads at work, and a spare shirt! (pg 72)
22. Some mothers find that once they are down to two breastfeeds a day, their milk reduces very rapidly. The signs to watch out for are: baby being irritable and unsettled after a feed; or wanting a feed long before it is normally due. If baby shows either of these signs, he should be topped up immediately after the breast-feed with 30-60ml of expressed milk or formula. This will ensure that his sleeping pattern does not go wrong due to hunger. (pg 75) 

(5.2) How to Express Using Breast Pump

1. Wash hands and make sure all equipment is sterilized before expressing.
2. Sit in a comfortable position.
3. Before pumping, massage your breasts. Every 5-7 minutes between pumping, massage again.
4. To promote let-down, think about your baby.
5. Position the breastshield correctly such that it does not press against your nipple.
6. Start your pump at the lowest level. Then increase to the moderate setting.
7. Your nipples should not feel sore during or after pumping.
8. After you finish pumping, rub a little breastmilk over your nipples and areola to protect them. Allow to air dry.
9. Express each breast for about 15-20 minutes. Single pump will take about 30-40 minutes per session and double pump takes about 20 minutes per session. (pg 124)

(5.3) How to Hand Express

1. Wash your hands.
2. Massage breast from the outer edge towards the areola.
3. Place thumb and fingers on the edge of areola.
4. Gently press inward towards the centre of the breast and squeeze fingers and thumb together. Do not slide your fingers forward.
5. Milk should emerge from the nipple pores.
6. Repeat with a rhythmic movement.
7. Move fingers around areola and express to drain all sectors of the breast. (pg 125)

(5.4) Storing Expressed Breast Milk

1. Room temperature (25°C): Up to 4 hours
2. Thawed EBM in fridge (4°C): Up to 24 hours
3. Cooler box with ice packs (15°C): Up to 24 hours
4. Refrigerator (4°C): Up to 48 hours
5. Freezer with separate door (-20°C): Up to 3-6 months
6. Deep freezer (-20°C):  Up to 6-12 months
7. Give freshly expressed milk to your baby daily; then use the frozen milk on first-in-first-out basis whenever needed.
8. If you know in advance that the milk won't be used within 4 days, freeze it immediately.
9. It’s useful to freeze milk in quantities of about 90-120ml - the amount of a single feeding.
10. You can also freeze some 30-60ml portions; these will come in handy if the baby wants a little extra at any feeding.
11. Thawing: Thaw frozen milk in the fridge. 10 minutes before feeding, remove the bottle from the fridge and warm in a bowl of warm water. Do not boil the milk or put in the microwave oven as this will kill the vitamins. Swirl the bottle before feeding. If using milkbags, swirl the bag and pour into bottle before feeding. Discard excess milk after feeding.
12. Once milk is heated, it should never be reheated, as this very rapidly increases the bacteria levels in the milk, which is once of the main cause of upset tummies in formula-fed babies. (pg 78)
13. Thawed milk should be used within 24 hours. Never refreeze it.
14. Always check the milk by smelling and tasting it before you feed your baby. Ensure that it has not gone sour. (pg 73)
15. Because the fats in human milk begin to break down over time, use the frozen milk as soon as possible.
16. It's good idea to place a label with the date on each container so you can use the oldest milk first.
17. Baby may prefer that the milk be heated to at least room temperature (20-22°C) for feeding.
18. Incidentally, once milk is thawed, its fat may separate, but that does not affect its quality.
19. You may swirl the container gently until the milk returns to a uniform consistency.

(5.5) Bottle-feeding with Formula 

1. Studies have shown that the risk of contamination in bottle-feeding is 19 times higher than that in breastfeeding. This happens especially when the feed is not prepared and given properly. Diarrhea is the usual symptom of contamination.
2. Bottles that are designed to promote self-feeding are not recommended, as they may contribute to nursing-bottle tooth decay by promoting constant feeding and exposure of the teeth to sugars throughout the day and night. When milk collects behind the teeth, bacterial growth occurs.
3. Also, self-feeding in a supine position (lying down on the back) has been shown to contribute occasionally to ear infections. Infants and older children should not receive a bottle to suck on during the night. If you give your baby a feeding at bedtime, take away the bottle before he falls asleep.
4. If the nipple of the bottle is too small, your baby may suck too so hard that he swallows too much air; if it’s too big, the formula may flow so fast that he chokes. Ideally, formula should flow at a rate of one drop per second when you first turn the bottle upside down. (It should stop dripping after a few seconds) (pg 137)

(5.6) Infant Formula

1. The base component is usually cow’s milk from which the fat is removed and replaced with mixture of vegetable and fish oils. The sodium is reduced. The composition of infant formulas is designed to be very close to that breast milk.
2. Avoid changing from one formula to another without consulting your doctor first.
3. There are four basic types: milk-based formula, milk-based formula with added whey proteins, soy-based formula and protein hydrolysate-based formula.
4. It is not necessary for baby to be given additional vitamins and mineral supplements as long as he is feeding well.
5. Iron supplements are not necessary for babies up to 6 months old. (pg 22-24)

(5.7) Sterilizing Feeding Utensils

1. Contaminated feeding utensils can cause tummy upset and discomfort. Protect your baby’s health by making sure that all feeding accessories are sterilized and germ-free. The person handling the equipment should also practice a high level of hygiene. (pg 17)
2. Every morning the work-top should be thoroughly washed down with hot soapy water, the cloth used should then be rinsed well under hot running water and the surface wiped again to remove any traces of soap. This should be followed by a final wipe-down using kitchen roll and antiseptic spray.
3. Hands should always be washed thoroughly with anti-bacterial soap under warm running water, then dried with kitchen roll, not a tea towel, which is a breeding ground for germs. (pg 80)
4. Washing dirty bottles: Wash your hands. Fill the bowl in which the dirty bottles are stored with hot, soapy water. Using a long-handled bottlebrush, carefully scrub all the bottles, rims and caps inside and out (Do not scrub too hard as it can damage the inside lining of the bottle). Carefully rinse everything under a hot running tap. Rub the teat first in soapy liquid on both the inside and outside of the teat to remove any milk curd. Wash and rinse the bowl thoroughly, then place all the equipment in the bowl under the running cold water tap. This is to check that everything is thoroughly rinsed – the water should run clear. (pg 81)  Keep them in a clean container until you are ready to sterilize them.
5. The Boiling Method: Using a large stainless steel pot, submerge all clean bottles, teats and caps in clean water. Boil all the feeding items for 10 minutes. You can leave the items in the container and keep it covered until you use them. Ideally, you should take them out using clean pair of tongs, assemble them and keep them in a clean place. All sterilized assembled equipment can be kept that way for 24 hours.
6. The Soaking Method: Special sterilizing liquid or tables are used and no boiling is required. Start by washing your hands with soap and water. Prepare the sterilizing solution in a large plastic or porcelain container according to the manufacturer’s instructions. Submerge all clean bottles, teats and caps into the sterilizing solution and soak them for at least an hour or as indicated in the manufacturer’s instructions. Use clean tongs to remove the items and assembled them and put them in a clean place while awaiting use. The sterilizing solution has to be changed daily. If your baby has a tendency to throw up his feeds, you may have to rinse the utensils first before preparing each feed as the chemicals in the soaking solution can irritate your baby’s stomach. The sterilizing solution is effective for 24 hours.
7. The Steaming Method: It is one of the easiest and quickest methods of sterilizing. Some steam sterilizers take as little as 8 minutes to sterilize bottles. You can also load in your feeding utensils and breast pump all at the same time. Clean the utensils as in the other methods. Then steam the feeding equipment as instructed by the manufacturer. Again, try to assemble the equipment and have them ready for use beforehand. The sterilizer should be rinsed out every day, and the removable parts checked and, if necessary, washed and rinsed. (pg 81)
8. The Microwave Method: This is another form of sterilizing that kill germs effectively. A specially designed rack is needed to hold all the equipment for microwaving. Clean the utensils as in the other methods before you microwave them as instructed by the manufacturer.

(5.8) Preparing a Feed

1. A baby’s feed should be prepared fresh, just before you actually feed him. If you have to leave it in the refrigerator, keep it there for no longer than 24 hours.
2. Always wash your hands with soap and water before preparing each feed.
3. Use tongs to remove a bottle from the sterilizing container or just pick up the already sterilized bottle.
4. Follow the preparation instructions on the milk powder tin. Pour the correct amount of water into the sterilized bottle, using both cool and hot boiled water or simply allow hot water to cool in a clean jug.
5. Add the recommended number of scoops of milk powder, leveling each scoop lightly, then add into the bottle. Always use the scoop provided in the milk tin for measuring. Don’t mix the scoops of different milk formulas or add more scoops. Additional scoops increase the concentration of milk and can put a strain on your baby’s kidneys and cause other problems such as wind, indigestion and obesity.
6. Use a clean teat to close the feeding bottle and swirl gently until all the powder has dissolved. Don’t microwave milk formula as the milk may be heated unevenly. Neither should you shake the bottle vigorously nor stir with a spoon as excessive air bubbles can form.
7. Feed your baby immediately. Be careful not to touch the part of the teat that goes into your baby’s mouth to avoid contamination.
8. Clean and dry the knife or spatula for leveling the milk powder in the scoop after each use and close the milk tin tightly.
9. Always store milk powder in a cool, dry place and away from direct sunlight. Do not keep the milk tin on top of an oven.
10. To avoid interruptions during feeding, check and change baby’s diapers before feeding.
11. Test the temperature of the feed by dripping a few drops on the inside of your wrist. The milk should feel comfortably warm.
12. Don’t keep a feed warm for the whole day. Germs multiply rapidly and can cause tummy upset. It is not necessary to have warm milk although a warm feed is more comfortable for baby. One of the easiest ways to keep milk warm is to let it sit in a mug of hot water or baby food warmer. (pg 19-20)

(5.9) Giving the feed

1. By holding the baby upright with your arm supported by cushion, you will lessen the likelihood of your baby getting air trapped in his tummy.
2. Loosen and screw the teat back on; it should be very slightly loose. If it is screwed on too tightly it will not allow air into the bottle, and your baby will end up sucking and not getting any milk.
3. Check also that the milk is not too hot; it should be just slightly warm. If you get your baby used to very warm milk, you will find that, as the feed progresses and the milk gets cool, he will refuse to feed. As it is dangerous to reheat the milk or keep it standing in hot water for any length of time, you could end up having to make up 2 bottles for every feed.
4. Once feeding, make sure that the bottle is kept tilted up far enough to ensure that the teat is always filled with milk, to prevent your baby taking in too much air.
5. Remove the bottle occasionally during feeding to allow baby to rest. Remove the teat from your baby’s mouth occasionally to let air enter the bottle.
6. Some babies will take most of their feed, burp and then want a break of 10-15 minutes before finishing the remainder of the milk. In the early days, allowing for a break mid-way, it can take up to 40 minutes to give the bottle. Once your baby is 6-8 weeks old he will most likely finish his feed in about 20 minutes.
7. If you find your baby is taking a very long time to feed, or keeps falling asleep halfway through a feed, it could be because the hole in the teat is too small. Most babies have to go straight on to a medium-flow teat as the slow-flow one is too slow.
8. If your baby is taking the required amount of formula at each feed very quickly and looking for more, it may be worthwhile trying a teat with a smaller hole. Offering him a dummy after feeds may also help satisfy his ‘sucking needs’.
9. A baby who is overeating, and regularly putting on more than 240g each week, will eventually become overweight and reach a stage where milk alone is not enough to satisfy his hunger. If this happens before the recommended age for giving solids, it can create a real problem. (pg 81-84)
10. Avoid twisting the teat inside the baby’s mouth to release air. Don’t force or rush feeding.
11. Milk Flow: Ensure that baby is coping well before switching him to a teat with a faster flow. Rubber latex teats are more suitable for newborns. As they grow up, silicon teats are better as the texture of the teat does not collapse easily during vigorous suckling and fewer replacements are needed. They also have a harder texture for baby to chew on.

(5.10) How Much Does Baby Need?

1. For babies older than one week, the formula for calculating suitable amount of feed is 150ml x weight/number of feeds per day.
2. Underfeeding is unlikely with bottle-feeding.
3. If your baby demands more feed but doesn’t finish his milk, it is likely to be a teat problem.
4. 0-1 week: 30-60ml per feed, 7-8 times per day
5. 1-2 weeks: 60-90ml per feed, 6-7 times per day
6. 2-4 weeks: 90-120ml per feed, 5-6 times per day
7. 1-2 months: 120-150ml per feed, 5 times per day
8. 2-3 months: 180ml per feed, 5 times per day
9. 3-4 months: 210ml per feed, 5 times per day
10. 4-5 months: 210ml per feed, 4 times per day
11. 5-6 months: 240ml per feed, 4 times per day
12. Above 6 months: 240ml per feed, 3-4 times per day (pg 20-21)

(5.11) Formula: Overfeeding

1. Some babies take the bottle of formula so quickly that their natural sucking instincts are not satisfied and they end screaming when the bottle is removed from their mouth. Many mother interpret this cry as one of hunger and end up giving them another bottle of formula.
2. A pattern of overfeeding can quickly emerge, resulting in the baby gaining huge amounts of weight each week. If this problem is allowed to continue, the baby quickly reaches a stage where milk alone will not satisfy his appetite, yet he is too young to be given solids (under 6 months).
3. When a formula-fed baby shows signs of being particularly ‘sucky’, offer some cool boiled water between feeds and a dummy afterwards helps to satisfy their sucking needs. (pg 85)

(5.12) Burping

1. Burping baby helps to ease wind discomfort. Almost all babies love being burped.  If baby does not burp up, don’t be too concerned. Some babies does not like to stop halfway to burp so let him pause naturally and then burp him.
2. Avoid stroking upwards if your baby possets easily. As the force of wind may be too great, this may force the milk out through his nose and mouth. If this happens, try cupping his back with your hand instead of rubbing upwards. (pg 22)
3. How to burp a baby: (1) Hold the baby upright with his head on your shoulder, supporting his head and back while you gently pat his back with your other hand. (2) Sit the baby on your lap, supporting his chin and lean him slightly forward. Burp him by cupping your hand and tapping him gently on his back. (3) Lay the baby on your lap with his back up. Support his head so that it is higher than his chest, and gently pat or rotate your hand on his back. (pg 145-146)

(5.13) Spitting Up

1. It is common during infancy. Sometimes it means the baby has eaten more than her stomach can hold; sometimes she spits up while burping or drooling.
2. It is usually no cause for concern. It almost never involves choking, coughing, discomfort, or danger to your child, even if it occurs while she’s sleeping.
3. Prevention: Make each feeding calm, quiet and leisurely; Avoid interruptions, sudden noises, bright lights; Burp bottle-fed baby at least every 3-5 minutes during feedings; Avoid feeding while infant is lying down; Hold baby in an upright position for 20-30 minutes after each feeding; Do not jostle or play vigorously with baby immediately after feeding; Try to feed her before she gets frantically hungry; Elevate the head of the entire crib with blocks (don’t use a pillow) and put her to sleep on her back. This keeps her head higher than her stomach and prevents her from choking in case she spits up while sleeping. (pg 148-150)

(5.14) Choking with Milk

1. If milk is coming out of the baby’s nose and mouth and he is lying on his back, quickly turn the baby to his side and administer a few back blows. Avoid sitting the baby up as he may regurgitate and aspirate the milk back into his airway.
2. After that, put the baby upright and burp him. The baby will usually not choke on his milk if the feeding technique is right. (pg 100)

(5.15) Weaning to Food

1. Babies thrive well on breast milk or formula alone for the first 6 months. However, they undergo growth spurts when they are at 3 weeks, 6 weeks and 3 months during which their appetites may increase.
2. If, after 6 months, your baby seems to be more demanding and unsatisfied during these periods, it is time to introduce solids. The baby’s swallowing mechanism is not developed till around 3 months. All weaning must be done gradually and progressively.
3. After that, your baby needs other foods to supplement his diet. Always consider baby’s size, weight, activities and appetite before you start weaning. (pg 25)
4. 6 months: 5 milk feeds, 1-2 solids 
5. 8 months: 4 milk feeds, 3 solids 
6. 12 months: 3 milk feeds, 3 solids + snacks (pg 25) 
7. No need to rush: Children at this age still have immature immune systems and may develop allergies to certain foods. Introduce solids one item at a time. Wait a week before introducing another new food. In this way, if your child develops an allergic rash or fever, you will be able to quickly isolate which is the ‘culprit’, and discontinue that food until your child is much older.
8. Breastmilk still most important: Solid foods should be seen as supplementing the child’s intake of breastmilk. You should continue to maintain and increase your milk supply by feeding your child about 4-5 times a day. Solid food can be given once or twice daily to children after 6 months of age. (pg 139-142)