• best to breastfeed for 12mo

• cows mild formula used if baby not breasat fed until at least 12mo

• cows milk avoided until at least 12mo

  • prone to iron deficiency anaemia

• in first 3-4mo ‘baby knows best’

• 150ml/kg/day

• only reliable measure of adequate nutrition is weight gain

• baby only needs breast milk or formula for first 5-6mo

• good to introduce soft solid foods

  • 5-6mo

Breastfeeding

• should begin as soon as possible

  • usually within 1st hour

• nursed whenever show signs of hunger

  • increase alertness, activity, motuthin or rooting

  • crying = late indicator of hunger

  • 8-12 times every 24hours until satiety

    • 10-15min each breast

• in early weeks nondemanding babies aroused to feed if 4 hours elapsed since last nursing

• avoid supplements unless medical indication exists

http://pediatrics.aappublications.org/content/100/6/1035.full

Sore nipples

• many causes;

  • normal tenderness in intiial days to weeks

    • expect tenderness at beginnning of feed until about d7-10 post birth

    • peak tenderness between d3-6

    • after 10d not normal

  • poor positioning and attachment

  • infection of nipple

    • fluclox for bacterial infection

    • candida

      • oral antifungal liquid - nystatin for baby

      • topical antifungal for mother - effective

        • excess cream should be removed from the nipple before BF

        • Oral fluconazole may be required in more severfe/painful cases

          • Use is unlicensed

            • 400mg as loading

            • 200mg/day for 10d

  • vasospasm

    • blanched nipple - Raynaud’s-type phenomenon

      • avoid caffeine/nicotine as may exacerbate

      • latch/positioning

      • try nifedipine

  • milk blisters -> blocked nipple pore

  • BF should not hurt

    • pain = problem

MoH breastfeeding

Absolute contraindications:

• infant diagnosed with galactosemia

• infant whose mother:

  • infected with HIV

  • taking antiretroviral

  • untreated active tuberculosis

  • infected with T-cell lymphotropic virus type I or type II

  • using/dependent on ilicit drug

  • chemotherapy

    • antimetabolites that interfere with DNA replication

    • undergoing radiationi therapy

      • only temporary

Drugs known to be associated with significant effefcts;

• atenolol

  • bradycardia, cyanosis

• ergotamine

  • vomiting, diarrhoea, convulsions

• lithium

  • 1/3-1/2 therapeutic blood concentration

Solids

• gradually introduced at about 5-6mo

• never forced

• offered after a feed or between feeds of milk

• texture pureed

• introduce new food after 3-4d - early in day

• lumpy foods 6-9mo - learns to chew