Avocado, bananas, and chicken. The ABC's of introducing real food to wee ones.

Starting your baby on solids can be new and exciting, however there is a lot of misguided or outdated information and providers who push parents to start solids (infant cereal) too early. Here is some information on why you may want to hold off on the solid food craze and why you also may want to make better choices for first foods.

a better choice for first food is obviously a donut...

Many articles state that solids can be introduced between 4 and 6 months, however there are also studies that show parents are starting solids even earlier than 4 months( CBS news article ). Years ago, I'm talking in the 40s and 50s, parents left the hospital with cereal in their babies bottles. Times have definitely changed since then but some parents are still misguided when it comes to food introduction. The American Academy of Pediatrics recommends exclusively breastfeeding for at least 6 months (AAP), which is contradictory to how many pediatricians practice, encouraging parents to start solids at 4 months.

Many pediatricians still recommend starting baby on infant rice cereals as their first food, mainly because the cereals are fortified with iron. FORTIFIED=not naturally occurring. When people talk about cereals, it most often refers to infant rice cereal (regular oatmeal is a healthier option for babies). Grains/starches are typically harder to digest because you need amylase to break them down. Infants are born with very little amylase and continue to produce more in the 4-6 month range, which is why many providers say it's okay to start these starches, however the amylase that a 4 or 6 month old produces, is still considerably less than and adult or even a toddler. Hold on hold on, saliva contains amylase which can help break down the starches, and also breast milk contains amylase as well, so maybe babies can digest starches and grains fine? Possibly, however should this be their first food? Are there any nutritional values in these processed cereals?

Many people want to attack the baby cereal industry, however there are a few things to look at first. Cereals are fortified with iron and other vitamins/nutrients that babies need, especially starting at 6 months. Some research points to gluten intolerance with babies that are introduced to grains too late in life (8+ months), so maybe there's a balance that we need to understand. Yet, infant cereals are still a processed food, and breast milk contains iron, but is it enough past 6 months? Maybe the processed infant cereals are not the starch or grain that should be introduced. So then what? Healthy Children, an informative website by the American Academy of Pediatrics states that there's no medical evidence that cereal should be the first food introduced, it's just tradition. TRADITION! (Healthy Children).

How about starting with real food!? Before baby cereals were produced by the big food companies, babies were eating real food, sometimes steamed, sometimes blended, and other times whole. Baby led weaning (BLW) is a new phenomenon yet an old one. Don't confuse the term "weaning" with weaning a baby from breast. BLW starts at 6 months or later when baby shows an interest in food- this is key. What does that mean? Your baby should be able to hold head up properly, baby should have the absence of the tongue thrust reflex which is a reflex to push things out of their mouth- a protective mechanism in babies that eventually goes away, allowing them to swallow food that is placed in mouth. Some babies do not show an interest in real food, so no need to force them, we should take cues from the baby, not the calendar. For example, my babe Avielle is just about 5 months, and like other moms, we got the green light from our pediatrician to start baby cereals. I know that Avi still has the tongue thrust reflex and is just not mature enough to start solids, she's still happy and healthy with her all you can eat breast milk buffet.

Baby led weaning does not talk about blending, mashing, or steaming foods- no need to buy that baby blender or steamer! It's simply offering babies regular food, often parts of the meal the family is enjoying (with some discretion). For example, if the family is eating chicken, then give piece to baby to explore. Obviously at the early stages, more food is going on the floor or on their face then in tummies, so this is not for major nutritional value at first, more to help baby learn eating habits and build dexterity with hands and fingers. As a bonus they get to eat good tasty food, not weird veggie fruit mashed combos that would make anyone else gag, and mamas don't need to spend time prepping baby food. WIN WIN. This is yet another reason babies must be at least 6 months, so they are able to reach and hold pieces of their own food. Baby Led Weaning website offers a ton of information on how to start. Iron is an important part of infant development, which is why iron fortified cereals are pushed. After the age of 6 months, it's thought that babies need more iron than breast milk can provide, however there are healthy foods that can be added to the diet that are iron rich, such as:

• winter squash
• sweet potatoes
• prune juice
• meat & poultry (beef, beef & chicken liver, turkey, chicken)
• mushrooms
• sea vegetables (arame, dulse), algaes (spirulina), kelp
• greens (spinach, chard, dandelion, beet, nettle, parsley, watercress)
• meat (pork)
• shellfish (clams, oysters, shrimp) *be aware of food allergies
• tuna, sardines

Once you start introducing foods to your kiddo, it's important to be aware of food allergies or sensitivities. If you have a family history of a food allergy, especially an anaphylaxis reaction, you will want to delay offering that food and talk to your pediatrician before starting that food. You may also want to introduce one food at a time over a few days (about 4) to make sure no allergy or sensitivity develops. Start with low risk allergen foods and start new foods in morning so an allergy doesn't develop overnight (you would hate to wake up to see a rash filled baby). Food allergies can be terrifying and there's no way in knowing if your little one will develop an allergy or not, so it's best to be prepared and observant. I would also recommend starting with organic foods so that all the gross additives or pesticides are not in the food you're giving little one, those can cause reactions as well. This is a good food allergy chart that shows when you should introduce high sensitivity foods.

Is your head spinning yet?

The most important take away points are to hold off on feeding your baby until they are absolutely ready (at least 6 months) and know that there are better choices of food other than infant rice cereal.

HAPPY EATING!

that liquid gold:info on pumping, storage and indulging in a few cocktails

When you get home from the hospital and have decided to give breast feeding a try, all you can really wrap your head around is getting the hang of feeding your kid. A few weeks or months pass and then other questions arise, like how to pump, how to store, and most importantly can I have a cocktail? Hopefully this answers all your questions!

**there is little research being done regarding breast milk so many of the resources out there are on the conservative side with a lot of guess work, hopefully soon we will have a better understanding of breast milk, it's properties and benefits**

1. Pumping: Unless you are exclusively pumping (props to those mamas),  you don't need to bust out your pump right away, unless you want to stimulate some milk production or are working with a LC to make sure in the future you know how to use it. In the beginning focus on nursing your babe on demand, they are more efficient in milk production than your pump! Once you have gotten the hang of nursing, you can try out the pump.All pumps are different, so make sure you read the manual of your specific model. Bottles and pump parts need to be sterilized the first time, this can be done with boiling water or in the dishwasher, after that only soap and warm water needed.

• If you're pumping multiple sessions in a day, you don't need to wash your parts in between, just put pump parts in the refrigerator(you can put parts in a plastic baggie in the fridge if that's easier). 
• At the end of the day wash the parts with soapy water
• Pumping into bottles or bags? It's a personal preference really, and depends on what you're doing with the milk. If you're freezing, you could pump right into a bag (not all pump models have the attachment). I personally pump into the Medela bottles for more accurate ounce measurement then pour into bags and write the # of ounces on the bags with date.
• If you have a sudden decrease in output when pumping, try and change some of the pump parts. Remember your output when pumping does not correlate to how much milk you're producing. Again, your baby is much more efficient "pump".
• When pumping, the best thing to do is relax and not watch the bottle, it will stop a letdown quickly. Instead do mindless activities or look at pictures of your babe. (I always feel a little creepy pumping and fawning over my baby, but it works :)
• Another technique is manual expression, it takes time and patience but can give you more output http://newborns.stanford.edu/Breastfeeding/HandExpression.html (video does contain breasts and pumping mamas!)

2. Storage of milk:

• Freshly pumped milk can be left out at room temperature for up to 8 hours
• If your babe drinks from the bottle but doesn't finish it, there is not a lot of evidence on the number of hours you can save the milk, anywhere from 1-48+ hours, so obviously there's little research or knowledge. I have put the half used bottle back in the fridge and used 2 days later without issues. The thing is, your milk will smell SOUR if it's bad, and your babe won't drink it. Refrigeration also decreases the bacteria growth in the milk from the babies mouth.
• Milk can be in the refrigerated up to 8 days
• Milk can be in the freezer for up to 12 months, so be sure to put exact date on the bags! (I made this mistake the first month of making a freezer stash). The freezer does not have to be a deep freezer, contradictory to some early articles.
• If you take a frozen bag and thaw, use within 24-48 hours, but again, there's not a lot of research on this. To thaw a bag, you can put in the refrigerator or run bag under hot water (I use hot water, it thaws very quickly), never microwave breast milk.

3. Alcohol and a breast feeding mama: I wish I could give you hard evidence for this, but again, this is understudied and not very know with a lot of mixed sources.

•  Many sources will state drinking alcohol in moderation is fine for a breast feeding mama, and I agree. Abstaining from alcohol for the duration of breast feeding just isn't expected and here's a little of why:
• by the time your body metabolizes alcohol, there's a small amount that can pass through the breast milk, and again, we aren't sure exactly how much or how soon after alcohol is consumed, but it is a fraction of your blood alcohol volume and also dependent on your alcohol consumption.
• Lactation consultants and pediatricians agree that drinking alcohol during breastfeeding can be done if done in moderation
• The current rule of thumb is, if you can drive a car, then you're fine to nurse baby
• If you're such a rockstar mama that you have a little one and are able to get sloshed (I'm jealous), then you can do a few things: you can pump and split the milk to mix later with "non-alcohol" milk, you can use the milk for something other than bottle feeding, or you can wait and sober up and nurse... whatever you do NEVER DUMP YOUR MILK!
• If you're not comfortable with that, here are some non-food uses for breast milk http://parentingpatch.com/healing-uses-of-breast-milk/
• If you're still paranoid at first then have a drink while you nurse... breast milk is magic, but it's not THAT magical to pass through your body that quickly.
• Some people say that alcohol can increase milk output or at least help with let down. Many people say the yeast in beer is best. I personally find that rum, for whatever reason makes me leak and produce more, no idea why, just have found that correlation.
• In the end you just have to figure out what you're comfortable with
  

4. Bottle feeding a breast fed baby: I find this really important and often not well known. When you breast feed your baby, it's work for that baby to suck milk from your nipple. When you introduce a bottle you want to make sure that the nipple and the way you feed the baby closely mimics breast feeding so that first, your baby won't get used to a faster flow and become discouraged at the breast and second, your babe isn't getting overfed at the bottle.

• Breastfed babies should always drink from a bottle  using a slow flow (level 1) nipple. The nipple levels correlate with age, however if you're still breast feeding, you'll want to stay at a level 1. Again, this will mimic the flow of your breast.
• You or your caregivers should do paced bottle feeding, again this will mimic feeding from the breast and not allow for your baby to get used to a quick meal. This technique also helps caregivers avoid over feeding and blowing through your frozen stash of precious gold.  Here's a great video that explains paced bottle feeding: https://www.youtube.com/watch?v=UH4T70OSzGs

A few extras:

• You will meet people who will know someone who knew someone that had their milk dry up because of this or that. In most cases, your milk will change as your baby grows, and you may go through times of over supply or times of low supply, but unless you stop feeding or pumping frequently enough, your supply should not dry up.
• There's never any reason to give your exclusively breast fed infant (less than 6 mo) water. Breast milk is about 88% water and even in hot weather, you do not need to offer a baby water, just nurse more in hot weather..
• There are medications that are safe with breast feeding. The most knowledgeable people are infant risk, they have a hotline where you can call and ask about certain medications and the safety with breast feeding: (p) 806-352-2519
• If your babe doesn't seem to take a bottle of thawed milk, try scalding the milk right after pumping and then freeze it. You can also try mixing part frozen and part fresh.
• People will talk about hind milk and fore milk. This has turned out to be a myth. Your body will adjust how much fat is needed. You will see sometimes you have more fat in your milk and sometimes it will be watery. Either is fine and great for baby, trust your body! Also, breast milk can vary in color. Times it will be white, yellow, grey or blue. If it's pink, most likely you have a cracked nipple, still fine to feed baby.
• If you have a great freezer stash without a need for it, look into donation. Again, never throw out that milk! (unless it's obviously sour)
• I always recommend seeing a lactation consultant in hospital and about a week after you leave the hospital. I recommend this no matter if you think you have no issues with latch, ect, they are very helpful with offering advice, showing you new techniques or more efficient ways to do things.  
• Make sure your pediatrician and any other providers you or baby see are supportive of breast feeding and do not push you to stop or add anything into the bottle (NICU babies and failure to thrive babies can be the exception)
• Lastly, find local groups that encourage breast feeding and offer advice, wisdom and support. This is a learned activity and you don't have to do it alone!

mama's do it all for these fat rolls

Websites with helpful information:
Kellymom: a very informational website, but there are some areas that are yet to be updated
La Leche League
Infant Risk

nurse on mamas. nurse on.