Healthy lifestyle: October 2018

Friday, October 26, 2018

Introducing solid food

By the time your baby is about 6 months of age - but not before 4 months - breast milk or formula will no longer provide all the nutrition they need for healthy growth. That’s when it’s time to begin adding solid foods to your baby’s diet.

Your baby will learn to chew by offering increasingly lumpy textures of food in the first few months.

Start by offering small amounts of solids once a day, at a time of the day that suits you and your baby.

Eventually your baby will increase the amount of solid food they eat, until they are able to eat 3 small meals a day with the rest of the family.

Breastfeeding or formula feeding should continue alongside the solid foods, as they still form an essential part of the infant diet.

Why start at 6 months?

At around 6 months of age:

Your baby’s appetite will not be satisfied by breast milk or formula alone.
Your baby will be running low on iron and zinc — solids are needed to replenish these and other nutrient levels so your baby can continue to grow.
Your baby’s digestive system will be ready to cope with solid food.
Your baby will be physically mature enough to take food from a spoon with their mouth.
This is also the time you should start to introduce allergy foods to your baby’s diet.

Why not start earlier?

By waiting until your baby is about 6 months old, you will ensure that they quickly adjust to this new way of feeding. Younger babies who are not ready for solids will just push the solid food back out of their mouth — making mealtimes frustrating and time-consuming.

Other disadvantages to starting your baby on solids too early include:

increased risk of infections
decreased breast milk production, if you are breastfeeding

How do I know when my baby is ready?

As your baby approaches 6 months, look for the following 4 signs that they are ready to add some solid food to their diet:

Your baby can sit up without support and hold their head steady.
They have the co-ordination to look at food, and pick it up and put it in their mouth without help from you.
They can bite and swallow solid food instead of just pushing it out of their mouth with their tongue.
They have increased appetite, such as demanding more frequent milk feeds, more hand-to-mouth behaviour, like putting toys in their mouth, and showing interest in food, including the food on your plate.

Getting the texture right

Your baby’s first solids food might be smooth, mashed or in soft pieces, depending on what they like. They can quickly go on to minced foods and then chopped foods.

Your baby needs a variety of food textures. This helps them learn how to chew, and chewing helps with your baby’s speech development. It also helps to encourage self-feeding and prevent feeding difficulties as your baby develops.

By the time your baby is 12 months old, he or she should be eating food with the same texture as the food the rest of the family is eating.

Very first foods

There is no set order for introducing food as long as you include iron-rich foods — like iron-fortified rice cereal, meat, fish, chicken and tofu — and the texture is right. Start with offering mashed foods that are easily digested, which may include:

vegetables (eg pumpkin, potato, sweet potato, taro) fruits (eg cooked pears/apple, ripe banana)
well-cooked rice or iron-enriched rice cereal
coarsely mashed fruit and vegetables,
well-cooked meat: minced, stewed or grated (cook, freeze then grate)
fish (fresh or tinned) — bones removed
legumes (eg lentils)
pasta and bread (e.g. toast fingers and rusks)

Dairy products including full-fat yoghurt, cheese and custard may be given, but not cow’s milk as a main drink before 12 months.

From about 8 months most babies are ready for finger foods that they can pick up for themselves. Examples include:

soft pieces of soft raw fruit or cooked vegetables (such as, whole small banana, pieces of melon or avocado and tomato slices)
small pieces of boiled or steamed vegetables (for example, beans, potato, pumpkin, carrot circles and broccoli florets)
toast fingers and rusks
cooked meat that is cut into strips that your baby can pick up and chew

By 12 months your baby should be eating family foods, plus breast milk or cow’s milk, plus some healthy snacks like pieces of fruit and rice cakes.

What should my baby drink?

Keep giving your baby breast milk or infant formula as their main drink up until they are 12 months old. Small amounts of cooled, boiled water may also be given in a cup.
As your baby eats more solids they will gradually reduce their intake of milk, or drop one of their milk feeds altogether.
Beyond 12 months, your baby can drink full-fat pasteurised cow’s milk and water from a cup. You may wish to keep offering your baby some breast milk beyond 12 months, as well.

Some food and drinks to avoid

Avoid giving your baby small, hard pieces of food that can cause choking, such as, nuts, seeds, raw carrot, celery sticks and chunks of apple. Also avoid juices and sugar-sweetened drinks, coffee and tea and honey.

Excessive amounts of salt and sugar are also unhealthy for your baby, and can encourage bad eating habits. It’s best to cook everything yourself using fresh ingredients, rather than using processed foods. However commercial baby foods are convenient on occasions.

Cow’s milk, other animal milks, and plant-based milks like soy, almond or rice milk, are not suitable alternatives to breast milk or infant formula in the first 12 months. However, they may be used in cooking or be mixed with foods from 6 months.

See Introducing solid food — common questions.

Some tips for introducing solid foods

Pick a quiet time, when you and your baby are relaxed and you have plenty of time.
Breastfeed (or offer infant formula) first.
Begin by offering a few teaspoons of food, once a day.
If your baby isn’t interested the first time you try with solid food, wait until tomorrow and try again.
You may have to try a new food several times before your baby accepts it — don’t get put off if they reject a food to begin with.
Let your baby be your guide when it comes to knowing when they are full. Don’t try to force your baby to finish a portion of food if they don’t want to.

Safety tips

Always supervise your baby at mealtimes.
If you have heated or defrosted baby food, always check the temperature yourself before offering it to your baby.
Wash your hands and your baby’s hands before each meal.

Sources: , Australian Breastfeeding Association(Confused about introducing solids?) , National Health and Medical Research Council(Infant feeding guidelines) , Raising Children Network (Introducing solids) Tresillian(Nutrition 6-8 months)

Reflux

Sometimes babies spit up milk out of their mouth or nose. They may bring up small amounts of milk along with air when they are burped. Reflux, also called spitting up or regurgitation, is very common in newborns. The medical term for reflux is gastro-oesophageal reflux, or GOR. If GOR is more serious or has complications it may lead to gastro-oesophageal reflux disease or GORD.

Reflux or spitting up is very common in newborns.

Reflux occurs because a muscle at the top of the stomach, called the sphincter, is loose. It can also be caused by air bubbles in the stomach or by eating too much food too quickly.

Spitting up does not discomfort the baby and your baby may seem not notice.

Reflux is not the same as vomiting.

Vomiting is forceful, is usually more than a tablespoon or two, and upsets the baby. Vomitingcan be a sign of illness.

Spitting up often peaks by four months of age and by seven months many babies no longer do it, although for some it takes longer.

Here are some things you can do to minimise your baby’s reflux:

Make each feed calm and relaxed.
Hold your baby in an upright position, not lying down, while you feed them.
Feed your baby smaller amounts at a time.
Feed your baby without delay. If the baby has cried for a long time before a feed, they may have swallowed air. Spitting up is more likely if the baby has air in the stomach at the beginning of a feeding.
Check the size of the opening in the teat if you are bottle feeding. The bottle should leak several drops of milk per second. A hole that is too big will let the baby swallow formula too quickly and baby is likely to spit up the excess. A hole that is too small forces the baby to suck very hard and swallow air.
Burp your baby several times during each feeding. It works best to support the infant’s head and burp them sitting on your lap. Burping your baby over your shoulder may put too much pressure on the their stomach.
Keep your baby upright for 30 minutes after feeding. An infant seat or car seat works well.
If you are supervising your baby, you can place them on their tummy for an hour or so after the feed. Take care not to let baby sleep on their tummy because of the link with sudden unexpected death in infancy. Always place your baby on their back to sleep.
Make sure nappies are not too tight and do not put pressure on the baby’s stomach.

If your baby is otherwise healthy and happy and they are just bringing up milk, nothing needs to be done. Talk to your doctor or maternal child health nurse if:

you have any other concerns
your baby is not gaining weight
there is a change in bowel movements or urination
your baby shows signs of discomfort or pain.

Reflux and lactose intolerance - video

Video provided by Raising Children Network.

Sources: , Raising Children Network (Gastro-oesophageal reflux and GORD) Reflux Infant Support Association (Management tips - reflux) , Royal Children's Hospital Melbourne (Reflux GOR) , Royal Children's Hospital Melbourne (Gastrooesophageal reflux in infants)

Cleaning and sterilising baby bottles

A baby’s immune system is not yet fully developed, and babies are more susceptible to infection and illness than an older child or adult. Cleanliness is therefore very important when preparing your baby’s bottles.

Cleaning bottles

Bottles, lids, teats and other equipment you use to prepare a feed should always be thoroughly cleaned after each use:

As soon as possible after your baby finishes a feed, wash the bottle, teat and lid in hot soapy water.
Use a bottle brush, and be sure to clean out any dried milk stuck inside the bottle and teat.
Once it is clean, rinse the equipment with some fresh water and allow it to air dry.

This kind of cleaning is important for getting rid of all traces of milk or formula left inside the bottles, but it does not ensure that the feeding equipment is completely germ-free.

Sterilising bottles

Sterilising is the process of killing any harmful germs that may be clinging to surfaces of the bottles and other equipment.

It is important to sterilise baby bottles before each use, for at least the first 12 months of your baby’s life. This applies whether you are bottle feeding with infant formula or with expressed breast milk.

How to sterilise feeding equipment

There are a few different ways to sterilise your baby’s bottles, teats, lids and other feeding equipment.

Boiling

Boiling works by raising the temperature high enough to kill any bacteria left over after washing.

Place clean bottles, teats, caps and utensils in a large saucepan on the back burner of the stove.
Add enough water to cover all the equipment, making sure there are no air bubbles.
Bring water to the boil, and boil rapidly for 5 minutes.
Turn off the stove and allow the water to cool down.
Wash your hands thoroughly before you handle the equipment, and disinfect the surface where you plan to make up the bottle.
Take the equipment from the saucepan and shake off any excess water.
If you are not using them straight away, put the lid and teat onto the bottle, and store in a clean container in the fridge.
Re-boil the bottle and other equipment if it is not used within 24 hours.

Chemicals

Chemical sterilisers are disinfectant solutions that come as liquids or tablets that you dilute with water.

Make sure bottles, teats, caps and utensils are thoroughly clean before you begin.
Read and follow the manufacturer’s instructions for making up the sterilising solution.
Place the feeding equipment in the sterilising solution, making sure it is completely under water and there are no air bubbles.
Leave the equipment in the sterilising solution for the recommended amount of time (usually about 30 minutes – check the manufacturer’s instructions).
You can then leave the equipment in the solution until you need to use it.
Allow bottles, teats and lids to drain before you use them – don’t rinse off the sterilising solution, as this exposes equipment to germs again.
Throw away the solution after 24 hours. Clean the sterilising container thoroughly in warm, soapy water, before making up a fresh lot of solution.

Steam (microwave or electric sterilisers)

Much like boiling, steaming works by raising the temperature high enough to kill bacteria.

There are several different types of sterilisers available – follow the instructions provided by the manufacturer.
Make sure bottles, teats, caps and utensils are thoroughly clean before you begin.
Make sure that bottles and teats are placed with openings facing down in the steriliser.
Follow instructions for adding water to the unit and turning it on.
Leave bottles in the steriliser until they are needed.
If you are not using the bottles straight away, check instructions for how long you can leave them in the steriliser before you have to re-sterilise them.

Bottle and formula preparation tips - video

Video provided by Raising Children Network.

Safety tips

Never leave hot or boiling liquidsunattended or within reach of children.
Be aware that steam can burn or scald you just as badly as boiling water.
Keep chemicals and chemical solutions out of reach of children.
Always wash your hands thoroughly before handling equipment that has been sterilised.

Sources: , National Health and Medical Research Council(Infant Feeding Guidelines) , NHS Choices (UK) (Making up infant formula, Sterilising baby bottles) Raising Children Network (Bottle feeding: cleaning and sterilising equipment)

Cleaning and sterilising baby bottles

Cleaning bottles

Bottles, lids, teats and other equipment you use to prepare a feed should always be thoroughly cleaned after each use:

As soon as possible after your baby finishes a feed, wash the bottle, teat and lid in hot soapy water.
Use a bottle brush, and be sure to clean out any dried milk stuck inside the bottle and teat.
Once it is clean, rinse the equipment with some fresh water and allow it to air dry.

This kind of cleaning is important for getting rid of all traces of milk or formula left inside the bottles, but it does not ensure that the feeding equipment is completely germ-free.

Sterilising bottles

Sterilising is the process of killing any harmful germs that may be clinging to surfaces of the bottles and other equipment.

How to sterilise feeding equipment

There are a few different ways to sterilise your baby’s bottles, teats, lids and other feeding equipment.

Boiling

Boiling works by raising the temperature high enough to kill any bacteria left over after washing.

Place clean bottles, teats, caps and utensils in a large saucepan on the back burner of the stove.
Add enough water to cover all the equipment, making sure there are no air bubbles.
Bring water to the boil, and boil rapidly for 5 minutes.
Turn off the stove and allow the water to cool down.
Wash your hands thoroughly before you handle the equipment, and disinfect the surface where you plan to make up the bottle.
Take the equipment from the saucepan and shake off any excess water.
If you are not using them straight away, put the lid and teat onto the bottle, and store in a clean container in the fridge.
Re-boil the bottle and other equipment if it is not used within 24 hours.

Chemicals

Chemical sterilisers are disinfectant solutions that come as liquids or tablets that you dilute with water.

Make sure bottles, teats, caps and utensils are thoroughly clean before you begin.
Read and follow the manufacturer’s instructions for making up the sterilising solution.
Place the feeding equipment in the sterilising solution, making sure it is completely under water and there are no air bubbles.
Leave the equipment in the sterilising solution for the recommended amount of time (usually about 30 minutes – check the manufacturer’s instructions).
You can then leave the equipment in the solution until you need to use it.
Allow bottles, teats and lids to drain before you use them – don’t rinse off the sterilising solution, as this exposes equipment to germs again.
Throw away the solution after 24 hours. Clean the sterilising container thoroughly in warm, soapy water, before making up a fresh lot of solution.

Steam (microwave or electric sterilisers)

Much like boiling, steaming works by raising the temperature high enough to kill bacteria.

There are several different types of sterilisers available – follow the instructions provided by the manufacturer.
Make sure bottles, teats, caps and utensils are thoroughly clean before you begin.
Make sure that bottles and teats are placed with openings facing down in the steriliser.
Follow instructions for adding water to the unit and turning it on.
Leave bottles in the steriliser until they are needed.
If you are not using the bottles straight away, check instructions for how long you can leave them in the steriliser before you have to re-sterilise them.

Bottle and formula preparation tips - video

Video provided by Raising Children Network.

Safety tips

Never leave hot or boiling liquidsunattended or within reach of children.
Be aware that steam can burn or scald you just as badly as boiling water.
Keep chemicals and chemical solutions out of reach of children.
Always wash your hands thoroughly before handling equipment that has been sterilised.

How to feed your baby with formula

There are a few important guidelines to remember when feeding your baby using a bottle. You will also find some helpful tips and commonly asked questions.

A step-by-step guide to preparing a powdered-formula feed:

Step 1 Fill the kettle with at least 1 litre of fresh tap water (don’t use water that has been boiled before).
Step 2 Boil the water. Then leave and allow it to cool until lukewarm at least 30 minutes.
Step 3 Clean and disinfect the surface you are going to use to prepare the formula.
Step 4 Wash your hands thoroughly, using soap, and dry them.
Step 5 If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse the bottle with cooled boiled water from the kettle (not the tap).
Step 6 Stand the bottle on a clean surface.
Step 7 Keep the teat and cap on the upturned lid of the steriliser. Avoid putting them on the work surface.
Step 8 Follow the manufacturer’s instructions and pour the correct amount of previously boiled (now cooled) water that you need into the bottle. Double check that the water level is correct. Always put the water in the bottle first before adding the powdered infant formula.
Step 9 Loosely fill the scoop with formula, according to the manufacturer’s instructions, and level it off using either the flat edge of a clean, dry knife or the leveller provided. Different tins of formula come with different scoops. Make sure you use only the scoop that is enclosed with the powdered infant formula that you are using.
Step 10 Holding the edge of the teat, put it on the bottle. Then screw the retaining ring onto the bottle.
Step 11 Cover the teat with the cap and shake the bottle until the powder is dissolved.
Step 12 Test the temperature of the infant formula on the inside of your wrist before giving it to your baby. It should be body-temperature, which means it should feel just warm, but not hot.
Step 13 If there is any made-up infant formula left after a feed, throw it away.

Dos and don’ts of making up infant formula

As manufacturers’ instructions vary as to how much water and powder to use, it is important to follow the instructions very carefully.
Do not add extra powdered infant formula when making up a feed. This can make your baby constipated and may cause dehydration. Too little powdered infant formula may not provide your baby with enough nourishment.
Do not add sugar or cereals to the feed in the bottle.
Never warm up infant formula in a microwave, as it can heat the feed unevenly and may burn your baby’s mouth.

Bottle and formula preparation tips - video

Video provided by Raising Children Network.

Infant formula and allergies

If you think your baby might be allergic to infant formula, talk to your doctor before making any changes.

Cow’s milk-based formula is suitable for most healthy full-term babies, and is recommended over any other type of formula, such as that made from soybeans or goat’s milk.

Australian guidelines do not recommend using other types of formula, including formula labelled as hypoallergenic, for preventing allergies. However, special formulas may be used on the advice of your doctor, if your baby can’t take cow’s milk-based products for medical reasons.

Bacteria in infant formula

Powdered infant formula is not a sterile product. Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria but the risk of a harmful infection remains low if the formula is prepared properly.

Infants are not at risk from bacteria when formula is prepared properly with lukewarm (body temperature) previously boiled water, and used within one hour of being made. However, babies may be at risk when conditions allow bacteria to multiply to harmful levels, such as through poor storage practices.

To effectively control the growth of bacteria:

Formula should always be prepared in a clean area.
Fresh water should be boiled, then allowed to cool until lukewarm.
After adding the powder to the measured water in the bottle, mix well and test the temperature of the milk with a few drops on the inside of the wrist. It should feel just warm, but cool is better than too hot.
Ideally only one bottle of formula should be prepared at a time, and it should be offered to the baby without delay.
A feed should take no longer than one hour. Any formula that has been at room temperature for longer than one hour should be discarded.
Any formula left at the end of the feed must be discarded.
If formula is prepared in advance (for example for a babysitter) it must be refrigerated (at 5°C or below) and used within 24 hours. Alternatively, refrigerate prepared sterilised bottles of boiled water and use as required, first warming by standing bottle in a container of warm water and then adding formula.

Preparation and hygiene of infant formula

A baby’s immune system is not as strong or as well developed as an adult’s. This means that babies are much more susceptible to illness and infection. Therefore, good hygiene is very important when making up a feed.

All equipment used to feed your baby must be sterilised. Bottles, teats and any other feeding equipment need to be cleaned and sterilised before each feed to reduce the chances of your baby falling sick or getting diarrhoea. Boiling is the preferred option for sterilising bottles and other feeding equipment.

It is best to use boiled drinking water from the tap to make up a feed. Do not use artificially softened water or water that has been previously boiled then left sitting around.

Tips when using formula

Buying your feeding equipment

You will need a number of bottles and teats, as well as sterilising equipment. There is no evidence that one type of teat or bottle is better than any other. All feeding bottles are made of food-grade plastic, but some have shapes or patterns that make them difficult to clean thoroughly. A simple, easy-to-clean bottle is probably best.

Sterilise and safety check

Make sure your bottles and teats are sterilised. If you’re using infant formula, pay close attention to the instructions on the packet when you make up the feed.